Shoulder impingement is a common cause of shoulder pain that can lead to significant decrease in function causing debilitating pain. If you’re already dealing with shoulder pain, you understand how incredibly aggravating this form of shoulder pain can be … making lifting your arm, reaching behind back, reaching or even sleeping extremely painful and frustrating. I’ve seen this injury make extremely active people afraid to even move their arm and get to the point where they cannot even think about the idea of playing fetch with dog. Even worse it is a difficult to do simple tasks like put a shirt on or off and wash their hair. Without the right treatment to fix their problem many end up unable to continue to be active, have difficulty sleeping and become depressed because of the limitations this aggravating shoulder pain is putting on their life.
As you’ll read in this article, shoulder impingement can have many different causes that can be easily missed by a busy, rushed, physician or health care professional. For this reason, this form of shoulder pain has a high tendency to become a chronic problem. In some cases, failure to properly address shoulder impingement syndrome can lead to frozen shoulder which is a severe shoulder disability that can last 1-2 years. It is best if you can to avoid this terrible condition.
I have had patients that I have treated that were unable to use their arm for any form of exercise, play fetch with the dog or even hold the leash with that arm while taking their dog for a walk along the Queens Quay in Toronto, Ontario. This is such a shame because it doesn’t have to be this way, and typically occurs because they received shoulder impingement treatment that is directed at symptoms rather than the true underlying causes of the shoulder pain (Or from getting treatment that didn’t fully address all the causes of the problem).
Unfortunately, a stubborn case of shoulder impingement doesn’t typically go away on its own and will usually get worse if you don’t get the right treatment or just try to push through the pain. So if you are having shoulder pain and reading this article, I hope to give you the knowledge you need to make the right decisions about shoulder pain treatment and get you back to the active Toronto lifestyle that you deserve.
More specifically, the aim of this article is to:
1) give you an understanding of why shoulder impingement can be so difficult to fully resolve, and how with the right treatment these difficulties can be addressed and the problem fixed.
2) give you extremely important information on how to choose the right shoulder impingement syndrome treatment so that your shoulder pain doesn’t linger for years
3) provide a number of self-treatment techniques to start easing your shoulder pain and get you
back to the activities you are currently limited from or unable to do
Why Shoulder Impingement Treatment Often Fails To Get Rid of Your Shoulder Pain.
I believe a big reason that shoulder impingement becomes a chronic long-term shoulder pain for many people is that most shoulder impingement treatment approaches do not fully address all the causes of the shoulder pain. Most physicians and physiotherapists are forced to rush from one patient to the next and simply don’t have the time to identify and treat all the potential causes of your pain
Furthermore, depending on who you see for help, many treatment approaches are aimed at symptoms rather than causes. For example, many physicians will simply tell you to rest, take anti-inflammatories and offer a steroid injection into the shoulder subacromial space. Though people occasionally get some relief from this approach, I can promise you that your shoulder is not in pain because it is deficient in cortisone. Painful inflammation is a symptom caused by other factors, and cortisone simply just decreases the inflammation rather than resolving the cause of the inflammation. Without addressing the underlying causes of the shoulder pain it will only be a matter of time before the pain returns. Often the pain can even return 6-8 weeks later even worse. What is even more frightening that people do not know is cortisone breaks down collagen in muscle, tendons and cartilage. This results in weakening of the muscle and tendons in the rotator cuff. This can make it more difficult to strengthen the rotator cuff which is often part of the shoulder impingement puzzle. This can also make the rotator cuff tendons more likely to tear, causing even further damage and increase the likelihood of possible surgery.
Another reason this injury is often unsuccessfully treated is that there is many causes and factors of shoulder impingement and therefore the same treatment plan will not fix all shoulder impingement. If you use the same approach to address all forms of shoulder impingement syndrome, then you will not have much success.
Every shoulder injury case is different and therefore each condition needs its own individualized treatment plan to get the best results. Shawn’s patients with shoulder impingement and other forms of shoulder pain have a wide variety of activity levels and body types. From baseball players to sedentary desk workers, a huge variety of people develop this debilitating condition in Toronto and seek Shawn Williams Physiotherapy for treatment.
When one is hit with shoulder impingement, it can completely effect your lifestyle. If you’re reading this and already experiencing shoulder pain, you probably know what I mean … you can barely put your shirt on or wash your hair, dreading reaching your arm out too far and getting that extremely sudden pinch. Unable to play simple fetch with the dog. I need to reassure you that you do not have to live like this. With the right treatment approach shoulder impingement can resolve and you can go back to the active Toronto lifestyle you had.
What Are The Causes Of Shoulder Impingement?
As you have read above Shoulder impingement can have many underlying causes. The only way to completely get rid of this shoulder pain is to fully address every possible factor you’re dealing with, which can be many things depending on each individual case. Here are some examples of common and not-so-common causes of shoulder impingement:
– Tight chest muscles
– Tight shoulder capsule
– Tight rotator cuff
– weak rotator cuff
– poor scapula stabilizers
– tight neck muscles
– tight neck joints
– tight upper back
– Weak neck muscles
– weak upper back muscles
– Tight biceps
– tight triceps
– rotator cuff tear
– rotator cuff tendonitis
And the list goes on …
As you can see sometimes tight structures will cause shoulder impingement and sometimes weak structures will cause shoulder impingement. These are the complete opposite things but can result in the same injury.
And just because you have a common cause of shoulder impingement doesn’t mean you’ll develop shoulder pain or that it’s a major contributor to the pain you’re experiencing … we’ve had patients with perfectly loose shoulder muscles which still develop shoulder impingement. In those cases, it was often the mobility of the shoulder joint capsule that was the primary cause of the shoulder pain. Many of the causes of shoulder impingement are interlinked and often one cause leads to another, or may have been present due to an injury from long ago that you completely forgot about. For example: Overtime desk posture slowly causes your back position to become more flexed and your chest muscles more tight which leads to the shoulder joint drifting forward causing the shoulder to no longer sit in the center of the joint.
In that situation, you could strengthen your rotator cuff for months if you do not address the poor posture the shoulder impingement will continue. Want to find out which of the things on the list above might be causing your shoulder pain? If you’re in the Toronto area, click here to request a FREE in-person consultation with Shawn who has over a decade experience working with shoulder pain.
Let’s look at some other causes on our list above …
Some people get confused when they read that tight rotator cuff and weak rotator cuff can have
anything to do with shoulder impingement syndrome. Tight rotator cuff can lead to the shoulder not sitting in the center of joint all day.
Weak rotator cuff muscles can contribute to excessive upward sliding of your humerus when you lift your arm because your deltoid over powers your rotator cuff, this will cause the rotator cuff tendons to pinch into the acromion resulting in shoulder impingement.
What If I small shoulder sub-acromial space? Can shoulder physiotherapy Treatment Still Work with a small acromial space or bone spurs in my shoulder?
In some cases, shoulder pain can actually be coming from a “bone spur” which is a bony
growth off your acromion (part of the clavicle a bone that makes up the shoulder). Making this diagnosis requires a thorough assessment and unfortunately sometimes not even a skilled manual therapist can help with these types of shoulders.
HOWEVER, even when we’ve had patients with bone spurs, there are typically other factors aside from the bony growth that’s causing their pain. So addressing those other factors are a must if you’re going to fully resolve shoulder pain, even if you have a bone spur. We’ve even seen pain completely resolve with hands-on manual therapy techniques and specific physiotherapy exercises even though those techniques do not remove or change the actual bone spur. In fact, many people have bone spurs and don’t know it because they don’t all cause pain.
In some cases, if the bone spur or small sub-acromial space is a primary driver of your symptoms, it may ultimately need shoulder decompression surgery so that the pain can be completely fixed this however is rare and is a surgery that should not be taken lightly without a complete assessment from a physiotherapist with vast experience in shoulder pain.
So What Is The Best Shoulder Impingement Treatment in Toronto, Ontario?
I’ve written all the above to make the point that every case of Shoulder impingement is different and. Therefore, requires an expert physiotherapist to identify all the various components of the problem. Missing even one part of the puzzle can be enough to keep treatment attempts from fully resolving your shoulder pain and the limitations it is placing on your life. Depending on which factors are causing your shoulder pain, different types of health professionals will be best suited to help you get rid of the pain and back to the active lifestyle you desire here in Toronto.
It does not cost you a dime to figure out if a manual physiotherapy approach is the best option for your shoulder pain. If you are in the Toronto area, click here to request a FREE in-person consultation with Shawn who is an expert in shoulder pain. Of course I am little biased, but I can honestly say that good physiotherapy treatment and advice should be able to resolve most shoulder impingement cases without interventions from other providers such as a cortisone injection or decompression surgery from a physician. Sometimes relief can be achieved after a couple session and other times it can take a large number of treatments, but most cases of shoulder impingement are fixable with the right specific treatment for that specific case.
A physiotherapist who is also an expert in hands-on manual therapy is equipped with a many potential highly effective treatment techniques and strategies that many physiotherapists are unable to provide. Not all physiotherapy approaches are created equal. Here are some things you need to consider when seeking physiotherapy, or any other form of treatment.
1) They are trained in, and use, hands-on manual therapy techniques as part of their treatment plans. In Canada these physiotherapists will be identified with the credentials FCAMPT which stands for Fellow of the Canadian Academy of Manipulative Physiotherapy. These physiotherapists have completed years of post-graduate education and attained internationally-recognized qualifications in hands-on therapy.
2) They see very few patients per hour and provide plenty of one on one hands on assessment and treatment so they actually have the time to identify all the factors causing your shoulder pain and the time to treat every one of those factors.
3) They are progressing your exercises each week and closely monitoring if you are doing them properly. If your healthcare profession is not using some form of hands-on manual therapy, you are likely not getting everything you need to completely get rid of your shoulder pain. If they are rushing from one patient to the next, seeing multiple patients per hour or multiple patients at one time, it’s impossible to give the highest quality of care. In order to fully resolve shoulder pain, you need high quality care and undivided attention in your treatment sessions.
Shawn Williams Physiotherapy, treatment sessions are always 1-on-1 with a FCAMPT credentialed physiotherapist and all physiotherapy sessions are hour long treatment sessions in Toronto. This allows for time and focused attention on your shoulder pain so that we look at every possible cause of your shoulder impingement and do not end up just treating the symptoms. This will allow you to get back to running, exercise, sports or those activities that you are missing out on as quickly as possible. Shawn teaches patients everything they need to be doing on their own time to get better. Physiotherapy therapeutic exercises are a very important part of any shoulder impingement treatment plan but Shawn also offers dry needling services which can occasionally be a key component of successful shoulder impingement treatment.
Shawn also wants to make sure that all patients are 100% confident that we can help before they begin treatment. For that reason, we offer FREE phone consultations and FREE onsite consultations in Toronto.
What Are the Best Shoulder Impingement Exercises and Shoulder Impingement Stretches?
The video below provides further information on shoulder impingement syndrome.
***Please note that this is not a complete list of potential self-treatments nor is it likely to resolve your shoulder pain that what’s included in the video will completely resolve your shoulder pain. Diagnosis and hands-on treatment by a qualified manual physiotherapist is your best option to fix your shoulder pain in almost all cases of shoulder impingement.
Shoulder Impingement is not a condition you have to live with. It does not have to stop you from doing all those active things in life that you love to do. The following is what Shawn Williams Physiotherapy does best: We help busy working professionals in Toronto who are suffering from pain or injury to quickly return to running, exercise, sports and an active healthy lifestyle. If shoulder impingement or any form of shoulder pain is keeping you from being as active as you would like to be, let Shawn help you get to the bottom of the issue and create a plan to get you back to the active lifestyle you deserve. If you are in the Toronto area, request a free phone consultation here or call/text us at 416-660-4187.
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