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Shoulder Impingement

Subacromial impingement is a common cause of shoulder pain.

As a Chiropractor who treats weight lifting and sport’s related injuries, the clinical presentation of shoulder impingement is a very common complaint. The rotator cuff tendons (mainly supraspinatus) become “pinched” against the bony “roof” (acromion) of the shoulder (glenohumeral) joint leading to acute pain, inflammation and weakness. Overhead sport sand movements where impingement can occur are Olympic weightlifting, powerlifting/bench press, volleyball and baseball.

Impingement is the end result of one of many possible causes but it can be classified as either structural (primary) or functional (secondary). In the former, a potential narrowing of the subacromial space occurs due to a curved or hooked acromion or thickening of surrounding ligaments. This can be diagnosed on an X ray or MRI which are usually ordered only after the injury occurs. In the latter, there are normal X-ray findings but muscle imbalance and/or weakness is evident in the rotator cuff and scapular stabilising muscles (serratus anterior, trapezius, levator scapulae, and rhomboids).

Left untreated, repeated painful episodes over many years often leads to degeneration and tearing of the rotator cuff tendons.

Surgery is the treatment of choice for a structural impingement but treatment for functional impingement is more conservative, requiring prescribed exercises aimed at strengthening and restoring muscle balance. A successful rehabilitation program must address poor timing and control of the shoulder complex (GH joint and scapula) not just volitional strength gains (e.g. Isolated external rotation exercises for the rotator cuff).

We need to realise though that the body behaves as one functional unit and discussion on local anatomy and function of one region is only describing one link in an entire chain. Changes in posture of one body segment (e.g. thoracic spine) can influence another (i.e. shoulder complex).

To prove this point, let us do a posture check right now. As you sit in your chair, let your arms hang by your waist, slouch forward (like people on their smartphones!) and now try and raise one arm away from your body above your head as high as possible. Note how high it went. Now, reverse that slouched posture by straightening up and bringing your head back over your shoulders. Once again, with hands by your side, try and raise the same arm as high as possible.

While slouching, you would of barely passed shoulder level elevating your arm and may even have experienced a slight niggle or pinch in the shoulder. After correcting your posture your shoulder range would have increased instantly and any impingement symptoms should have decreased.

As can be seen from the above discussion, a thorough history and examination is required to diagnose the root cause of an individual’s shoulder impingement. A highly trained Chiropractor familiar with weightlifting and sports’ injuries will achieve this and guide you through the necessary treatment and rehabilitation.

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