Dr. Clint Woo, DPT, PT
Shoulder Impingement Physical Therapy: Get That Chip Off Your Shoulder!
Updated: Aug 3, 2020
I remember a shoulder surgeon saying aloud "if you're over 40, you most likely have a tear in your shoulder whether you feel it or not". This was unsurprising to me as someone who has seen so many patients both in the hospital and the clinic with shoulder pain. One of the more common causes of shoulder pain is impingement of a rotator cuff tenon. This impingement (pinching) of a tendon (namely the supraspinatus, one of your rotator cuff muscles) leads to tendonitis (simply an inflammation of the tendon). When a tendon is squished between your arm bone (humerus) and shoulder bony roof (acromion), it is unable to produce its usual power and movement.....plus it hurts!
So what causes this pinching? Really anything that decreases the space through which the supraspinatus tendon travels through on its way from the scapula to the outside of your arm bone. I'll use the imagery of you crawling through a tunnel to describe the different ways shoulder impingement can occur. The ceiling of the tunnel will be the acromion (bony end-piece roof of the scapula), YOU will be the supraspinatus tendon, the subacromial space will be the tunnel, and the humerus (arm bone) will be the floor of the tunnel.
-Bone spurs (aka osteophytes for those who have already gotten an x-ray!) absolutely can impact that subacromial space. Imagine crawling through a tunnel and there's a stalagmite partially blocking your way. Maybe you'll make it through, but you're most likely going to get some scrapes! Shoulder Impingement and most likely, shoulder pain!
-Researchers have also theorized that the shape of your acromion can affect shoulder impingement. Imagine if the tunnel this time isn't a nice circular shape, but has a flattened top! Again, less space to crawl through. Shoulder Impingement and most likely, shoulder pain!
-Muscle imbalance can also cause shoulder impingement. There are 4 muscles that make up the rotator cuff on each shoulder and if even one of these are doing too much or too little, then that causes issues of your humerus not moving in a smooth motion as you go about your day! So imagine the tunnel you're crawling through has a spring-loaded floor (this one is a bit of a stretch to imagine, but bear with me)! Even if the ceiling this time is perfectly smooth and round, if the floor keeps bouncing you around, you're going to get beat up in the process of crawling through! Shoulder Impingement and most likely, shoulder pain!
So what to do about this? Inflammation is going to be prevalent with any shoulder pain associated with shoulder impingement. Get some ice on it (consult a PT or physician about how long is safe for you) to control inflammation. Keep a journal to see what position your shoulder is every hour of the day (do I wake up on my side sleeping on it?, am I shrugging my shoulders or pitching them forward a lot while typing?, do I have a job or hobby which has my arm overhead?, is my rotator cuff potentially weak (doing 50 push ups and 50 chin ups does NOT mean you have an adequate rotator cuff!)? These are the questions you want to find out. If the answer is "yes" to the previous questions, then physical therapy is most likely an excellent route for you to address your shoulder pain! I have even seen instances where patients come in with confirmed bone spurs and physical therapy STILL helped with their pain.
Shoulder impingement (leading to shoulder pain) can be debilitating for any age and any occupation as the shoulder is meant to have constant action. When something causes that shoulder movement to be weak or painful, you can't help, but notice it constantly. We can work with you for these issues whether it is in-person or online!
As a disclaimer, this blog post isn’t intended as professional clinical advice. We at Woo Physical Therapy and Wellness are proud to serve the Anne Arundel, Howard, and Prince George's counties in-home and online anywhere in the U.S.A.!!