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Hands-On Care for Shoulder Impingement Syndrome

Hands-On Care for Shoulder Impingement Syndrome
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Shoulder impingement syndrome (SIS) is a very common cause of shoulder pain that affects about half of adults at some point in life. Essentially, the condition describes the pinching of pain-sensitive structures in the shoulder that restricts normal use or function, with raising the shoulder being a very common activity that triggers a painful reaction. 

When you first visit your doctor of chiropractic for suspected SIS, you will complete a detailed history regarding their occupation, sports involvement, and positions or situations that increase and decrease pain or prohibit function. This information will guide the physical examination to help your chiropractor gain a greater understanding of your unique case. The exam may also encompass areas beyond the shoulder as studies have shown that forward head posture, altered scapular (shoulder blade) motion, neck/upper back joint and muscle issues can contribute to SIS and would need to be co-managed to achieve a satisfactory outcome. This is especially true in cases in which shoulder pain has increased gradually over time vs. sudden onset. 

Treatment will typically involve manual therapies to reduce capsular adhesions or tightness and stretching and stabilization exercises to improve range of motion. Some of the manual therapies a chiropractor may use include mobilization to the different sub-joints of the shoulder (glenohumeral, scapulothoracic, sternoclavicular, and acromioclavicular); soft-tissue manipulation of various muscles around the shoulder region; forward, backward, and downward glides to increase external rotation, internal rotation, and abduction of the glenohumeral joint; and long-axis distraction to address hypomobility of the glenohumeral joint. In fact, a 2024 study found this approach combined with stretching and strengthening exercises (twelve visits spread over four weeks) resulted in greater improvements in pain, functional capacity, and range of motion than exercises alone in patients with chronic SIS.

If musculoskeletal issues beyond the shoulder, such as in the neck or mid back, are present, your chiropractor will address them with a similar multimodal approach. In 2019, researchers conducted a retrospective review of MRIs from SIS patients and found that 35% had nerve root compression on the same side as their affected shoulder. Because SIS and cervical radiculopathy share symptoms, the researchers note that it’s possible for one condition to be confused with the other. Additionally, several studies have found that SIS patients experience greater improvements in shoulder pain and function when their treatment plan includes manual therapies—such as spinal manipulation—applied to the thoracic spine.

The good news is that SIS can often be resolved with conservative treatment approaches, of which chiropractic care is an excellent choice.

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