Health and Wellness: Targeting the root cause of shoulder Impingement - not just symptoms
If you’re ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge, or place grocery bags on the counter - you were likely dealing with shoulder impingement syndrome - also known as rotator cuff impingement.
They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder and a hook-shaped bone from your shoulder blade that is in the front of your shoulder joint (called the acromion). This can occur for a number of reasons. You could have a deformity in your joint, a previous injury could cause this, arthritis is known to be a contributing factor, and something as simple as poor posture can cause shoulder impingement syndrome.
Regardless of the cause, the mechanism of discomfort comes from crowding of your rotator cuff tendon within the space where it passes in front of your shoulder. If this happens often enough - it’s going to get irritated - and you’ll feel that every time you raise your arm past 90 degrees or reach behind you. Typically, shoulder impingement syndrome is considered chronic. But it starts out as rotator cuff tendonitis. The mistake people often make is that when the pain from the acute tendonitis subsides, they think the problem is gone. But the absence of pain does not guarantee the absence of the problem. Shoulder impingement can linger for quite some time and many folks I speak with just accept the situation and assume they have a “bad shoulder” - or worse - they get surgery that often doesn’t work.
With the exception of a deformity being the cause, almost all cases of shoulder impingement can (and should) be resolved naturally. But what you have to understand is that pain and irritation of your rotator cuff tendon is a symptom - and not the root cause. The tempting and easy fix is to get a cortisone shot to calm the inflammation of your tendon - as in the case of rotator cuff tendonitis. But while the cortisone will temporarily mask your problem, it will eventually cause damage to your tendon if you keep getting injections. Remember, impingement is caused by crowding of the space
where your tendon passes through. You can temporarily take the inflammation away and it will feel better - but unless you address the reason for the crowded space - your problem will keep coming back.
So what is the root cause of shoulder impingement and how do you address it?
Most often - it’s due to poor postural habits and immobility around your shoulder joint - specifically your neck and upper back. For example, if your upper back is stiff, curved, and lacks adequate mobility - it’s going to impact how your shoulder blades move and are positioned. With a stiff and curved upper back, your shoulder blades will have to compensate by being more forward, up and out when you move your arm. This scenario makes that hook-like bone (the acromion) sit more down and forward - which crowds your tendon when you move your arm up, out, or behind you. The friction created by the bony surfaces above and below your tendon in this crowded space eventually leads to pain and inflammation. This can happen slowly over time - or more quickly if you’ve got something like arthritis where that space might have naturally already narrowed.
Another common scenario is after experiencing a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury - and the result is some unwanted postural deformities that have now led to impingement of your rotator cuff tendon - just like in the example above.
So next time you go to the doctor complaining of shoulder pain - and you hear the words “impingement syndrome” or “rotator cuff tendonitis” - be cautious of resorting to treatments that only address the symptoms (pain and inflammation of your tendon). Rest, ice, cortisone shots, and even surgery to “clean out” the crowded space will only have an impact on your symptoms. They will not address the root cause (crowding of the tendon) - and your problem will continue to come back. If you’re suffering from shoulder impingement and you want to get back to lifting, reaching, and carrying things without any worry - it’s essential that you identify and address the root cause, not just the symptoms. Always make sure to examine your neck and upper back first, as this is often where the root cause lies.
Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or reserve a seat in her upcoming Masterclass for Neck and Shoulder Pain Sufferers, visit her website www.cjphysicaltherapy.com or call 603-605-0402.
This article originally appeared on Portsmouth Herald: Carrie Jose targeting root cause of shoulder Impingement not symptoms
