Challenging Misconceptions about Shoulder Impingement: Active Strategies for Management

Shoulder impingement, also known as subacromial impingement, has long been associated with the idea that the rotator cuff gets pinched between bones, causing pain and dysfunction. However, current evidence challenges this traditional understanding and calls for an update in our approach to subacromial related pain. This blog aims to shed light on the misconceptions surrounding shoulder impingement and emphasize the importance of active strategies for its management.

The Origins of the Term "Subacromial Impingement"

The term "subacromial impingement" was coined by Dr. Neer, a renowned shoulder surgeon, in the early 1980s. At that time, the biomedical model of pain management attributed pain to biomechanical factors and structural abnormalities. Dr. Neer's theory suggested that the rotator cuff was being pinched between the acromion and humerus, leading to pain and damage. This theory gained popularity and led to common diagnoses such as chronic bursitis, partial rotator cuff tears, or complete tears.

Challenging the Impingement Theory

Over the years, new research has challenged the impingement theory and provided new insights into the complexity of shoulder pain. Below are some key findings:

• Impingement occurs at different angles than originally believed and does not align with the positions that commonly elicit symptoms.

• Impingement happens in the shoulder naturally, often without pain.

• Having a larger subacromial space does not lead to less instance of shoulder pain.

• Improve your subacromial space size does not lead to reductions in pain.

• Surgical procedures aimed at eliminating impingement have not consistently shown significant improvements in pain and function, questioning the structural argument.

Shifting Paradigms in Pain Understanding

A significant shift has occurred in our understanding of pain. Pain is no longer viewed solely as a result of tissue damage but as a complex interaction between various factors, including biological, psychological, and social influences. This updated perspective challenges the notion that structural abnormalities are the primary cause of shoulder pain.

The Importance of Active Strategies for Management

Relying solely on structural factors to explain shoulder pain can lead to challenges in therapeutic approaches. Patients may become fixated on the belief that their pain stems from specific tissue damage and require imaging for a definitive diagnosis. However, studies have shown a poor correlation between imaging findings and symptoms. Informed by the understanding that pain is multifactorial, active, conservative strategies that prioritize movement and function have emerged as effective alternatives to surgical management.

Discover a New Approach to Shoulder Pain

The common understanding of subacromial impingement as a structural problem that directly causes pain is being challenged by current evidence. Pain is a complex experience influenced by multiple factors, and solely focusing on structural abnormalities limits our understanding and treatment options. Active strategies based on movement and function offer a promising approach to managing shoulder pain. If you are tired of experiencing shoulder pain when you work out, it's time to explore a different approach. It's time to embrace a new perspective and take control of your shoulder health. I invite you to book a discovery call to see if my model of physical therapy aligns with your goals. Together, we can challenge the misconceptions surrounding shoulder impingement and pave the way for a more effective and comprehensive approach to managing shoulder pain.