Shoulder Impingement Syndrome

Shoulder impingement syndrome (SIS) is a common cause of shoulder pain, and you experience that pain when raising the arm overhead. It occurs when the soft tissues in the shoulder, such as tendons or a small cushion known as the bursa, are pinched in a narrow gap between the top of the shoulder blade and the upper arm bone.

This pinching causes pain and swelling and can limit your movement. SIS is associated with tendon irritation, rotator cuff problems, or bursitis (bursa inflammation). Since the shoulder is a highly mobile joint, it relies on powerful muscles and healthy tissues to operate effectively, and these may easily become irritated.

At Suarez Physical Therapy, our Las Vegas physical therapists can guide you in learning about your shoulder pain and the exercises you can do to relieve pain. They can also develop a unique plan to help you move comfortably again.

Causes and Risk Factors of Shoulder Impingement

Shoulder Impingement Syndrome happens when the space above the rotator cuff becomes too narrow, making it tight. This tightening pinches the soft tissues, such as tendons or the bursa, particularly when the arm is raised above the head. The pinching may also lead to swelling, pain, and stiffness. In the long run, the tendons can become weak or even tear, which causes even more severe issues, such as rotator cuff tears.

Overhead Repetitive Activities

Frequent overhead activity in sports or at work is a significant risk factor for SIS. Swimmers, volleyball players, tennis players, and baseball pitchers are some athletes who put a lot of stress on their shoulders. Workers such as painters, carpenters, and roofers face a higher risk. Such repetitive movements may cause strain on the shoulder muscles, imbalances, and joint pressure.

Age-Related Changes and Degeneration

With age, the shoulder tissues tend to become weak. The tendons may form small tears, and the shoulder becomes less stable. Bone spurs can also develop, further reducing the space between the joints. Rotator cuff tears become more common with age. Aging and years of use on the shoulder make the joint susceptible to impingement.

Younger people can also be affected, especially with overuse during sports or work. These changes may be accelerated by repeated overuse. This demonstrates that aging and activity levels combined affect shoulder health. In the case of athletes, it is significant to employ correct technique and balance training. In older adults, maintaining muscle strength and flexibility may reduce the rate of normal wear and tear.

Poor Posture and Biomechanics

The health of the shoulders is also dependent on posture. Rounded shoulders, forward head position, or slouching decrease the shoulder joint space. This may cause additional strain on the rotator cuff and cause impingement. Postural correction is not cosmetic. It can reduce pain and help prevent further injury. Physical therapists emphasise learning proper alignment as a form of treatment and prevention.

Acute Trauma and Injuries

Occasionally, impingement can be caused by an acute injury. A fall on the shoulder, reaching out to break the fall, or picking up a heavy object may injure the tendons or tear them immediately, causing painful impingement.

Anatomical Variations

Some people are naturally born with bone shapes that narrow the space between the top of the shoulder blade and the upper arm bone, increasing their risk of shoulder impingement. For example, a hooked or curved acromion can reduce this space. Impingement is also more likely if bone spurs or small extra bones develop in the area.

Weakness and Imbalance of the Muscles

When the rotator cuff or shoulder blade muscles are weak, the arm bone can move out of its normal position. This causes it to rub against the acromion, leading to irritation and pain.

Other Causative Factors

• Systemic conditions: Health problems like diabetes, rheumatoid arthritis, or other inflammatory diseases may make the shoulder tissues more sensitive

• Lifestyle-related risk factors: Smoking, obesity, and poor general health are risk factors for shoulder problems

• Psychosocial: Stress, anxiety, depression, poor sleep, and fear of movement may be contributing factors that worsen the shoulder pain and delay recovery

These factors demonstrate that SIS is not just a matter of physical issues. Emotions, daily habits, and the general lifestyle can influence pain. This is why treatment is most effective when considering the entire person, not just the shoulder. Physical therapists can work on posture, strength, and movement and assist patients in managing stress, sleeping better, and learning the effects of thoughts and emotions on pain.

How to Know that You Have Shoulder Impingement

The first step to receiving the correct treatment is understanding the symptoms of Shoulder Impingement Syndrome (SIS). The disease develops over time, and the pain and stiffness may impair everyday life.

Common Pain Patterns

The most common pain location is the top and outer side, and it can extend down the arm. It tends to increase with lifting the arm above the shoulder, behind the back, and with overhead activities such as throwing a ball.

The leading indicator is the so-called painful arc. The pain comes when the arm is lifted at an angle of 70-120 degrees. Night pain is also common in many people, and it may even interfere with sleep when lying on the painful side. Although the pain might begin on a small scale, in most cases, it usually increases with time when not treated.

Limited Movement and Weakness

SIS tends to restrict movement in addition to pain. Simple things such as reaching up, putting on a bra or washing hair can be challenging. Arm or shoulder weakness is also frequent, particularly when lifting or pushing against resistance. This weakness can cause difficulty carrying groceries, lifting things or making throwing motions.

Effect on Everyday Life and Sleep

Pain, stiffness, and weakness can disrupt everyday activities at home, work, sports, or hobbies. One of the most exasperating symptoms is night pain, which can cause insomnia and fatigue. These restrictions make many individuals less independent and lower the quality of life in general.

How Physical Therapists Diagnose SIS

Diagnosis of Shoulder Impingement Syndrome (SIS) starts with a thorough conversation about your symptoms and a practical physical examination. A physician or a physical therapist will inquire about the time of onset, location, intensity of the pain, and activities that aggravate or alleviate the pain. They can also ask about previous injuries, occupation, hobbies, and how the pain affects sleep and everyday activities.

Medical History and Physical Examination

Your provider will examine your posture, shoulder positioning, and muscle appearance initially. They look for shoulder asymmetry, muscle loss, swelling, or abnormal shoulder-blade motion.

They can also examine tender areas, swelling or abnormalities in the bones and joints by pressing lightly around the shoulder.

Range of Motion (ROM)

Your active movement (when you move yourself) and passive movement (when the therapist assists you in moving your arm) are tested. This helps determine stiffness, pain points, or movement patterns such as the painful arc characteristic of impingement.

Strength Testing

The strength of each of the rotator cuff muscles is tested. Specific tests can determine whether some muscles are weak or damaged.

Special Impingement Tests

Your provider may perform special shoulder tests like the Neer or Hawkins test. These gently move your shoulder into positions that make the space narrower. If this movement brings on your pain, it helps confirm the diagnosis of shoulder impingement.

Neck or other shoulder problems may sometimes cause pain. A complete examination eliminates such problems as arthritis, instability, or nerve compression.

Imaging Tests

Imaging may give more detail when physical exams do not provide sufficient information. X-rays can reveal the bones and identify bone spurs, arthritis, or specific shapes of the shoulders that can lead to narrowing.

Ultrasound provides real-time images of tendons and muscles, revealing how they move and whether they are inflamed or have small tears. At the same time, MRI offers extremely detailed images of all the tissues in the shoulder, which can be used to identify inflammation or partial/complete tears.

You should understand that imaging is not the whole process. Rotator cuff tears or bone spurs can be painless in many people, and some may have significant pain with little or no change on imaging. The most valuable tools in deciding treatment are the history and physical exam.

The Diagnostic Role of a Physical Therapist

Specially trained physical therapists can diagnose shoulder impingement by asking detailed questions, testing your shoulder movements, and examining your strength. They can spot muscle imbalances, poor posture, and movement habits that may be causing pain. They also watch for more serious problems such as infections, fractures, or other diseases, and will refer you to a doctor if needed.

The assessment of a physical therapist is a synthesis of your narrative, test findings, and (when present) the imaging results to form a precise diagnosis and an individualized treatment program. This will guarantee that you obtain care that treats the cause of your pain and the most effective way of recovery.

How Physical Therapy Can Help You Recover

Non-surgical care is the most appropriate and the initial form of treatment in most individuals with Shoulder Impingement Syndrome. The most essential intervention is physical therapy, which can assist in:

• Decreasing pain

• Improving shoulder movement

• Building up weak muscles

• Enhancing general functioning

Therapy works on the causes of the impingement, including poor posture, weak muscles, and incorrect movement patterns, to allow the tissues of the shoulder more space and less compression.

Early Intervention and Adherence

You should seek early treatment. Early physical therapy at the onset of symptoms before the condition progresses reduces the risk of complications and prevents the condition from worsening.

An effective rehabilitation program employs optimal loading. Optimal loading uses the shoulder gently and gradually instead of completely resting. This aids in the faster healing of tissues and prevents joint stiffening.

The key to success is regularity; regular therapy sessions and a home exercise program are essential for long-term recovery and avoiding the recurrence of symptoms.

Risks of Untreated Shoulder Impingement

Shoulder impingement should not be ignored because it may cause severe complications in the long run:

• Rotator Cuff Degeneration and Tears: Inflammation may advance to partial or complete tendon tears, complicating treatment

• Adhesive Capsulitis (Frozen Shoulder): Stiffness and loss of movement can become severe in the event of untreated impingement

• Chronic Bursitis: The continued inflammation of the bursa may destroy these tissues, resulting in repeated pain and restricted movement

• Severe Chronic Complications: Untreated impingement may, in rare cases, result in arthritis due to chronic rotator cuff tears or even more complex pain syndromes resulting in permanent disability

Most individuals respond well to early diagnosis and regular physical therapy and do not require surgery.

Components of Physical Therapy Treatment

The treatment of SIS is all-rounded. It is not just to lessen pain and restore movement, but also to correct the causes so that the problem does not recur. Treatment is a combination of:

• Pain relief

• Stretching

• Strength training

• Posture correction

• Training to resume activity safely

1. Pain Management Strategies

Initially, one should restrict or avoid those activities that exacerbate pain, including repetitive overhead movements. However, this is not a complete rest; a safe and gentle activity is recommended to allow healing without stiffness.

• Other Therapies and Ice

Swelling and pain can be reduced with the help of ice packs (15-20 minutes, two to three times a day). Therapists may also use ultrasound or iontophoresis (a patch that administers medicine through mild electricity) to soothe inflammation.

• Pain Triggers Education

Patients are taught by therapists which movements or postures aggravate their pain and how to change them. This information provides the means to safeguard your shoulders in your daily life.

2. Regaining Movement and Mobility

With SIS, tight tissues and stiffness are common, and stretching is essential. Typical stretches are:

• Pendulum Exercises: Swinging the arm to loosen the joint

• Shoulder Circles: Small rotations to larger rotations to enhance mobility

• Doorway Stretches: Forward bend to stretch the chest and front shoulder

• Cross-body and Sleeper Stretches: They stretch the back of the shoulder

• Stick-assisted Stretches: A stick is used to move the arm

The therapists may also use manual therapy, including joint mobilization and soft-tissue massage, to decrease tension and enhance motion.

3. Strengthening and Stabilization

Weak or unbalanced muscles cause impingement. The rotator cuff and shoulder blade (scapular) muscles can be strengthened to move the shoulder freely without pinching.

Some of the common strength training exercises include the following:

• Scapula Squeezes: Bringing the shoulder blades together to have a better posture

• External and Internal Rotations: Band or weight strengthening the rotator cuff

• Prone Exercises: Lift your arms when on your stomach to develop support for the shoulder blades

Resistance is added gradually to build strength safely. Exercises should be done slowly and with control, never rushed, and should not cause pain.

4. Core Strengthening

A healthy core muscle helps the shoulder by stabilizing the entire body. Therapy may include exercises such as planks, bridges, crunches, and bird-dogs.

Some of the exercises to be avoided include the following:

Specific exercises in the gym may aggravate impingement, including the following:

• Behind-the-neck pull-downs or presses

• Wide-grip bench presses

• Overhead triceps presses

• Chest flys

• Lateral raises with heavy weight and dips

These exercises can place undue pressure on the shoulder.

5. Body Mechanics and Posture Correction

Poor posture (such as rounded shoulders and forward head posture) decreases the space in the shoulder and adds to impingement. Therapists assist patients in having better posture while sitting, standing, lifting, or working.

Workplace changes, such as adjusting the desk height or reducing repetitive strain, may also be recommended to help protect the shoulder. Patients are also taught safe lifting techniques, such as using the legs instead of the shoulders, to prevent further injury.

6. Return to Activity and Functional Training

The final objective of the treatment is to restore patients to their usual everyday life, sport, or employment without any danger.

Motor Control Training

Therapists concentrate on retraining you on how the shoulder and shoulder blade work together. Correct movement patterns reduce impingement and help prevent injuries in the future.

During motor control training, you practice controlled, efficient movements in preparation for daily activities such as throwing, lifting overhead or job-specific activities.

How to Choose a Reliable Physical Therapist in California

Choosing an appropriate physical therapist is a significant factor in the healing process of shoulder impingement syndrome. There are numerous qualified specialists in California, but knowing what qualities are needed to receive the best treatment is vital.

Qualifications and Specializations

Excellent qualifications are an indicator of expertise. Seek out physical therapists who have a Doctor of Physical Therapy (DPT) degree and have advanced certification through the American Board of Physical Therapy Specialties (ABPTS) in Orthopaedics (OCS) or Sports (SCS). These programs offer advanced practical training, manual therapy, and experience managing complicated shoulder problems and are therefore particularly well placed to assist.

Inquire about Shoulder Impingement Experience

When talking to a clinic, inquire whether the therapist treats shoulder impingement or other conditions regularly. Although the majority of therapists have been trained in general injury treatment, specialists with specific experience may be able to offer a more effective treatment. If the therapist is not specialized in shoulder impingement, they might refer you to a specialist.

Talk about Insurance and Services

Before scheduling, check if the clinic accepts your insurance and your out-of-pocket costs. Some clinics also offer self-pay options. Ask about their services, such as hands-on therapy, personalized exercise programs, and patient education programmes, to ensure they approach the entire shoulder recovery.

Seek a Patient-Centred Approach

Choose a therapist who listens to your history, concerns, and personal goals. A patient-centred approach ensures your treatment plan is personalized and considers all the factors affecting your recovery.

Find a Reliable Physical Therapist Near Me

Shoulder Impingement Syndrome is a treatable condition that is very common and results in pain, stiffness, and restricted motion. Physical therapy and early detection are the main factors that prevent complications such as rotator cuff tears or frozen shoulders. A customized program that incorporates pain management, stretching, strengthening, and posture correction is the most effective way to recover long-term. You must select an experienced and qualified physical therapist who can help you recover effectively.

Begin your pain-free movement experience in Las Vegas with Suarez Physical Therapy. Contact us today at 702-368-6778 to book an appointment and start your journey to healthier shoulders.