Shoulder Impingement Part 3: Treatment
The other week when I was lecturing fourth year physio students at UTS, a debate started about strengthening versus stretching in treatment, which is of particular relevance for shoulder impingement. A mistake I commonly see with clients that have coracoacromial impingement is using a cross body stretch to relieve tension felt in the back of the shoulder. However, this short-term relief can backfire, especially if it’s used as a band-aid solution before carrying out a heavy upper body workout thinking they can just “work through it.”
While I agree the back of the shoulder (posterior capsule) does need to be freed to improve shoulder mobility, this stretch is not the answer as it will only further aggravate and inflame the tissue.
For successful treatment of impingement, you must first work on “calming shit down” before you even consider working on improving range of motion. This can frustrate a lot of clients who just want to get back in the gym as soon as possible, but taking a long-term approach to treatment has much better outcomes than just sugar coating someone’s symptoms without addressing the root cause.
For coracoacromial impingement a few key ways to “calm shit down” include:
- Avoiding aggravating movements: no lateral flies, cross body exercises or even pec flies (not that I encourage them anyway)
- Ice to reduce discomfort and inflammation
- Anti-inflammatory medications: while I certainly don’t encourage long term use or reliance on these medications, they are helpful short-term
- Provide education on how to stay active without aggravating the joint to maintain general mental and physical health
Once the tissue has settled down we need to start looking at long term approaches to movement and management to prevent impingement coming back again. Here are some of the things your physio might address with you (depending on your shoulder situation):
- Movement mechanics
- Exercise technique
- Muscle imbalances to address the cause of the impingement, for example
- Weakness in the rotator cuff
- Overactive deltoids and upper trap muscles
- Poor serratus anterior activation
- Decreased thoracic range
- Neck issues which can cause issues at the shoulder joint
- Shoulder mobility
That last point has significant importance. If you don’t have full shoulder mobility, then you can expect some type of impingement. You really need to prioritise working on a pain free full range of motion in order to lift effectively without pain or impingement, something your physio can definitely help you with.
I know I haven’t listed the “best stretches for shoulder” impingement or another cookie cutter approach to treating this common problem, but that’s for good reason! There really is no one size fits all treatment. Instead my take home message for you from this 3-part shoulder impingement series is simple:
- Find the cause
- Differentiate the type of impingement (Primary vs. Secondary, Acromial or Coracoacromial)
- Calm shit down
- Establish full range of motion
- Strengthen the imbalances
- Improve mobility issues in the thoracic spine region
- Make it strong but not imbalanced
- Add load
- Add speed
Andrew Ilieff is a physiotherapy based in Double Bay, Sydney. Andrew has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.