What is shoulder impingement and how can physical therapy help?
Do you experience sharp pain in your shoulder when lifting overhead or even during pressing movements?
You may have heard of or diagnosed yourself with shoulder impingement.
Shoulder impingement can have different names including: impingement syndrome, subacromial impingement syndrome, and swimmer’s shoulder.
There is so much information out there on shoulder impingement and it can get confusing…the term was discussed as early as 1972[1].
Here’s what you need to know about shoulder impingement
Regardless of the many names, shoulder impingement can be defined as…
"All non-traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion, often worsening during or subsequent to lifting the arm[2]”.
As mentioned, it’s a pain at the tip of the shoulder that is noticeable in lifting your arm overhead.
Dr. Charles S. Neer, MD argued that the shoulder structures located in the subacromial space (between the shoulder blade and head of the upper arm bone) were being pinched during lifting movements.
He believed that there was damage occurring to the structures in this space and his explanation was shoulder impingement.
With this being the case, surgery was the go-to treatment…
If the structures of your shoulder created the issue, changing the structure would solve the problem BUT…
It’s not that simple.
What the current research says about shoulder impingement
By today’s standards of research, , the above research is not evidence-based - think of it more like what we consider a blog.
Taking a peek at current research, there is more at play than just a lack of space in the shoulder causing compression of the structures in that space.
Because of this, we can’t solely blame the rubbing and compression of tissues for the pain experienced by those with ‘shoulder impingement.’
This is seen when looking at the research comparing surgery vs. conservative treatment.
Participants who underwent shoulder impingement surgery were compared to those who received a placebo arthroscopy (the surgeons went in but made no structural changes) which means getting stitches without changes structurally.
The results showed no differences in pain severity when reassessed for up to 24 months[3].
The current philosophy on treating shoulder impingement
This is a golden point that proves, in the absence of trauma, shoulder impingement symptoms can improve without surgery that structurally changes the shoulder.
What about the sub-acromial space itself?
If there’s less space would that be a main driver of pain?
Not necessarily - research shows us that there is no relationship between that space and shoulder impingement[4].
Bones remain similar in shape and spatial arrangement so chances are your shoulder was prone to the pain experienced that is associated with shoulder impingement for some time.
It’s not so much the structure causing the issue as much as it is other potential factors adding up together.
Whether it’s picking up a new hobby, training routine, and/or simply life becoming a little more stressful - these changes can cause shoulder sensitivity.
And that sensitivity in itself, can cause symptoms associated with shoulder impingement.
So what is the best way to address shoulder impingement?
Movement.
The latest evidence supports exercise and a more active approach as the first-line of defense against shoulder impingement[5,6].
The goal is to find a way to modify one’s training to something tolerable to allow things to calm down before building back up.
This is vital- modifying movements to remain active as you go through the rehab process.
In regard to the modification process - how do we do that? Some options…
Modify the weight you train with
Change the range of motion you are working in
Manipulate the tempo that you are utilizing for exercises
Add support to exercises to make it more tolerable
Find isolation exercises that can improve capacity safely
Prioritize exercises that feel safe and productive
And more!
The goal should be to figure out what the provocative factors are so you can scale it back for a period of time before progressing it back to what was previously causing your shoulder to be symptomatic
This allows to find confidence in your shoulder, train comfortably, and bridge the gap to your goals as safely as possible[7,8].
Remember… shoulder impingement is a biomechanical observation more than it is a helpful diagnosis.
Shoulder pain is frustrating to experience and resolve, but the pain that you are attributing to shoulder impingement can be treated conservatively and without surgery.
If you’re struggling with shoulder impingement symptoms and want to figure out a way to get back to doing what you love.
Schedule your first appointment here by getting on a discovery call.
The steps are very simple:
You’ll speak with one of our physical therapists
They’ll get to know you over the phone by listening to your story
If what you’re dealing with is something that we can help you get long-term relief with then we’ll get you scheduled!
Citations:
Lewis J. The End of an Era?. J Orthop Sports Phys Ther. 2018;48(3):127-129. doi:10.2519/jospt.2018.0102
Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314-322. doi:10.3109/17453674.2014.920991
Paavola M, Malmivaara A, Taimela S, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ. 2018;362:k2860. Published 2018 Jul 19. doi:10.1136/bmj.k2860
Park SW, Chen YT, Thompson L, et al. No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis. Sci Rep. 2020;10(1):20611. Published 2020 Nov 26. doi:10.1038/s41598-020-76704-z
Pieters L, Lewis J, Kuppens K, et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther. 2020;50(3):131-141. doi:10.2519/jospt.2020.8498
Lafrance S, Charron M, Roy JS, et al. Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 2022;52(10):647-664. doi:10.2519/jospt.2022.11306
Chester R, Jerosch-Herold C, Lewis J, Shepstone L. Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med. 2018;52(4):269-275. doi:10.1136/bjsports-2016-096084
Meehan K, Wassinger C, Roy JS, Sole G. Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review. J Orthop Sports Phys Ther. 2020;50(6):285-a12. doi:10.2519/jospt.2020.9152