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Shoulder Impingement Syndrome: An Incorrect Diagnosis

Shoulder impingement is often touted as one of the main causes of pain in the shoulder. It’s used to explain almost any kind of shoulder pain that we don’t have a clear answer for.

Moving your arm up hurts? Shoulder impingement.

Lifting a weight overhead hurts? Shoulder impingement.

Shoulder pain when bench pressing? Shoulder impingement.

Putting on your jacket hurtss? Shoulder impingement.

It’s an overused diagnosis first described in 1852, and it turns out, an interestingly incorrect one as well.

WebMD says “Shoulder impingement syndrome is a common cause of shoulder pain. It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome.” Sounds painful right?

Except what WebMD is describing is in fact the normal biomechanics of the shoulder. As the arm is elevated overhead, the rotator cuff tendons and the bursae are impinged between the bones and this happens to everyone wether or not you have pain.

Understandably, if you didn’t know this was the way the shoulder was supposed to work, this image looks painful. But it’s simply normal shoulder biomechanics.

Here’s another fun fact: Syndrome = we don’t know for sure what’s going on.

Syndrome Definition: “a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms.” (Wikipedia)

So what’s really going on here? Why was I diagnosed with shoulder impingement syndrome?

Well without studying healthy individuals, when only looking at patients with pain in the shoulder, it’s understandable that a likely culprit of said “syndrome” would be impingement if we didn’t know these were normal mechanics, especially when we consider that this condition was first invented in 1852. What has changed since then is we’ve realized that impingement happens in many individuals with and without shoulder pain. So is the squeezing of rotator cuff muscles between the acromion and humeral head the cause? Probably not. Which is why we’ve started using the term “Sub-Acromial Sensitivity Syndrome”. It doesn’t explain any better what the cause of your pain is, to be fair. In reality, we aren’t really sure. What we do know is that that specific area of the shoulder is sensitive to arm elevation movements, and that the right exercises can help reduce the pain significantly.

So why change the name if we don’t know what’s going on?

Well the name change is an important one. If we don’t know what’s causing the pain, and people with impingement can either have pain or no pain at all, then it’s important not to pathologize normal body mechanics. Especially when we know that most people get better from this condition. What sounds more likely to get better? Something that is sensitive, or something that is impinged? I know for me, when I was a patient, shoulder impingement sounded like something was wrong with my body and the way it functions, and it was likely something structurally wrong with me that I was going to have to learn to live with. If I was told the space under my acromion was sensitive, then it would’ve been a lot less scary and feel much less permanent. When something is sensitive, we just have to get it to calm down. When something isn’t functioning right, we can’t just close our eyes and pretend it’ll go away. So changing the terminology is extremely important. The next time a friend or loved one has shoulder pain, don’t say they might have an impinged shoulder, say they may be suffering from “Sub-Acromial Sensitivity Syndrome”, they’ll be much better off.

So what do we do about it?

Everyone is different, so to sum up my answer → It depends.

That being said, I’ll give you a general idea of what we do. My job, first and foremost, involves ruling out any serious conditions that require medical care. With that out of the way, I’m looking to find out how this pain is limiting your daily life. What sports, hobbies, jobs, family functions, social functions, etc. are being affected by this discomfort? What can we do to modify things so you can get back to these activities sooner? Next I want to figure out what your true deficits are. What kind of Strength and Range of motion are you lacking? What are some exercises we can do to work on improving these deficits? Generally many of the exercises are geared towards getting you comfortable with lifting your arm overhead. This can take the form of strengthening exercises, stretches, repetitive movements, etc. As your symptoms improve, my goal is to gradually upgrade your exercises until you are back to normal and your normal workout is the “rehab” program. That is, in a nutshell, what I do for this condition.

If you or a loved one is suffering from shoulder pain either in the gym or in your daily life, come see me. I’ll be happy to help.

Jordan Octeau is a Physiotherapist and Personal Trainer with 9 years of experience in the strength and conditioning industry. He helps keep people out of pain and in the gym.

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