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 therapists today. 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!
We’ve been in this game for a long time and one of the questions we often ask patients is, “how would you describe physio to a friend?” The responses often range from an “I don’t actually know” to a “ you’ll show me some exercises and perform some treatments to fix me.” At first, these responses were surprising and confusing as you wouldn’t invest your time and money into something you didn’t fully understand. You wouldn’t go buy a car without knowing how to drive and you shouldn’t place your trust in a professional without understanding the nature of how they can help. So let’s take a moment and briefly go over the top 5 reasons to visit a physical therapist.
Most musculoskeletal conditions that are minor and don’t require guiding the body back to full recovery take around 2-4 weeks depending on severity. If your injury is lasting longer than these timelines then getting an opinion or assistance to guide the recovery process back to thoughtless, careless, fearless movement may be indicated.
2. Your recovery requires a targeted adaptive outcome
There are many benefits to physiotherapy but one of our favourites is manipulating the body through adaptive stress to achieve a desired outcome. The body can produce 9 total adaptions to a well dosed physical stress. These outcomes include: strength, flexibility, power, skill acquisition to name a few. Knowing which one to target can be essential for both performance and injury reduction as you make your way through your recovery.
3. You find your pain experience is unpredictable or unmanageable
Pain is confusing. Sometimes we don’t understand why we have it, where it came from and how to get ride of it. Our job is to teach and guide you through this relationship with both hands on care and education so that pain becomes more of a teacher rather than a disciplinarian.
4. Your own effort results in re-injury or re-aggravation
In our experience there are two types of patients who struggle with recovery. Those who fear and avoid pain and those who disrespect it. To put it another way, we all operate the most complicated piece of technology to ever exist on this earth (the human body). Let us help you read the user’s manual.
5. You want to move forward in your recovery but you’re unsure of how to do it safely
One of the primary reasons people seek our help is because they lack structure. They know where they are, they know where they want to go, but creating an actionable plan to get there safely and successfully can sometimes feel out of reach. An initial assessment is designed for this purpose. Come equipped with your biggest dreams and a curious mind and watch what physio can do for you! If you’re looking for physiotherapy in Victoria, you can book an appointment with our team online here.
At South Island Physiotherapy, we educate patients regarding Osteoarthritis every single day. Over the past 11 years two things have become clear: 1. Osteoarthritis scares the heck out of people and 2. It is often highly misunderstood and/or carelessly diagnosed. The following post is meant to dispel some of the most common Osteoarthritis (OA) myths and misconceptions we see around this complicated condition. If you’re looking for a physiotherapist that specializes in the management of OA – book here.
Myth #1: OA is a consequence of getting older
This is a particularly pernicious myth influenced by joint changes reflected in the findings of medical images (X-ray, MRI, CT scan, etc). Though the changes are real, they are often influenced by a combination of the aging process and lifestyle behaviours. Research has determined that there is not a strong relationship between these findings and OA symptoms. For example, some people have medical images revealing a lot of joint change, but they experience very few symptoms. This myth buster is a reminder that you aren’t your medical image. Ready to improve the health of your joints? Book with one of our Physiotherapists that specialize in the management of OA.
Myth #2: OA is the result of “wear and tear” on the joint(s)
This myth is so common that it’s found what appears to be a permanent home in our vernacular. We find that this myth results in people restricting their participation in the activities they love in order to avoid ‘wear and tear’. It’s important for everyone to know that OA is not caused by a joint ‘wearing out’. OA is an inflammatory disease that interferes with how the cartilage in your joint(s) repairs itself. OA is not inevitable and not everyone will develop it as they age. So go ahead, participate in the things you love. Make sure to do so progressively and consistently with the help of a Registered Physiotherapist.
Myth #3: Exercise will damage my joint(s) further
This myth is related to the idea that joints suffer ‘wear and tear’. When is comes to the notion that exercise will advance OA, it’s important to know that the opposite is true. Exercise and general movement are the best defence against OA. Exercise avoidance results in stiff, deconditioned joints. Engaging in progressive, consistent exercise keeps joints lubricated, mobile, and resilient. Be safe and find a Physiotherapist specialized in the management of OA.
Myth #4: Pain during exercise means I’m causing damage to my joint(s)
Ironically, this myth results in activity avoidance, deconditioning, and the progression of OA. Though the pain experience is complicated, we do know that it is independent from tissue health. This means that pain is not directly related to the structural changes of your joint. Pain is influenced by stress, sleep quality, dietary fluctuations, and a host of other variables independent from the structure of your joint. Experiencing joint related pain? Our Registered Physiotherapist’s can help you navigate pain and injury.
Myth #5: My OA is doomed to get worse
This myth results in people feeling defeated by their diagnosis of OA. There are plenty of positive, active things you can do to help with the pain associated with OA. Strength training, balance exercise, walking, and progressive exercise can stimulate tissue adaption. This can result in better lubricated, more mobile, and resilient joints. Interested in creating a more resilient joint? Find a Physiotherapist that specializes in the management of OA.
So there you have it – OA is a complicated, misunderstood disease that often limits and restricts the lives of those with a diagnosis. This blog post is meant to dispel some common Osteoarthritis myths so that you can move towards the things you love with a bit more assurance. South Island Physiotherapy is here to help those with OA navigate the process of creating healthier, more resilient joints.
Have you ever wondered what causes Back Pain (BP)? It’s a big topic and there are plenty of opinions enjoying mass circulation. For instance, you might have heard about slipped discs, pinched nerves, wear and tear, misalignment, and postural dysfunction. Perhaps you’ve been informed that the back is particularly susceptible to injury and you should avoid using or lifting with it. In either case, the word on the street seems to be that there’s something unique about our backs.
But is this true? Is our back somehow separate and different from the other tissues and joints of our body? If it’s not, then why is BP a leading cause of global disability? This blog post is meant to share with you 10 Back Pain secrets that are supported by research. These facts can help us better understand the phenomenon that is BP.
Fact #1: Persistent back pain can be scary, but it’s rarely dangerous
Persistent BP can be distressing and disabling, but it’s rarely serious and you’re likely to recover with the right approach to physical rehabilitation.
Fact #2:Getting older is not a cause of low back pain
Although this is a widely accepted concern and belief, research does not support the idea that age causes BP. Evidence-based physical therapy can help at any age.
Fact #3: Persistent back pain is rarely associated with serious tissue damage
Backs are strong and resilient. If you’ve experienced an injury, tissue healing occurs within three months. Pain persisting beyond this time frame is likely influenced by other contributing factors. These include sleep quality, stress levels, activity levels, and diet (just to name a few).
Fact #4: Scans rarely show the cause of back pain
Plenty of scary-sounding things can be found on medical scans. These include disc bulges, protrusions, degeneration, arthritis, etc. Interestingly enough, research shows that these findings are common in people without BP or injury. Therefore, medical scans are only helpful in a minority of cases.
Fact #5: Pain with exercise and movement doesn’t mean you are doing harm
When pain becomes persistent, the spine and surrounding structures can become sensitive to movement. It’s likely that the pain you’re feeling during activity is a reflection of how sensitive these structures have become – not how damaged they are. Therefore, it’s normal to feel some degree of pain or discomfort as we participate in physical rehabilitation. Your Physical Therapist will place structure around your recovery to ensure that you’re stimulating tissue adaption through appropriate challenge and that pain will reduce in a timely manner.
Fact # 6: Back pain is not caused by poor posture
How we sit, stand, and bend does not cause BP, though too much of any one thing can lead to discomfort. Your spine is meant to move and you should allow it to enjoy a variety of positions throughout your day.
Fact #7: Back pain is not caused by a ‘weak core’
Weak core muscles do not cause BP. In fact, individuals with BP often clench their core muscles as a protective response, which can exacerbate the situation. Imagine clenching your fist. The first two minutes are fine, but eight hours later you’re moaning in agony.
Fact #8: Backs do not wear out with everyday bending and loading
The same way lifting weights makes muscles stronger, moving and loading the spine makes it more resilient and healthy. Activities like lifting, running, twisting, and bending are safe so long as you progress gradually and practice regularly.
Fact #9: Pain flare-ups don’t mean you’re damaging yourself
While pain flare-ups can be disabling and scary, they are not often related to tissue damage. Common triggers include poor sleep, stress, tension, dietary fluctuations, and inactivity. Controlling these variables can reduce the likelihood of pain flare-ups. When they do happen try to relax, stay calm, and keep moving.
Fact # 10: Injections, surgery, and strong drugs aren’t a cure
Spine injections, surgery, and strong medications aren’t very effective for persistent BP in the long term. They also come with risks and side effects. A strong physical rehabilitation protocol involving activity pacing, progressive exercise, and pain management techniques is the safest and most effective way to recover from BP.
So there you have it. Your back is stronger, healthier, and more resilient than often advertised. It’s meant to lift, bend, twist, and move! If you’re struggling with BP, we recommend finding a Physical Therapist that inspires hope, provides challenge, and offers guidance along the way. We ought to acknowledge Peter O’Sullivan for dedicating his time and energy towards debunking common misconceptions about BP. Without his work the 10 secrets that you just read wouldn’t exist. We also want to acknowledge Dr. Stuart McGill who has dedicated his career towards understanding spinal injury. Though biomechanics is on the ebb, his contributions to the field shouldn’t go unnoticed.
If you’re suffering from BP, we have a a number of Physical Therapist that can help through evidence-based care. Book here.
So, you’ve been in a motor vehicle accident (MVA) and you’re attempting to submit an ICBC claim. Not a good feeling. Your car has likely taken on some damage, you’re feeling banged up, and now you need to organize car repairs and healthcare appointments. This blog post is meant to help you with organizing your healthcare appointments following a MVA.
South Island Physiotherapy is here to assist you in rehabilitating from injuries sustained from your MVA. Immediately following your accident, ICBC will cover Physiotherapy (25 visits), Registered Massage Therapy (12 visits), and Kinesiology (12 visits). These services will help you navigate the early stages of pain and injury, develop resiliency, and assist you in returning to pre-accident levels of function. Throughout the course of treatment, should your practitioner determine that you require additional treatment, an extension request will be submitted to ICBC so that you receive the care you deserve.
If you’ve experienced a MVA and you’re ready to get your health back on track, here are the steps you should follow:
Step three: the practitioner will create a detailed treatment plan specific to your needs and stage of healing
Step four: follow the prescribed treatment plan
Step five: recover from pain, injury, and return to pre-accident levels of function
For those that do best with visual explanations, here’s an infographic communicating the same information but in different form:
A Motor Vehicle Accident and ICBC claims can be complicated, but your recovery doesn’t need to be. Using the information above, you should find the process of submitting a claim, booking treatment, and recovering from injury a little bit easier. The practitioners at South Island Physiotherapy have the experience and knowledge to assist you in recovery. Book now and let us help you get back to the life you love.
