Shoulder Impingement

 

The majority of shoulder problems develop from micro-traumatic events occurring due to poor posture which results in abnormal shoulder mechanics. It is important for the patient to understand that shoulder pain is usually a symptom of deeper underlying problem that, unless corrected, may lead to significant shoulder injury.  Poor posture leads to a very predictable chain reaction of events that can lead to shoulder impingement, rotator cuff tendonitis, bursitis, or a rotator cuff tear.  Humans have a tendency to assume a posture in which we spend most of our time, for many of us that work on a computer all day, this leads to an increased thoracic curve (kyphosis), elevated and protracted shoulder blades, head-forward posture, and internally rotated shoulders.  This abnormal scapular positioning affects the biomechanics of the glenohumeral (ball & socket) joint.  Through the neurological adaptation of reciprocal inhibition, the internal rotating muscles of the shoulder: subscapularis, pectorals, lats, and teres major become dominant which in turn neurologically inhibits the scapular retractors, and external rotating muscles of the shoulder.  When the mid/lower trap, rhomboids, teres minor, and infraspinatus are neurologically inhibited, there is nothing to prevent the upward migration of the scapulas on the ribcage.  This upward migration eventually leads to a physical shortening of the upper trap and levator scap muscle which further contributes to the problem.  When the glenohumeral joint becomes internally rotated, it leads to an upward migration of the humeral head under the subacromial arch during overhead activities, which predisposes the supraspinatus muscles, and the tendonous attachment of the biceps tendon to painful tendonitis.

In order to accomplish long term correction of the problem, the following protocol should be followed:  Alignment, Inhibit, Activate, and Reinforce.  When referring to alignment, we want restore thoracic extension.  Without extension of the thoracic spine, it is impossible to retract and depress the shoulder blades.  To do this, we combine chiropractic adjustments if there is a true joint fixation and by incorporating thoracic extension over a foam roller.  It is also important to restore pelvic alignment as well, since the abnormal torso rotation that accompanies pelvic misalignment significantly impacts the ribcage and scapular positioning.  In reference to inhibition, we utilize ART (Active Release Technique) to the anterior neck muscles, pectorals, Subscapularis, Levator Scapularis, and the Upper Trap.  ART will help break up the fibrotic adhesion that have developed and also help elongate the chronically shortened muscles.  Next we want to activate the Rhomboids, Mid & Lower Traps through the use of MAT (Muscle Activation Technique).  Lastly, we want to reinforce the proper movement pattern through a functional movement pattern.

When you consider that 95% of what we do on a day to day basis reinforces Improper Movement Patterns, it goes without saying that we should make a conscious effort to incorporate this protocol into our exercise routine.