Shoulder impingement pain can be worrisome because
of the fear of it progressing to something worse, like a torn rotator cuff tendon. And often people
suffering from shoulder impingement syndrome tried to do exercises to improve it, but it leaves
them feeling worse. But the fact is that shoulder impingement syndrome can heal nearly 100% of
the time, you just need to understand it better. Well, in this video, I'm going to explain
everything you need to know to get healthy again, if you're suffering from
shoulder impingement syndrome, be sure to watch the whole video because at the
end, I'm going to tell you which exercises are specifically making shoulder impingement syndrome
worse, so you can stop doing those immediately. So let's answer the question what is
shoulder impingement syndrome? I've got my skeleton here. This is men lab because
we're called the pasal. Manual physical therapy, my clinic. And sometimes people think that there's
a manual manual that works with us like like an M manual. So this is Manuel er skeleton.
So in shoulder impingement, you have the ball and socket joint right here. And what happens
is the space between the ball and the socket, and this overhanging bone right here, it's
called the acromion. It's part of the shoulder blade here, you can see the whole shoulder blade,
and it has this part of the bone that sticks out upwards this way, that's called the acromion.
So that space right there is where tissues or tendons Bursa, there's all kinds of things in
there, it gets pinched, and especially when you're raising your arm up, because that space
has to close a bit in order for you to raise your arm up. That is when people tend to feel
pain when it comes to shoulder impingement. Now let's answer the question of What Causes
shoulder impingement? Why does that space get smaller? Why? Why does Why do things pinch in
that area? Well, there's three main factors in figuring out shoulder impingement. One is a
muscle imbalance within the rotator cuff muscles, there's four rotator cuff muscles, supraspinatus,
infraspinatus, teres minor, and subscapularis. And they surround the entire shoulder blade,
and they all come out and kind of grab the ball part of the ball socket joint, and they suck
the ball into the socket. And if you have an imbalance between those, usually it's the muscle
here in the front called the subscapularis, it gets kind of weak, then it starts to allow
the ball to move differently on the socket. This then becomes an alignment issue of the
ball and socket joint. And so any movement that happens after that is from bad alignment,
you're going to have an increased chance of pinching something in the joint, there's a
second muscle imbalance that very often happens with this. And it has to do with the control of
the shoulder blade back here, when this shoulder blade can't properly move in all the directions
that it needs to because it should be able to move up down inwards towards the spine outwards.
And it should rotate up and down. And just to show you what it looks like on my shoulder right
here to move up down towards the spine away from the spine, and then it can rotate up and
down too. And it actually can tip forward and backwards as well. If you don't have
good control of all those muscles, then you can develop a muscle imbalance within
the muscles that control the shoulder blade. So it's kind of a double whammy because there's
muscles right in this area between the spine and the ribs and the shoulder blade that are in
an imbalance. And then you have the muscles from the shoulder blade to the ball over here
the rotator cuff muscles that are also did an imbalance. And a third problem. And this is
kind of new and controversial a bit I'll tell you more about it later on in this video is a
change in shape of the acromion of this bone, it can actually begin to hang down.
And people often get surgery for this where they clean up the joint they do
what's called a subacromial debridement or a subacromial decompression is the other
name for it. And that so this bone coming downwards can also pinch the tissues there.
But now coming back to the muscle imbalances. People often ask well how do those muscles
get weak because I'm exercising or I'm not exercising. So I kind of know how those muscles
got weak. There's a bunch of different reasons. It could be that it's the way that you
exercise if you tend to emphasize certain muscles more than others and there's some that
you just completely miss or don't accurately exercise effectively exercise whenever you
go to the gym and do upper body exercises, then you can develop an imbalance this way.
If you're just overall weak because you just aren't a person who's been working out for a
long time. It happens for a variety of reasons, then that can also set you up for imbalances
between those two areas that I told you. And then another factor that you might consider
is if you have weak neck muscles up here, those joints can pinch the nerves and you
can get disc herniations as well and if those nerves get pinched, these are the nerves that
come out from here that run into the muscles around the shoulder and helps to control the
shoulder movements all the muscles in the area. So if you have a pinch up here, it's going to
decrease the nerve flow to the muscles and that can contribute to the muscle imbalance in the
loop weakness as well. Now, so now let me tell you how to diagnose shoulder impingement
in case you've never been to the doctor, and you think you might have a, what are some
ways you can tell that it really is shoulder impingement, or something else like tendinitis,
or bursitis, or maybe even a rotator cuff tear because they can progress into those things.
The number one sign that you have one of these problems is pain when reaching up overhead, once
you get to a certain point, it just starts to hurt in the shoulder joint. Sometimes there's a
certain spot and other times it's more diffused, it's all it's kind of in different areas and
all over, it's harder to pinpoint in one spot. When I see patients that have diffuse pain, I
usually ask them is there a specific spot that hurts and then they start poking around. And you
know, if I give him a few seconds, and they can't find the spot, then I'm assuming it's diffuse
at that time. Because if it's a specific spot, people usually find it within a second or two.
Now, if you do have a specific spot that hurts that's more in line with tendinitis bursitis
in the shoulder, or even a rotator cuff tear, but not with shoulder impingement syndrome.
And something else that happens is if you go live on your side, like when you
go to sleep, or if you're relaxing, reclining on the couch or something and you're
putting more pressure on the side that hurts you. It's going to hurt that's common with all of these
conditions are with shoulder impingement syndrome, tendinitis, bursitis, and a rotator cuff tear.
And by the way, I'm mentioning all these because they're on a spectrum. I've done a video on this.
In fact, it's linked in the description below. If you want to go get more details about
how shoulder impingement happens first, and then you move into tendinitis bursitis.
And then after that, it starts to wear down more and you hit a rotator cuff tear.
So it's the same process that gets you there. It's important that you treat it right now
and make sure you're doing the right things to get rid of it. So you're not progressing into worse
shoulder problems. With shoulder impingement, it may not bother you, if you're in a
certain comfortable position, it usually doesn't hurt if you're if you're just comfortable.
If you're not moving. If you're not raising your arm. If you're not exercising, it tends to hurt
more if you put pressure on it. If you reach up all the way if you get into extreme positions,
like sometimes reaching behind your back can be painful, or reaching out and picking up
something heavy can be painful in certain times, exercising in the gym, of course, like
weightlifting, anything that involves your arms. As people get more tired and use their arms
more. That's when their shoulders begin to begin to ache and throb and become uncomfortable
for a time afterwards, maybe the rest of the day, sometimes even for a few days if it's more
irritated. But when it comes to tendinitis and rotator cuff tears, those tend to
hurt more consistently even at rest. Now, as far as motion goes, people that
just have shoulder impingement syndrome don't typically have a loss of motion, so they can
move both arms the same way up behind their back, they can move freely, it may hurt at
the end ranges, but they don't have a loss of motion. Same goes for tendinitis.
But when it comes to a rotator cuff tear, there usually is a loss of motion so they can't
come up, they feel restricted or very, very, very painful to the point where they don't want
to come up more, or they have to kind of help with their other arm. That's more in line with a
rotator cuff tear in other restricted motion with a rotator cuff tears reaching up behind the back
like that they have a lot of difficulty, they'll be able to do it on one side than the other side.
They can't get up very comfortably. And there's a lot of pain associated with it. With shoulder
impingement, there may be pain associated with it, but usually not a noticeable loss of
motion. And then there's pain in other areas that happened with all three of
these conditions will four be counted. Bursitis tendinitis is separate ones, you'll
get pain up in the neck area at times in this neck and shoulder area, it's actually the
ribs first and second rib right there that are part of that problem. And then on the
back of the shoulder blade, you may even get pain in the front of the upper chest area
like by where the ball and socket joint is especially in pain in the shoulder joint itself.
And sometimes if the nerves become affected, you can get pain down the arm all the way into the
hand and fingertips. It is common for people with shoulder impingement syndrome to come in telling
us that they're experiencing more numbness and tingling in their hand, especially like when
they go lay down at night. Or if they're using a mobile device for an extended period of time.
Those symptoms have come on more often. Now what happens if shoulder impingement syndrome goes on
untreated? Well, after a while the tissues that are getting pinched right here, just begin rubbing
more and more. And then it turns into an it is. Itis means inflammation. So we're talking
like tendinitis, or bursitis. And all that is is the rotator cuff tendons that are
right here. When they get rubbed a lot. Then you have rotator cuff tendinitis, and it
hasn't torn yet but it's on its way to tearing to becoming a rotator cuff tear. But right
up right near that tendon. It's right here. There's a big burst that's called the subacromial
bursa and that's just a sack it's a fluid filled SAC is how it's described. Its purpose is
to reduce friction between two different structures inside the joints. So in this case,
the rotator cuff tendon and then the bone, the underside of this bone right here because it can
rub inappropriately and cause problems but that bursa helps to protect it from excessive friction.
The problem is if you wear out the bursa, then it begins to come inflamed as well. So
now you have bursitis, the bursa is inflamed, but tendinitis and bursitis eventually happen
if the shoulder impingement syndrome is not handled well. And then it's just a matter of time
before you develop a rotator cuff tendon tear, you can get a partial tear to begin with
where just part of the tendon is torn. And then eventually, you can get a complete
tear where it tears all the way. And that's usually a surgical case, we're seeing more cases
that can improve without surgery. But very often people end up having surgery because of the pain
and the loss of motion they're experiencing. And the rotator cuff repair surgery is actually
a pretty good surgery if you have to have it. Now let's talk common treatments for shoulder
impingement syndrome. If you end up going to the doctor, one of the first things we're going to
tell you is to rest from any activities that are aggravating it. So especially if you're somebody
who likes to exercise and go into the gym, especially if you'd like to lift weights, doctors
love to pick on CrossFitters, especially because they're doing a lot of weights in a short
amount of time, it gets kind of intense. But I want you to know right now that it
is okay to eventually go back to lifting weights once you fix the shoulder impingement
problem. In fact, I encourage it, and I've got exercises for shoulder impingement,
check it out in the description below. And you'll see towards the end of those
exercises, there's weightlifting in there, it's actually necessary, in order to heal
shoulder impingement problems for the long term, you just have to make sure that you're doing
things right, everything's in that video. So if rest isn't helping you out enough, then the
doctor is going to recommend over the counter pain medications. And if that's not enough, then they
may give you prescription string pain medications to deal with your shoulder pain.
And if that's not helping you out, they will resort to giving you an injection
for pain relief, usually a steroid shot, cortisone is the most commonly used medication in
that they'll inject the area right between that acromion that part of the of the shoulder blade
that hangs over and the top of the ball part of the ball and socket joint because that's because
that's where the shoulder impingement happens. And the medical term for shoulder impingement
is subacromial. Impingement sub means below and a chromium is this bone right here. So
sometimes I say subacromial impingement, because that's what got burned into my brain going
through all the schooling that I went through. Now, if none of those pain relieving options
work for you what the doctor will recommend next, they'll ask you to go to physical therapy,
they very often will do that. And I'll talk to you more about that. But in some cases,
they'll refer you to an orthopedic surgeon. And surgeons do have surgeries.
For this, they're extreme, they're not super commonly done, but they are
done. And one of the most common ones is what's called a shoulder decompression, where the more
medical term is a subacromial decompression. And the reason why they'll do this is that they'll
do X rays and imaging of your chromium, this this piece of the bone right here, and they're
trying to see if it's hanging downwards like that. And if it is, they go in and shave it off.
Sometimes there's also spiky, irregular surfaces on the bottom of that acromion. And they'll go in
and shave that off and smooth that out with the hopes that you're going to have more free motion
in your joint. But that doesn't solve the root problem. I'll tell you more about that in just a
moment. Another surgery that's often done at the same time as that subacromial decompression is
a bursae ectomy, so they'll take out a piece or all of the bursa and it actually grows back.
But they're doing that in hopes that they can reduce the inflammation, which is kind of
backwards because surgery causes inflammation because it's a controlled injury to the body. But
it's what's been done in the past and sometimes successful sometimes not. Again, they're missing
the root problem that needs to be addressed in order to get rid of subacromial impingement
syndrome. Now let's talk physical therapy. If you go to physical therapy, they may help
you out. But what you need to know is that most physical therapists are trained in helping people
after they've had a surgery. And if you're looking to avoid a surgery for your shoulder impingement
syndrome, then you need to do some research and make sure that you're in the right spot, or that
if you have to go to this physical therapist that they're doing the right things for you.
And I'm not trying to throw anybody under the bus. I'm a physical therapist myself. I've trained
lots of physical therapists. I've worked in physical therapy schools, I've done tons of guest
lectures and I've been on staff before as well. And physical therapy programs, especially
throughout the United States are excellent at graduating physical therapists that know
exactly what to do if you've had a surgery, but it's a specialty that requires
more schooling to know exactly what to do if you're trying to avoid surgery.
So very often physical therapists are guiding their shoulder pain patients or impingement
patients to do rotator cuff exercises where they're moving a band in and out like this.
And this is one of the worst things you can do because it doesn't train the rotator cuff
to do its primary motion. which is to compress the ball against the socket. And oftentimes
it feeds the muscle imbalance that messed with the alignment of the ball and socket joint.
So just do your research. And if you're attending physical therapy right now, and it's just not
working out for you see another one, look up into the physical therapist, and look up our videos
here as well as a starting point. But sometimes you just need to go see somebody in person
to make sure that you're on the right track. And it may be that you need some hands on
help as well. And working with an experienced manual therapist like I am, I've done extra
training to become a manual physical therapist, that may make an enormous difference in
solving your shoulder impingement problem. Because if you can solve that, then you're
going to protect yourself from getting a rotator cuff tear later on in life and
possibly needing more invasive treatment, like a rotator cuff repair, or even in later
stages of life, a shoulder replacement surgery. Now let me get to the root problem of shoulder
impingement syndrome. This is where I want you to hang out just a bit, that muscle imbalance that
I mentioned at the beginning, where there's two, the rotator cuff muscles all wrapped around the
shoulder blade, and they suck the ball into the socket. If one of those muscles gets weak, then
it shifts the alignment of the ball in the socket, because those are the main muscles that
are pulling the ball into the socket. So it's extremely important for them to be in
a proper balance. And the way to exercise the rotator cuff muscles is not with this kind
of motion. It's by doing activities that help to compress the ball into the socket. So
you're talking about more like push up position activities or things where you're having to
press and push. And you need to do exercises that forced your shoulder blade to move properly
to because that's a second muscle imbalance. Very often, the shoulder blade here is not able
to come up enough. So if you think about real quick and yourself, especially if you're dealing
with shoulder impingement syndrome right now, just shrug your shoulders. Now go higher.
See if you can go as high as you can, to the point where you're having to cringe
and you're feeling these shoulder muscles right here really squeezed and tighten.
You may have felt a pop in your collarbones, or maybe in your neck. That Pop is a sign that
your joints have not moved in that direction in a long, long time. And you probably
felt that muscle activity to be really, really intense, because it's weak.
So training your shoulder blade muscles to move upwards and move properly with your hand with
your shoulder is incredibly important at fixing the muscle imbalance. And there's more on this in
that video that covers the top five exercises for shoulder impingement syndrome. Let me tell you
one more part of the root problem of shoulder impingement syndrome, that a chromium that
hangs down how do we fix it because what they're thinking right now, and this is controversial
here, there isn't any research to back this up, which means that everyone in the medical field is
going to is going to think of this as negative. But that's how things started out. The guy
that figured out handwashing was important was shunned until after he passed away. Only then
was the people look at his information as like, oh, maybe we should be washing hands because it
prevents passages of diseases to other people. I think this is going to be like one of those
things when it comes to shoulder problems. In people that don't reach up overhead very much they
don't do this, the ball doesn't have a chance to push up against the acromion here, this part of
the bone that overhangs so over time, gravity starts to pull this part of the bone downwards.
And there's a ligament that attaches from this right here to the end of the acromion. And that
ligament can shorten and close the space right here where the ball should be moving around
freely in this helps to feed into the shoulder impingement problem. So how do we solve it?
Well, there's a retired orthopedic surgeon named Dr. John Kirsch, we've actually
interviewed him on this channel. You can find a link to the interview in the description
below. And Dr. John Kirsch orthopedic surgeon is promoting hanging as a solution to do
this like hanging from a pull up bar. And in that same video where I'm telling you
exercises for shoulder impingement syndrome, there's hanging in there and I'll talk to
you about exactly how to do it. But it's, I think, real breakthrough thinking about
how to heal the shoulder for the long term, so that you can avoid things like
a rotator cuff tear, and surgery. Hope this makes sense to you. Please go
check out more videos on our channel to get a better understanding of how this
all works. do the exercises. See for yourself how they're helping you out?
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