Shoulder Pain: A New Outlook On Treating Impingement

If you read our previous article on the nocebo effect/placebo effect, then you know how much it can play into and drive the interaction that you as patients/clients and we as providers/coaches have together. If you are in the former category as a patient/client, you may be unaware of the paradigm shift that needs to occur in the rehab world. We are going to discuss a specific part of that in this blog, mainly shoulder impingement. While we will be focusing on the shoulder, the points laid out and discussed in this article will span the entirety of the body and are applicable to any pain that you experience.

The Journal of Orthopedic and Sports Physical Therapy released an editorial discussing shoulder impingement. It is short but jam-packed full of awesome data and quotes that are very helpful when considering how we in the rehab field have been looking at shoulder movement and how we might need to change how we look at shoulder pain. 

I’m sure a majority of the readers have either heard of shoulder impingement, known someone who has been diagnosed with it, or have been diagnosed with it themselves. 

In the past, we have been taught that shoulder impingement is exactly what it sounds like; something impinging or pinching within the shoulder ie. the supraspinatus tendon getting pinched between the acromion and the humeral head or the infraspinatus tendon getting pinched between the glenoid and the humeral head or what have you. I assume that most clinicians were taught that hands-on shoulder work was needed and helpful in stretching the capsule to aid in “making more room” for the subacromial area and structures to move, along with some scapular strengthening and stabilization of course. If you have been caught up in this diagnosis, this will all sound very familiar.

What this editorial says is that we may have been focusing on something that is only a small piece of the pie based on 50 odd years of research that is all moving the needle towards the fact that maybe the structure and mechanics of the shoulder joint are not the only things we need to consider. It talks about long term outcomes with subacromial decompression surgery (a very common shoulder surgery available) compared to sham (fake/placebo surgery) as well as shoulder scopes compared to sham and how the benefit of these surgeries may be placebo based or rest based or both. This information, along with some critical thinking can start to open one up to a whole host of questions concerning the why and how people are getting better. 

“The evidence unequivocally demonstrates that an exercise program is as effective as surgery for what has been termed subacromial impingement syndrome at 1, 2, 4, 5 and 10-year follow-ups and is as effective as surgery for partial-thickness rotator cuff tears.”¹

What exercises are going to be helpful to those people who are in a pain event or are dealing with some shoulder pain that they are unsure of? Well, it depends on a few things; such as, the prior level of training that the person was at or having trouble at, the goals that the person has in mind for themselves, the movements/exercise/modes of training that the person values, the person’s ability to tolerate what they are feeling including their expectations and beliefs about those perceptions, just to name a few. This is where having a coach or a rehab expert can be very helpful in wading through the large amount of information and variables that come into consideration when dealing with return to activity and/or pain. 

The reason why this is important is that this major journal is giving its thoughts on a lot of evidence and why structure is not what we should be focusing so much of our attention on. “This body of research should compel all health practitioners to speak with one voice, using carefully constructed language that does not introduce yellow flags by implicating structures that do not appear to be the cause of the symptoms.”¹ Meaning that, what we need to do for ourselves and for those people who trust our word is to start to move away from mechanical issues as well as structural issues that we used to think were the main pain generators or drivers of pain. We need to build resilience and confidence in our patients because no one else will, and that is exactly what we strive to do for our patients at The Movement Dr. 

If you are experiencing pain that you would like help with, or have any questions about where to go from here, get in touch with us today.

Sources:

1. Lewis, J. (2018). The End of an Era? Journal of Orthopaedic & Sports Physical Therapy, 48(3), 127–129.