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  • Dr Claire Chittleborough

Shoulder pain: treating a subacromial impingement


One very common cause of shoulder pain is subacromial impingement. This is a complicated name for an injury that occurs often (in approximately one in five people) when a tendon in the shoulder rubs or catches on nearby bone. It affects the rotator cuff, which are a group of muscles that allow you to rotate, raise and lower your arm. Which means that pain in this area can seriously impact your day-to-day life. So, what can you do about it? Let’s find out more.


What is a subacromial impingement?


The rotator cuff is made up of four muscles and their tendons, which lie under the acromion (an extension of the shoulder blade which forms the roof of the shoulder). In between the acromion and the rotator cuff is a fluid-filled sac called the subacromial bursa, which allows the rotator cuff to glide smoothly under the bone. Underneath the rotator cuff is the ball and socket joint of the shoulder, which is stabilised and controlled by the rotator cuff muscles to allow you to move your arm. Collectively, this area is known as the subacromial space, and it is a small space to have so much going on! Any inflammation causes swelling in a confined area, and that leads to pain.


Injury or overuse of the shoulder can lead to the tendons becoming swollen or torn, or to a condition called bursitis where the fluid-filled sac becomes irritated or inflamed. In either of these cases, you are then at increased risk of a tendon rubbing against or catching on the acromion, which is what causes subacromial impingement.


Symptoms of subacromial impingement can start suddenly or come on gradually, and are likely to include:


Pain at the top of your shoulder and down the arm

Pain when you lift your arm, particularly if you lift it above your head

Weakness in your arm


If the pain persists or interferes with your normal activities, you should seek help.


What causes subacromial impingement?

Sports that involve repeated movement of the shoulder and/or raising of the arm, such as swimming, tennis or baseball, can increase your risk of shoulder impingement. As can work that involves repetitive movements of the shoulder, such as construction, moving boxes or painting.

Poor posture is also a common cause of subacromial impingement. If you sit at a desk for long periods of time or have a job that involves a lot of driving, then hunching or slumping your shoulders can narrow the space between the rotator cuff and acromion, which increases your chances of developing subacromial impingement.


If you have had a shoulder injury in the past, there is a higher chance of you experiencing an impingement in the future. But it’s not all bad news...


What can you do to relieve a subacromial impingement?


Call your chiro! If you experience a shoulder impingement, begin by resting your arm as much as possible and avoid movements that increase the pain. But avoid completely immobilising your arm by using a sling - it is important to keep some movement to avoid the shoulder becoming stiff and weak.


Try using an ice pack a few times a day for 10 to 15 minutes to reduce the swelling and pain. Painkillers, such as ibuprofen or other anti-inflammatories may be helpful during the acute phase, but always speak to your doctor for advice before taking any medication.


Movement and stability of the spine is pivotal for shoulder function (and vice versa), so a chiropractor will be able to investigate the link between the two and may perform adjustments to relieve the pain. We will also look at possible techniques to relax the muscles and reduce the inflammation. We will also offer lifestyle advice, for example hobby and work-related advice, as these nearly always play a role in the development and maintenance of these types of conditions. We’ll set you on a stability and mobility exercise program as you will need to re-train your shoulder movements and strengthen in order for this issue to not return in the future.


Shoulder pain can have a real impact on your day-to-day life. Give us a call on 0413 774 399 or email us at claire.chittleborough2@gmail.com and we’ll do our best to get you back to normal in the quickest time possible.

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