Shoulder impingement occurs when the rotator cuff tendons or the bursa become compressed during arm movement. This frequent condition often causes pain, weakness, and limited motion, especially when lifting the arm overhead. Chiropractic care offers a recognized, non-surgical approach to manage this musculoskeletal issue. Chiropractors use conservative, hands-on techniques focused on restoring proper joint mechanics and improving overall shoulder function.
Understanding Shoulder Impingement
Shoulder Impingement Syndrome (SIS) involves the pinching of soft tissues in the narrow subacromial space beneath the acromion (shoulder blade). This space contains the rotator cuff tendons and the bursa. Repetitive overhead activities, poor posture, or muscle imbalances can irritate these tissues, causing them to swell and compress against the bone during movement.
The resulting friction causes pain, often described as a dull ache that sharpens when the arm is raised. Patients typically experience this pain, known as the painful arc, when lifting the arm between 60 and 120 degrees of elevation. Discomfort is usually felt at the front or top of the shoulder and may worsen at night. Chronic irritation can lead to inflammation (tendinitis or bursitis), potentially resulting in thinning or tearing of the rotator cuff tendons.
Initial Assessment and Identifying the Cause
A chiropractor begins the assessment with a detailed patient history, inquiring about the pain’s onset, location, and character, and noting aggravating activities. This intake helps differentiate SIS from other common shoulder issues, such as frozen shoulder or nerve compression from the neck. A physical examination follows, evaluating active and passive range of motion to identify restrictions and painful movements.
The clinician performs specific orthopedic tests to isolate the impingement and confirm the diagnosis. Common maneuvers like the Neer’s test and the Hawkins-Kennedy test provoke pain by intentionally narrowing the subacromial space. The assessment also examines the function of the scapula (shoulder blade) and the mobility of the upper back and neck, since dysfunction in these areas often contributes to poor shoulder mechanics.
Imaging, such as X-rays, may be ordered if the chiropractor suspects a structural cause, like a bone spur on the acromion, or to rule out conditions such as arthritis or fracture. This ensures the treatment plan addresses the underlying issue. For suspected significant soft tissue damage, such as a full-thickness rotator cuff tear, an MRI or ultrasound may be necessary to visualize the tendons and bursa.
Specific Chiropractic Treatment Techniques
The chiropractic approach uses a multi-modal strategy to reduce pressure on irritated tendons and restore optimal joint function. This involves joint mobilization and adjustments targeting the glenohumeral joint, clavicle, and upper thoracic spine. Restoring proper movement to these adjacent joints improves shoulder biomechanics, which increases the subacromial space and reduces tendon compression.
Soft tissue therapies address tight and dysfunctional muscles contributing to poor posture and shoulder positioning. Techniques like Active Release Technique (ART) or instrument-assisted soft tissue mobilization (IASTM) are applied to muscles such as the pectorals, subscapularis, or upper trapezius. These methods release tension, break down adhesions, and improve blood flow, allowing the shoulder to move more freely.
Rehabilitative Exercises
Rehabilitative exercises stabilize the shoulder and prevent recurrence by correcting muscular imbalances. The program includes stretches for flexibility and strengthening protocols for the rotator cuff and scapular stabilizer muscles. Exercises focus on the deeper rotator cuff muscles, enhancing the shoulder’s ability to maintain a centered position during movement. Postural correction exercises are also integrated to support healthy shoulder function.
Scope of Care and Referral Guidelines
Chiropractic care is effective for mechanical shoulder impingement, often leading to relief and restored function through conservative treatment. The recovery timeline varies, typically starting with pain and inflammation reduction, followed by rehabilitation to restore strength and range of motion. Prognosis depends on the condition’s severity, adherence to home exercises, and the duration of symptoms before treatment.
When Referral is Necessary
Chiropractors manage most SIS cases, but referral is necessary when the condition exceeds conservative care limits. If pain does not show measurable improvement after several treatment sessions, or if the assessment suggests a more severe pathology, a co-management or referral process is initiated. A suspected full-thickness rotator cuff tear, identified by significant weakness, requires consultation with an orthopedic specialist.
Referral is also appropriate if the patient needs interventions outside the chiropractic scope, such as corticosteroid injections for severe, unremitting inflammation or a surgical consultation. The chiropractor plays an important role in the multidisciplinary management of shoulder pain, collaborating with other healthcare providers to ensure the patient receives comprehensive care.