Written by: Emilie Smale, Certified Athletic Therapist
The shoulder is a very mobile joint comprised of many muscles, ligaments, and tendons. With so many different structures in a small space, impingement and pain in the shoulder is very common. Your shoulder is made up of three bones; your upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle). The three bones are held together with ligaments and supported by muscles. The muscles that are primarily involved in shoulder impingements are the rotator cuff muscles. A shoulder impingement is when there is decreased space between the top point of your shoulder blade (acromion) and the rotator cuff tendons. This decreased space causes rubbing/friction, resulting in pain, decreased range of motion, and often decreased strength due to pain.
his injury is common in all ages. It is seen most often in sports where the arm is overhead, such as volleyball, swimming, and baseball. Have you been remodeling your house during quarantine? It is also seen in people who frequently do activities such as painting and construction due to the overuse of overhead motions. It has also been seen in people who do a lot of computer work caused by a slouched, internally rotated shoulder position.
Things to look for if you suspect a shoulder impingement injury:
This injury can be frustrating for the individual to live with as it may hinder many activities of daily living. Luckily, there is hope. Once you have been diagnosed with this injury, your treatment plan will most likely involve a combination of heat, massage, and postural corrective exercises. See below for a variety of exercises to try to rehab a shoulder impingement. These exercises will help strengthen the upper back and posterior shoulder muscles, helping to keep your shoulders pulled back and out of that impinged position.
Prone I Y T
Laying face down, tuck your chin in and pull your shoulder blades back. Try to keep shoulders out of a shrugged position and away from your ears.
Banded External Rotation
Anchor your band next to your uninjured arm. Reach across your body to grab the band with your injured arm. Keeping your elbow at a 90-degree angle, shoulders pulled back and down, and your elbow tucked into your side, pull the band across your body and slowly return to the starting position.
With your back to a wall, place your shoulder blades, bent arms, and low back flat against the wall. Slowly slide your arms up the wall, maintaining contact, as if making a snow angel. Only lift your arms to a comfortable position, then slowly slide back down to the starting position.
This injury often involves tight chest (pectoral) muscles pulling your shoulder forward into an impinged position. Try this stretch to help increase the flexibility of your pectoralis muscles.
Written by: Jan Earl de Chavez BSc-Kin. CAT(C)
Before an athletic therapist begins physically testing joints and muscles, they need to ask the patient questions about what they are coming in for. These questions cover topics such as general health, occupation, sports or fitness, injury specifics, and pain sensations. By receiving answers to these questions, the athletic therapist better understands why their patient is here.
There are two parts to observation, standing and walking. Standing observation is where the AT observes the alignment of various structures of your body from the front, sides and behind. The walking observation is how the AT determines whether movement is being affected, or just how the patient walks in general. These two are important in giving the AT insight on how the body is compensating due to the injury or condition.
Joint Rule-Out and Functional Test
The joint rule-out quickly tests the joint above and below the affected area to ensure that there are no issues with them. The functional test is a simple movement test to determine whether daily tasks are affected by the injury.
Range of Motion Testing
Also called isometric resisted testing as there is no movement occurring in the joint but the muscles are contracting. Different than the active range of motion, muscle testing is conducted with the AT holding the joint at an angle that stresses a muscle group while the patient performs a muscle contraction. Different resistances are performed to test all the muscles groups that act on the joint. The AT determine the strength level of the contraction and compares between affected and unaffected parts.
These are unique tests for a specific joint that confirms or eliminates the presence of an injury or condition. The shoulder is a great example as it has numerous tests for ligamentous sprains, impingements, joint laxity and capsule issues, muscle strains or tightness, and nerve compression. To narrow down which tests to perform, the AT uses all the informed gained from all the previous components of the assessment, especially the history.
Palpation can also be done after the observation is conducted, or it can be used to conclude the assessment. This is where the AT feels for palpable bones, ligaments, muscles and tendons to confirm which structures they believe are affected by the injury or condition. They can also feel for swelling, or determine sensory changes of the area.
Once the orthopaedic physical assessment concludes, the AT presents their differential diagnosis where they present what they think is injured or affected and why. After this, the AT will educate the patient on the rehabilitation program they will undergo and the appointment moves on to the treatment. The assessment usually takes about 25-minutes which leaves plenty of time in the appointment for any manual treatment and rehabilitative exercises.
Now that you know what to expect on your initial assessment, come visit me at Insahyu Training + Therapy located at 250 Saulteaux Crescent, or you can visit our website at www.insahyu.com and book online.
Team Insahyu: Certified Athletic Therapists and Certified Personal Trainers.