Chiropractic Adjustment for Shoulder Impingement

in Boulder, CO

Rotator cuff lesions progress in a self-perpetuating cycle of dysfunction. Repetitive insults damage the tendon, leading to tendon degeneration and weakening which diminishes the tendon's capacity to do it's job in stabilizing the shoulder inside the joint. Through this process the tendon becomes impinged, leading to further insult. As tendon fibers fail, the enduring fibers remain under tension, thereby increasing load and the likelihood of increased pain or further injury.

SAIS is the most common disorder of the shoulder and accounts for 44-65% of all shoulder complaints seen by physicians. Rotator cuff problems are common in younger and middle-aged populations. Those who perform repetitive overhead activity are at greatest risk for SAIS. This group includes athletes who participate in: swimming, baseball, volleyball, weightlifting, and tennis as well as professions like carpenters, electricians, painters and wallpaper hangers.

What Does Shoulder Impingement Look and Feel Like?

The onset of SAIS is often related to a period of overuse. Initially, symptoms may be limited to a sharp pain during overhead activity or while reaching behind the back to fasten a bra or close a zipper. As the condition progresses, the patient may develop a constant ache that is present at rest. Nighttime pain is common, often disrupting sleep. Sleeping on the affected side may exacerbate symptoms. The discomfort is often located over the front and side of the shoulder areas.

One may experience decreased active and passive range of motion in reaching forward, out to the side or with rotation of the arm and shoulder. The patient often demonstrates a “painful arc” which, when reaching overhead, presents as pain in the middle of the range of motion around shoulder level. Reaching across the body or behind the back may provoke pain.

How Do We Treat Shoulder Impingement?

Management should start with conservative therapy, before considering surgery. Successful management of SAIS should initially focus on restoring range of motion in the shoulder while avoiding aggravating movements, i.e., elevation and internal rotation. We recommend a chiropractic adjustment for shoulder impingement pain. Patients should avoid overhead presses, lateral raises, and push-ups. Selective rest may be necessary for some patients. Ultrasound, anti-inflammatory modalities, and ice may be useful in the earliest stages. However, most passive therapy modalities, provide little benefit for chronic SAIS patients.

In-office management should include manual therapy and exercise. Soft tissue manipulation or myofascial release should address associated tight muscles to decrease pain and improve range of motion in SAIS patients. Manual manipulation is needed to address restrictions in the neck, mid back, and shoulder areas. Nerve mobilization has also been shown to decrease pain and disability in SAIS patients.

There is evidence to suggest that cervicothoracic and thoracic spine manipulation and adjustment may help decrease shoulder pain while improving mobility and function. Thoracic spine manipulation has been shown to significantly decrease pain and disability and significantly increase space within the joint for SAIS patients.

Strengthening may begin incrementally as the patient's pain-free range of motion allows. Strengthening should begin with isometric exercises and progress as tolerated. The ultimate goal of stability and strength training is to restore normal posture and movement of the shoulder. Home-based exercises are effective tools for managing SAIS. SAIS patients who adhere to exercise therapy recommendations have a 66% higher chance of recovery. Return to play should begin gradually and release to full activity is appropriate when ROM is full and pain-free, and strength testing reveals no significant weakness as compared to normal.