How to treat shoulder impingement and pain?

Oct 4, 2021

Shoulder Pain Relief, Physical Therapy

What is the main cause of shoulder pain and impingement?

1. Rounded shoulder and muscle imbalance

If your shoulders are rounded forward, it means you have muscle imbalance. The front side muscle groups are too tight, and back muscles are relatively weak. The back muscles (Rhomboid, middle trapezius) will be being stretched in this posture leading to muscle weakness. Under this condition, your shoulders are venerable to any injuries.

2. Connective tissue dysfunction (Myofascial restriction)

Overused or underused muscles in shoulders progressively develop poor quality of connective tissue (muscle, tendon, fascia). The tissues are getting tight and short, getting thicker and tangled each other. In this condition, shoulder muscles cannot smoothly glide each other, and it begins to increase pain with movement. The whole-body alignment will be distorted from abnormal tension of myofascial tightness.

3. Shoulder impingement mechanism

Under the above condition (myofascial restriction and rounded shoulder/ muscle imbalance), the shoulder joint presents with abnormal movement as elevated shoulder, scapula anterior tilt, limited glenohumeral joint and scapula movement. Poor muscle condition and coordination result in joint impingement in acromion of scapula and the head of humerus.

Please check the below links to get to know more about myofascial connective tissue dysfunction which is the most common cause of the pain you are experiencing

Myofascial Release Therapy ➡️

Trigger Point Therapy ➡️

How to treat shoulder pain and impingement?

1. Release dysfunctional muscle group/ myofascial restriction with manual therapy techniques (Trigger point therapy, Myofascial release, Glaston therapy, etc). Muscle activation and muscle group coordination will be restored naturally once the restriction is successfully removed.
2. Tight and short muscle groups must be stretched to restore normal muscle length. It can be performed by manual therapy as well as by the patient under the instruction. Big muscle groups such as pectoralis and latissimus should be addressed.
3. Exercise program using TheraBand is very effective to activate the shoulder stabilizers. Strengthening program will focus on the back muscles, posterior deltoid and scapular stabilizers.

What are the key muscles to be addressed in shoulder treatment?

The most common muscle group being involved in shoulder injuries.

Ant/ middle/ posterior deltoid, biceps long head, upper trapezius, pectoralis, rhomboid, Rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis)

Stretching is important in the below muscle group

Pectoralis major and minor, biceps and anterior deltoid, upper trapezius

Strengthening is important in the below muscle group

Rhomboid muscles, posterior deltoid, middle/ lower trapezius, serratus anterior

Our Shoulder Treatment Program

1. The practitioner needs to find the dysfunctional muscle groups through the exam
2. Break up adhesion and release trigger points with manual therapy (most important)
3. Begin balance exercise program using Theraband
4. Develop core muscles in scapula and shoulder joint by using weight and WB exercise
5. Posture correction – thoracic spine mobility, diaphragm, hip flexors (whole body concept)
6. Home exercise program education