Shoulder Impingement

Andrew O'Neill 

Have you pain IN and AROUND your shoulder or even running down your arm when you raise it up to reach for something in the cupboard. Do you struggle to put on your seat belt? Well, you probably have what clinicians like to call ‘Shoulder Impingement’.

Have you noticed it’s sore to lie on it and it actually gets worse when you aren’t using it or trying to rest it? Chances are there are a few small muscles in the shoulder joint that are really inflamed and angry. These muscles are called the rotator cuff muscles and they act to keep the shoulder bone in its socket like a clamp. All are attached to the humerus (arm bone) and the shoulder blade. Unfortunately, one of these muscles runs under a little hook notch or arch at the top of the shoulder blade and can become pinched on certain movements. If this happens repeatedly the tendon can become sore and aggravated.

What’s the root cause of the problem?

This is a very common complaint and in certain people's cases it may have started with trauma to the shoulder like a fall, but a lot of the time it can just start because of what we do in our daily lives, but also, and most likely because of our posture and more significantly the shape of our rib cage.

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Take a deep breath in. You will notice your rib cage elevates UPWARDS and you will also probably notice it lifting at the front of your chest more so than the back. We notice in the clinic that people that do this are really good at pulling air INTO their lungs but poor at blowing it all out.  So what tends to happen is the shoulders shrug upwards with the chest as they breathe in, but the shoulders never really get a chance to relax back down if the pattern persists. So you end up getting tight muscles around the neck, shoulders and shoulder blade causing less space for that muscle to run under that arch at the top of the shoulder blade and hence more pain.

What needs to be done to fix it?

Many people, unfortunately, seek to resolve the pain they are experiencing by getting an injection. Although this may or may not be effective for pain relief there is the danger that the injection may weaken the tendon further which may cause further problems in the future. We always encourage people to use the conservative route when trying to rehab their issue. Conservative treatment starts with finding the root cause of the problem and in this case, we have to look at the diaphragm.

The Diaphragm is a large concave shape muscle within the chest cavity. If this functions effectively (meaning it elevates and depresses with adequate force) we can efficiently pump air in and out of our lungs. A strong, efficient diaphragm allows the shoulder and neck muscles to relax which does wonders for our postures because it will keep the chest/ ribcage from elevating at the front but nice and rounded like a C-shape at the back. Your upper back should be rounded or C- shaped not flat. The only way to achieve a nice rounded upper back is to have an efficiently working diaphragm muscle. Having a nice C-shaped spine means your shoulder blades will be in a good place and hence allowing plenty of room for those rotator cuff muscles to move and work properly. So strengthening and training your diaphragm through specific breathing exercises over a period of time will do the trick. Couple these exercises with direct hands-on treatment to the affected shoulder, and hey presto, you're out of pain. 

Tommy ConwayComment