Are you suffering with Shoulder Pain?

Shoulder impingement: How long will it take for my shoulder to feel better?

Hands up if you have had or are suffering with shoulder pain? You won’t be the only one.

Shoulder related pain is really common and a horrible problem to experience affecting many of  your daily activities. The good news is, with appropriate advice and rehabilitation most cases of shoulder pain get better!

The shoulder is made up of several joints, tendons and muscles all of which work together to provide brilliant range of motion. Because of its complexity the shoulder is prone to a variety of problems.

What is Shoulder Impingement?

Shoulder Impingement is a common term that describes shoulder pain that isn’t due to a frozen shoulder, fracture, labrum or ligament injury. It is also known as rotator cuff related pain, tendonopathy, tendinitis or bursitis. Shoulder Impingement occurs when the tissues that sit underneath the acromion and between the humeral head becomes grumpy. This space is called the subacromial space.

The rotator cuff tendons, bursa and long head of the bicep tendon make up these tissues. All three of them may become inflamed in some circumstances.  As you raise your arm the rotator cuff serves to depress and centralise the humeral head in the shoulder joint.  If the rotator cuff is prevented from fulfilling this activity because of an injury, dysfunction can arise resulting in a very painful shoulder.

So what contributes to shoulder impingement?

People can acquire a bony spur on their acromion as they get older. This can reduce the subacromial space and irritate the tissues below the acromion. It is important to remember that a bone spur isn’t required to cause shoulder pain and many people with bony spurs never have shoulder pain.

Below the age of 35 years a healthy rotator cuff tendon contains collagen fibres that are closely packed together and very strong. A bit like dried spaghetti packed very closely together!  Tendon health deteriorates as we age, and these collagen fibres become considerably more disorganised ( a bit like a mass of over cooks spaghetti with gaps and holes). Fat, blood vessels and nerves can permeate the gapes and holes making it weaker and more vulnerable to injury such a degenerative tears. In the same way the bursa can swell causing further pain.

Signs and Symptoms of Shoulder Impingement

• Shoulder pain and weakness are extremely common. When you elevate your arm, take your hand behind your back, or lie on your shoulder a night, it is typically worse.
• Many people have mechanical night pain, which means you can get comfortable again if you shift positions.
• If these shoulder structures are really grumpy the shoulder can seem painful most of the time. At night, it can be difficult to find a comfortable settling position.

Research has shown many factors that can accelerate tendon degeneration, resulting in a very angry and painful tendon or bursa, especially while raising your arm. These are some of them:

• Smoking
• Obesity
• Diabetes
• High fatty food intake
• High processed food intake
• Low physical activity
• Long times spent in sustained positions
• High cholesterol levels
• Sudden changes in activity levels (increased or reduced)
• A long history of steroid use
• Recent cause of antibiotics

It may be that the shoulder has just become progressively weaker over time and finally gives in or fails to cope with everyday activities.

How do I get my shoulder better and how long will it take?

Hundreds of studies suggest that exercise is beneficial for this type of shoulder pain. Advice and education is also key, which is why this blog exists! The earlier you get treatment for your shoulder pain, such as arranging physiotherapy, the better.

According to the research, if you seek help early with a supervised exercise programme and no significant past medical history you should notice significant improvements in your symptoms within 12 weeks. There will be ups and downs in your pain throughout the first 12 weeks. This is completely normal. It’s important that exercises are progressed slowly and in accordance with your pain tolerance. It is imperative to pay attention to your therapist and adhere to their advice as they will carefully advise you on what to do and what not to do to assist with subsiding your pain.

The First Phase

It is very important to avoid positions or movements that increase your pain. Such as, repetitive arm movements, reaching behind your back, across your body or up over your head. Remember sustained positions such as desk work are also too much for a painful shoulder. Regular change of position is key. Your body needs good circulation to help the healing process and so going for a daily walk is helpful too.

The Second Phase- Three to Six Months

During the next 3-6 months you will be feeling so much better but you won’t be quite there yet! There will be some discomfort still with more work to be done. Usually at this stage you are more independent with your exercise program and self management strategies. We will still be carefully building up your shoulders tolerance back to what it wants to be doing.

The Final Phase- Six months onwards

You should be able to resume your normal activities within 6 month. Whether it’s getting back to gardening or the gym. This is the final stage of the process during which strength and mobility are  fine-tuned to meet the demands of the individual. It is important to remember that if you have had your pain for a while, perhaps 3 months or more, the first phase of rehab will take twice as long. If you have a major medical history or are unable to change your activities during your rehabilitation, the same rules apply.

During rehabilitation, we carefully monitor your pain. A bit of discomfort is okay but it should be very low grade and settle quickly after exercise. It is important to monitor your shoulder symptoms the next day to ensure there is no increase in night pain or morning symptoms.

If you have shoulder pain, even if it’s only a niggle, the key is to get advice as soon as possible to prevent prolonged symptoms. We are here to help you and would love to see you get better and back to all those activities you enjoy.

If you have any questions or would like to find out more about the treatment of Shoulder Impingement, feel free to send me an email.

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