Shoulder Pain - Impingement Syndrome

Do you get shoulder pain with exercise or bring your arm overhead?

Shoulder pain can come in a few different flavors, by far one of the most common seen in athletes is an impingement syndrome. It can be a tough injury to rehab and rest alone isn’t enough to fix it. Proper shoulder movement requires a symphony of rotator cuff muscle firing in the proper sequence

Shoulder impingement is an injury in which the supraspinatus tendon (one of the rotator cuff muscles) becomes squeezed or pinched when the shoulder biomechanics are faulty. Typically dull achy pain that becomes sharp or pinchy with overhead motions is felt.

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The shoulder is a ball and socket joint, the shoulder blade (scapula) forms the socket for the head of the humerus to insert. The tricky part is the socket moves and must move at the appropriate time for the shoulder to move pain free. As you raise the arm the shoulder blade is retracted or moved down and rotates upward. This allows the head of the humerus to clear the lip of the socket without a hitch. This also keeps the ball (head of the humerus) on the socket (glenoid fossa on the shoulder blade). If the shoulder blade doesn’t move, the head of the humerus doesn’t stay square on the socket, it rides up/forward which leads to anterior shoulder pain. This poor movement can lead to biceps tendon pain, bursa inflammation, superior labrum damage, etc.

In a shoulder with impingement syndrome, the shoulder blade does not retract and rotate upward. This causes the supraspinatus tendon (a rotator cuff muscle) to be pinched between the socket and the head of the humerus creating the pain with reaching upward.

With repetitive faulty overhead motion, the tendon becomes inflamed and pain ensues. Rest and anti-inflammatory treatments can help to decrease the pain. But, taking a few weeks off isn’t going to retrain the muscles to fire appropriately. So, your pain returns as soon as you resume activity.

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How to Fix it

  1. Decrease inflammation - giving your shoulder a break from the irritating motion and seeking help from a professional, like a Boulder Chiropractor, is a good start.

  2. At Boulder Sports Chiropractic we will examine the shoulder to identify the pain generator. Using diagnostic tools like the SFMA (selective functional movement assessment)

  3. Restore normal muscle tension - using a foam roller or lacrosse ball to roll out tight muscles will help restore normal biomechanics. At Boulder Sports Chiropractic we will use hands on, manual therapy techniques like ART (active release technique) and Graston Technique to release muscle knots, muscle adhesions, and decrease scar tissue; Dry Needling to release trigger points in the muscles, and Class IV Laser Therapy to decrease the inflammation.

  4. Rehab the shoulder and rotator cuff muscles with appropriate physical therapy exercises - Once we release the tight muscles and decrease the inflammation we need to activate certain muscles to restore normal biomechanics of the shoulder and rotator cuff so the problem doesn't return. Based on your situation we will give you exercise homework.

  5. Seek advice from a sport specific coach - if you have faulty swim biomechanics, a few corrections from a swim coach can go a long way toward preventing future flare ups.

Check your Thoracic Spine Motion

If you cannot move through your upper back, you will compensate by overusing the shoulder.

The way that this Boulder Chiropractor checks that is: Sit on your knees, with your butt all the way back on your heels. Place one hand on the back of your head. Without shifting your weight, isolate rotation to your spine and twist as far as you can in one direction. Compare to the other side. This will help identify thoracic spine limitation.

Fix: Side Lying Book Openers

Lay on your side with your knees bent, stacked on the ground in front of you. With your arms out in front of you, bring your top arm over top, following with your eyes. Try to increase your rotation until you can touch your wrist to the floor while keeping your knees on the ground in front of you.

Check your Shoulder Range of Motion

While Standing, take one arm and reach overhead toward the opposite shoulder blade. Good range of motion should allow you to touch the top of the opposite shoulder blade.

While standing, take the same arm and reach under and behind your back toward the bottom of the opposite shoulder blade. Good internal range of motion will allow you to touch the bottom corner of the opposite shoulder blade.

Compare side to side. This gives us an idea of which muscles are so tight they’re limiting your motion. Here is how to fix two of the most common limiters.

Fix: Foam roll your lats/posterior shoulder

Lay on your side with the foam roller underneath your shoulder with your arm overhead. Roll up and down from your shoulder to your ribs.

Stretch your pecs

Place one forearm on the door frame and fall in bringing your chest away from your arm to stretch your pecs.

There are many causes for shoulder pain. Be sure to get examined by a professional to identify your situation and find a solution specific to you.

If you’re experiencing shoulder pain, give us a call to get it fixed!

This Boulder Chiropractor will throughly examine your shoulder and use Active Release Technique, Dry Needling, and Class 4 laser therapy, amongst others to relieve your rotator cuff pain. 303-444-5105