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What You Need to Know About Shoulder Impingement Syndrome

Shoulder impingement syndrome is one of the most common complaints we see in the clinic. It’s also one of the most misunderstood by patients. Impingement suggests that something is pinching, and it is commonly explained this way. This may be true in some cases but we need to ask a bigger question:

Why is the tendon pinching in the first place and how relevant is this?

If we look at the condition as a symptom rather than a cause, it opens up a myriad of possibilities for treatment that may produce more durable results. So without further ado, let’s have a look at 3 categories of shoulder dysfunction, how shoulder impingement may manifest in each, and how to begin the process of recovering from the shoulder pain.

3 Types of Shoulder Pain

The Stiff and Painful Shoulder

Limited shoulder motion due to joint changes causes a stiff and painful shoulder. Physical examination will often show the shoulder’s inability to move freely and fully; both by the patient and the therapist. This inability to fully move the shoulder is often found with conditions like Frozen Shoulder (Adhesive Capsulitis) or Osteoarthritis.Both types of shoulder conditions create changes in the joint and tissues that can limit the range of the shoulder joint and consequently cause the scapula (shoulder blade) to rotate early. Over time, this inefficient arm movement can irritate structures in the shoulder (like a tendon or bursa), which can cause pain.To treat the cause of shoulder pain in this category of conditions, our focus is to improve the quality of shoulder mobility and use exercises to strengthen the supporting muscles.In the long term addressing the underlying causes of disease states like arthritis should be of interest for injury reduction….. but that’s a post for another time.

The Weak and Painful Shoulder

This category of shoulder pain is the broadest. It includes everything from rotator cuff injuries (which is a broad category in itself) to bursitis, ligament sprains or any other trauma that may reduce the shoulder’s ability to produce or tolerate force. In this presentation of shoulder impingement, physical exam often reveals that full passive movement can be achieved, but active cannot.Your physiotherapist will perform specific testing for shoulder function to target exercise strategies and customize pain relief efforts. The structural diagnosis doesn’t have a significant effect on the treatment plan in this category unless surgical intervention is a possibility. People with shoulder impingement in this category do best with a focus on pain relief followed by a customized and progressive exercise strategy.One of the most important indications of impingement is the “Cuff Strength Ratio,” used to assess the relative strength of the rotator cuff muscles. Cuff strength needs to be 1:1 internal to external rotation, meaning the patient must have equal parts strength in these ranges of movement. If not, the shoulder cannot centre in the joint properly which can cause mechanical compression in the subacromial region (the area underneath the acromion), and shoulder impingement occurs. Dedicated retraining exercises to resolve this deficit can greatly improve persistent symptoms.

The Unstable and Painful Shoulder

This injury carries the most trauma but isn’t necessarily the most complicated. Injuries in this category are represented by shoulder dislocations, subluxations or anatomical anomalies that may present a higher risk for instability of the shoulder. Common symptoms with these types of injuries often include fear, pain, and a sense of instability that can lead to guarding behaviours which manifest as impingement syndrome of the shoulder.The clinical term for this is “scapular dyskinesia,” which means abnormal movement or positioning of the shoulder blade during movement. It presents as shoulder shrugging and lifting the upper arm to achieve the desired motion. Unfortunately, this movement pattern can cause irritation to a rotator cuff tendon and create pain in the shoulder. The treatment for shoulder impingement here is to restore confidence in movement through gentle exercises to explore ranges of motion, followed by progressive strengthening exercises to get the shoulder more stable in its socket.Shoulders are one of the most common injuries we see in our line of work, and understandably so. They are the most mobile joint in the body, and tendons of the rotator cuff undergo many forms of stress. They need to be prepared to meet the demands of their life and although the injury process is complicated, the treatment plan doesn’t have to be!

Shoulder Impingement Syndrome FAQs

Does shoulder impingement go away on its own?

It is possible for shoulder impingement to go away on its own, but it depends on the severity and cause of the impingement. In many cases, reducing or modifying irritable activities for a period of time then strategically re-introducing them can help resolve symptoms. In rare cases, impingement symptoms may need further medical support and a physical therapist is perfectly equipped to help determine if this is required.

Does shoulder impingement require surgery?

It is rare for shoulder impingement to require surgery. Treatment options for shoulder impingement can include activity modification, physical therapy, anti-inflammatory medications, and corticosteroid injections. In some cases where conservative treatment does not improve symptoms, surgery may be indicated but this is a last resort. The decision to have surgery will depend on the severity of the impingement and the individual patient’s needs and goals.

Will shoulder impingement show on MRI?

Shoulder impingement does not show up on an MRI as it is the consequence of movement. MRIs take pictures while the patient is still.  MRIs can visualize soft tissues such as tendons, muscles, and ligaments and can detect potential abnormalities in these structures that may influence impingement. Having said that, MRIs do now show pain and the findings must be taken into account with patient experience to determine their relevance. A clinical exam by a physical therapist is usually the first step in diagnosing shoulder impingement, and an MRI may be ordered to confirm or further evaluate the diagnosis.

We hope you have gained a better understanding of shoulder impingement syndrome and how it can be effectively managed. At South Island Physio, we offer a wide range of treatment options for shoulder impingement syndrome, including physical therapy, manual therapy, Shockwave Therapy, IMS/dry needling and exercise programs tailored to your specific needs. If you are experiencing shoulder pain or discomfort, we encourage you to book an appointment with one of our experienced therapiststoday. Our team is here to help you get back to doing the things you love, pain-free.

Your best days are ahead of you! Make your move and let’s get your shoulder serving you and your joy!

From Shoulder Tendinopathy to Achilles Tendinopathy: What You Need to Know

Tendon pain and injury can be a confusing topic, particularly when you’re the one suffering. With various ‘quick fix’ options being advertised, as well as online fitness gurus proclaiming one approach over another, we find that patients are often left perplexed. This blog post is meant to simplify the complex topic of tendon pain, injury, and rehabilitation.

So what is a tendon? Simply put, a tendon is the structure that attaches your muscle to bone. It helps to transmit force produced by your muscle(s), to your bone(s), so that you can move. Dig a little deeper and you’ll find that tendon’s are composed of type 1 collagen and proteoglycan, which enable them to store and release energy, stretch, and adapt to stress.

What is Tendinopathy?

Tendinopathy is a fancy five-syllable word we use to define tendon pain and/or injury. It occurs when the tendon is exposed to an unfamiliar amount of activity without being given an appropriate amount of time to adapt or due to sudden compression (a hard fall). When one or both of these situations arise, the tendon will communicate its displeasure through the medium of pain and perhaps swelling.

What are the Different Tendon Conditions?

Though tendinopathy is a broad term used to define tendon pain and/or injury, we do have more specific categorizations for determining the severity of tendon injury. These categories help to make sense of terms like tendonitis, tendinosis, tendon pathology and degeneration, and other materials focused on tendon healing. These include having a normal tendon, reactive tendon, tendon in dysrepair, and degenerative tendon. To determine what stage of tendinopathy you might be suffering from, continue reading.

Normal Tendon

A normal tendon is optimal. It has been given enough time to adapt to a given training volume or level of physical activity. It has upregulated its ability to store and release energy so that you can engage in the activities you love. We all want normal tendons. They aren’t at risk for injury, inflammation or tendon rupture.

Reaction Tendon

A reactive tendon is the first step in developing acute tendon-related pain. It’s usually a product of abrupt overload but can also occur due to sudden compression (i.e., falling on your knee or elbow). The tendon experiences a non-inflammatory cell response and an increase in water content. There is a short-term adaption which thickens and stiffens the tendon to reduce stress or protect the tendon from further irritation. You’ll likely experience pain and a restriction in pain-free movements.

Tendon in Dysrepair

A tendon in dysrepair is another step away from having a normal tendon. It’s usually a product of chronic tendon overload. This is common in endurance athletes that suffer through training blocks despite having received multiple signals from their tendon(s) to reduce training volume. A tendon in dysrepair has attempted to heal, but the demands placed on it have interrupted the tendon repair process. During this phase, there is tendon tissue matrix breakdown, collagen separation/ disorganization, and possible vascular and neuronal ingrowth (things we don’t want to happen). At this point, the tendon may appear swollen and thick. It will be painful and limiting.

Degenerative Tendon

A degenerative tendon is the final stage of tendinopathy. It’s characterized by the progression of collagen matrix breakdown and intracellular changes (more of what we don’t want to happen). At this stage, cell death has occurred within the tendon and there’s an increased risk of rupture (try not to YouTube achilles tendon or patellar tendon rupture). Those with a degenerative tendon usually have a history of repeated bouts of tendon pain that reduces along with load management (slowing down from the activities that cause pain). Though this might provide intermittent relief, it’s not an optimal approach for the treatment or management of tendinopathy.

So what do we do about tendinopathy (particularly during the later stages)? First, it’s important to know that regardless of your stage of tendon injury, you can always progress towards having a normal tendon. Second, you want to make sure that you’re progressing into activities gradually. Enthusiasm is great, but we want to avoid overuse injury. Third, if you’re experiencing tendon related pain or injury, you should contact an experienced healthcare practitioner. At South Island Physiotherapy, our team of Physical Therapists, Massage Therapists, and Kinesiologists specialize in the treatment of tendinopathy or tendinopathies.

Tendinopathy FAQs

Where does tendinopathy occur?

Tendinopathy can occur in various parts of the body where tendons attach muscles to bones, such as the shoulders, elbows, wrists, hips, knees, and ankles. Examples include rotator cuff tendinopathy, tennis elbow, golfer’s elbow, achilles tendinopathy, patellar tendinopathy, gluteal tendinopathy, and so many more.

Can tendinopathy be permanent?

Yes, tendinopathy can be permanent if it is not properly treated or if it has been present for a long time. Chronic tendinopathy can lead to degenerative changes in the tendon and result in permanent damage. However, with appropriate management, such as rest, physical therapy, and medication, it is possible to improve symptoms and reduce the risk of long-term damage.

How to prevent tendinopathy?

1. Gradual Progression: Gradually increase your exercise program or activity level at a slow and steady pace.

Proper Equipment and Form: Make sure that you use the proper equipment, including shoes, and maintain proper form while exercising.

Warm-up and Cool-down: Always perform a proper warm-up and cool-down before and after any activity or exercise.

Rest and Recovery: Take adequate rest and recovery time between workouts to allow your body to recover fully.

Proper Nutrition: Ensure that you maintain a balanced and healthy diet, including sufficient amounts of vitamins and minerals.

Adapt to Age: Adapting your activity/program to your age is very essential.

Strength Training: Engage in strength training programs to build up your muscles and tendons.

Appropriate Exercises: Choose exercises that are appropriate for your fitness level, age, and overall health.

Seek medical advice: If you have pain or discomfort in your tendons, seek medical advice to prevent further injury.

If you’re suffering from tendon pain or injury, don’t let the confusion and conflicting advice leave you feeling helpless. Take control of your recovery by understanding tendinopathy and the treatment options available to you. At South Island Physiotherapy, our team of experienced healthcare practitioners specialize in the treatment of tendinopathy. Contact us today to learn more about how we can help you progress towards having a normal tendon and get back to doing the activities you love.