Shoulder impingement syndrome occurs when the tendons of the rotator cuff and the subacromial bursa (a fluid-filled sac that reduces friction in the shoulder joint) become compressed or pinched between the bones of the shoulder, particularly the acromion (part of the shoulder blade) and the head of the humerus (upper arm bone). The true causes of shoulder impingements are often multifactorial and can include a combination of anatomical, biomechanical, and environmental factors. Here are some of the key contributors:
I). Anatomical Factors:
- Acromial Shape: The shape of the acromion can influence the likelihood of impingement. A hooked or curved acromion may reduce the space available for the tendons and bursa, increasing the risk of impingement.
- Subacromial Spurs: Bony projections or spurs on the underside of the acromion can also contribute to impingement by further narrowing the subacromial space. This is one aspect of degenerative arthritis.
II). Muscle Imbalances:
- Rotator Cuff Weakness: Weakness in the muscles of the rotator cuff, which play a crucial role in stabilizing the shoulder joint, can lead to altered mechanics and impingement. Specifically we want a shoulder to see more external rotation compared to internal rotation.
- Muscular Tightness: Tightness in certain muscles, such as the chest muscles (pectoralis major) or the muscles around the shoulder blade (subscapularis), can affect shoulder biomechanics and contribute to impingement. Treating any muscle that involves internal rotation of the rotator cuff is a must as they do get very tight.
III). Poor Posture:
This is an area us chiropractors focus greatly on because if we can get people to stand more straight where the ears line up with the shoulders then the cervical spine, thoracic spine or glenohumeral joints would be in less pain but more importantly would have better functional range of motion. These are the biggest faults we see when assessing posture:
- Forward Shoulder Posture: When a person adopts a forward head and rounded shoulder posture, it can lead to a protracted or forward position of the shoulders. This position narrows the subacromial space, which is the space between the acromion (part of the shoulder blade) and the head of the humerus (upper arm bone). Narrowing of this space increases the risk of impingement.
- Thoracic Kyphosis: Poor posture often involves excessive rounding of the upper back, known as thoracic kyphosis. This can alter the normal mechanics of the shoulder joint, contributing to impingement issues. The altered position of the upper back can influence the orientation of the shoulder blades and impact the movement of the arm. You folks that sit 8-10 hours per day take note!
IV). Overuse or Repetitive Movements:
- Activities that involve repetitive overhead movements or excessive use of the shoulder joint, such as weightlifting, throwing, or certain sports, can lead to overuse injuries and impingement. When we give our patients rehab to follow, understanding scapular (shoulder blade) motion is a must when performing any exercise of the shoulder girdle.
V). Trauma or Injury:
- Previous injuries or trauma to the shoulder, such as dislocations or fractures, can alter the anatomy of the shoulder joint and increase the risk of impingement. Sometimes this can lead to overall instability and degenerative arthritis. But don’t let this dishearten you because we can still get functional range of motion. We just have to take one step back in order to get two steps forward with treatments or training.
VI). Age-Related Changes:
- As individuals age, the structures within the shoulder may undergo degenerative changes, including changes in the tendons and the acromion, which can contribute to impingement. Age related issues usually take longer to treat but we can still get results.
VII) Inflammation and Swelling:
- Inflammatory conditions, such as bursitis or tendonitis, can result in swelling and increased pressure within the subacromial space, contributing to impingement. Class IV Laser Therapy such as our Summus Laser helps modulate Inflammation so rehab can get quickly underway with less pain.
It’s important to note that a combination of factors can vary among patients. A comprehensive assessment by our team is crucial for accurate diagnosis which can possibly lead to special imaging and the development of an effective treatment plan tailored to the specific causes and needs of the individual. At The BodyFix, our treatments are focused on a holistic approach and a method that produces RESULTS! It is our opinion that a simple chiropractic adjustment (pop/crack) to the shoulder won’t do the trick and many times can make the matter worse because the shoulder is a highly mobile joint which needs more stability training. Not to say an adjustment wouldn’t help! It’s to say there is a time and place for that aspect of treatment to be used and it usually coincides with many muscle release techniques and rehabilitation exercise training. Which is why we provide more than a pop and crack and we strive for patients to leave pain free.
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