Shoulders and ‘Impingement’

By Chris Stoddard, Physiotherapist

Shoulders are amazing!

They’re a complex joint with architecture unlike any other joint in the body.

They have an incredible range of motion and for a good reason - we need to place our hands in so many different places that we need a joint mobile enough to get it there.

We use our shoulders for the mundane, for the repetitive, for the explosive tasks (like throwing) and occasionally even for weight bearing.

So when something goes wrong with a shoulder it can be very tricky to figure out exactly what it is going on.

With recent insight from some wonderful researchers (Jeremy Lewis, Chris Littlewood, Craig Boettcher to name a few) we now know the tests that we long thought were good tests to diagnose shoulder pain actually don’t tell us much more than ‘yes, you do indeed have a sore shoulder’.


How shoulders and impingement made me feel

This is why shoulders used to scare me.

With 1 in 3 people experiencing shoulder pain at some stage in their life and 2% of the population attending the GP every year because of it, there is an onus on us as physiotherapists to be excellent at assessing and treating shoulders.

Yet 40-54% of sufferers are reporting symptoms lasting up to1-3yrs even with treatment.

And this is why getting a good diagnosis is so important!


What about your shoulders?

For those reading this article that have had shoulder pain and been to the GP/physio, I’m sure many of you have been diagnosed with ‘impingement’.

This is not really a diagnosis, but is actually just a description of what happens in your shoulder every single time you lift it away from your body.

A perfectly normal, anatomical event.

But when we give a patient this as a diagnosis it invariably conjures up some negative imagery and nasty thoughts of tendons/bursae being squashed.

This is the equivalent of people being told they’ve ‘blown a disc’ and the imagery that can conjure up!

Not helpful and potentially can even worsen pain in some cases.

But, we’ve tended over the years to dole this out as a diagnosis because it’s easy; easier to explain to you and easier to hedge our bets then to dig deeper to distinguish the true source of pain.


What causes pain in shoulders?

With that said, I think a vast amount of shoulder pain is tendon related (and it’s usually easy to pick the ones that aren’t).

Once we’ve identified which tendon and why we thinks it’s getting irritated it is a matter of changing what we can (posture/positions/muscle tension/joint stiffness) and gradually exposing the tendon to loads that are normal through exercise (including compression or ‘impingement’ if you will).

We will usually focus a lot on strengthening and mobilising your shoulder blade or scapula as it is the all-important base of the shoulder (think the base of a crane).  


How I really feel about shoulders now...

Shoulders don’t scare me anymore.

I try not to use the word impingement and instead dig deeper into each patient’s individual features.

At Terrace Physio Plus, we all pride ourselves on our ability to communicate and educate our patients and know that for you knowledge is power.

If you’ve got shoulder pain and aren’t sure why or what’s causing it, come and see us!

We can guarantee a thorough assessment, a good/individualised exercise program if indicated, treatment tailored to what you specifically need and that you will leave empowered with knowledge and a clear path to moving well and feeling great again.