Shoulder impingement syndrome (SIS) is a prevalent cause of shoulder pain, often limiting mobility and interfering with daily activities. Conservative, non-surgical treatment options are the standard initial approach for managing this condition. Chiropractic care offers a noninvasive, drug-free pathway focused on restoring joint mechanics and reducing inflammation. By addressing both the symptoms and the underlying biomechanical factors contributing to the condition, chiropractic treatment can be an effective part of a comprehensive recovery strategy for SIS.
What Is Shoulder Impingement?
Shoulder impingement is a condition where soft tissues, typically the tendons of the rotator cuff or the bursa, become compressed in the subacromial space of the shoulder joint. This narrow passage lies beneath the acromion, which is the bony top of the shoulder blade. When the arm is raised, these tissues can be “pinched,” leading to irritation, swelling, and pain.
The most common symptoms include a dull ache in the shoulder, which can become sharp when lifting the arm, especially in an overhead motion. Individuals often experience weakness, a limited range of motion, and pain that worsens at night, particularly when lying on the affected side. Impingement is frequently caused by repetitive overhead arm movements common in certain sports or occupations, but poor posture or abnormal movement of the shoulder blade (scapular dyskinesis) can also contribute. These factors cause the space to narrow, increasing the likelihood of the tendons rubbing against the bone and triggering an inflammatory response.
How a Chiropractor Assesses Impingement
A chiropractor’s assessment process is designed to accurately identify shoulder impingement and rule out other potential causes of shoulder pain, such as a rotator cuff tear or cervical nerve issue. The examination begins with a detailed patient history, covering trauma, occupation, and the specific nature and location of the symptoms. This is followed by a visual inspection for swelling or deformity and a thorough evaluation of active, passive, and resisted ranges of motion.
The primary diagnostic step involves specific orthopedic tests designed to reproduce the impingement pain. Common examples include the Neer’s test and the Hawkins-Kennedy test, which passively position the arm to compress the subacromial tissues. A chiropractor will also perform a postural evaluation to identify any spinal misalignments in the neck or upper back that could be contributing to poor shoulder mechanics. This comprehensive approach ensures the treatment plan is tailored to the specific mechanical issues driving the patient’s shoulder pain.
Chiropractic Treatment Techniques for the Shoulder
Chiropractic intervention for shoulder impingement utilizes a multimodal approach that focuses on reducing inflammation, restoring joint function, and correcting underlying biomechanical faults. This approach typically involves manual techniques combined with active rehabilitation.
Joint Mobilization and Manipulation
One primary technique involves joint mobilization and manipulation, which may include controlled adjustments to the shoulder joint itself, the clavicle, or the related joints of the thoracic (mid-back) and cervical (neck) spine. Adjusting the spine and related joints is important because alignment and movement in the neck and upper back directly influence overall shoulder posture and function.
Soft Tissue Therapy
Soft tissue therapy is another foundational component, aiming to relax tight muscles and reduce inflammation in the surrounding area. Techniques like myofascial release, trigger point therapy, or instrument-assisted soft tissue mobilization (IASTM) are used to address tension in muscles such as the rotator cuff and scapular stabilizers. These manual therapies help to break down adhesions, improve blood flow, and relieve the pressure on the impinged tendons.
Active Rehabilitation and Exercise
The third aspect of care is active rehabilitation through therapeutic exercise. Chiropractors prescribe specific stretching and strengthening programs to improve flexibility and build endurance in the rotator cuff muscles and the muscles that stabilize the shoulder blade. Strengthening these specific muscles helps to maintain the necessary space within the shoulder joint, which is crucial for long-term recovery and preventing recurrence. This integrated pathway of manual therapy and active care is designed to alleviate pain while also addressing the functional deficits that caused the condition.
When Chiropractic Care Requires Co-Management or Referral
While conservative care is highly effective for most cases of shoulder impingement, co-management or a referral to a specialist becomes necessary in certain instances. Persistent pain that fails to improve after several weeks of conservative treatment, or a significant, sudden loss of strength, may indicate a more severe underlying issue like a substantial rotator cuff tear. A chiropractor will look for “red flags” that signal an urgent need for medical evaluation, such as visible deformity, severe swelling, or signs of fracture following acute trauma.
If imaging like an X-ray or MRI is required to assess the extent of soft tissue damage or bone spurs, the patient would be referred to an orthopedic specialist. Co-management is also common, particularly with physical therapists, for long-term functional rehabilitation in complex cases. This comprehensive care model ensures that patients receive the appropriate level of intervention, whether it is conservative management, corticosteroid injections, or surgical evaluation.