Impingement Syndrome & ART®
Impingement Syndrome – Active Release Techniques®
Dr. Sebastian Gonzales D.C., C.S.C.S., ART , Orange California
Keywords: Impingement syndrome, pinching shoulder pain, active release techniques, sebastian gonzales, can reach above their head, acromion process, treatment options, surgery, medications, cortisone injections, arm pain, loss of strength, muscular injury, sprain, strain, changes in shoulder biomechanics ___________________________________________________________________________________________________________
Shoulder Pain: A new fix to an old problem
What is the cause of Impingement Syndrome?
Most common treatments for Impingement Syndrome
What is the best treatment for Impingement Syndrome?
How does Active Release Techniques® permanently fix Impingement Syndrome?
Do you have pain in the front part of your shoulder, just where your arm attaches to your chest? Many times patients experience more pain in this area when they perform certain motions with their arms, such as reaching behind their head. Sometimes this pain can be so intense that it restricts patients from performing normal daily activities, which require overhead motion, such as reaching to a high cabinet. If this sound like you, you might have been told you have Impingement Syndrome of the shoulder.
What is the cause of Impingement Syndrome?
Traditionally Impingement Syndrome is thought to be primarily due to the overuse of the shoulder, such as pitching in baseball, old age or from an old shoulder injury. The pain most people feel at the AC joint is from the supraspinatus tendon becoming constantly irritated by contact on an anatomically normal bony projection of the scapula called the acromion. If the patient continues to use the shoulder without correcting the problem, the tendon can become frayed like an old piece of rope, which leads to a longer recovery time and possible surgery. What makes this contact occur?
Some doctors believe it is from an increase in fluid within the immediate area, pushing the tendon closer to the acromion. Another thought is that some people are more apt to develop the condition due the size and shape of their acromion. People born with a more hooked acromion are considered to have a Type 2 or 3 acromion, based upon the severity of the hooking. In fact, more rotator cuff tears were found in cadavers with Type 2 and 3 acromion than Type 1.1 There is no doubt that direct contact of one structure on another will cause the softer one to become damaged; but how can we correct the problem before there is damage to the supraspinatus tendon? Either way, regardless of what type of acromion you might have, there is often a deeper root to the problem. Why should someone with a Type 2 or 3 acromion refrain from playing the sports they love?
There is still another thought about why the humerus slides upward towards the acromion, causing a decrease in space between the two for the supraspinatus tendon to reside. Consider if the muscles, which normally pull the humerus downward, are not working correctly or the muscles, which pull up, are to strong, what would happen? The humerus would then go upward, pinching the supraspinatus tendon. That is it in a nutshell.
Most common treatments for Impingement Syndrome
Just like with every other musculoskeletal injury, patients with Impingement Syndrome start out at their general medical practitioners office. The most commonly recommended treatment from this source is the use of NSAIDs, such as aspirin and ibuprofen. Uses of these medications are common but the side effects of the treatment far outweigh the potential benefits. A study in 1999 stated “60 –100% of patients on NSAID therapy for only 1 –2 weeks develop submucosal hemorrhage, erythema, superficial erosions, or increase fecal blood loss”3 In addition to this, when considering the true cause of Impingement Syndrome it is easy to see that use of these drugs only address the pain, but it does not fix the underlying problem.
The next step is usually the use of Cortisone injections. In my experience, it is not uncommon to see patients who have had this type of therapy before they seek alternative types of treatment, such as acupuncture or chiropractic. The injections will definitely decrease pain for a few weeks, but again it generally does not address the primary cause. Before considering this as a treatment, find out more about it. Throughout my research I have found the process is not standardized, as it should be; different doctors inject from different locations for the same exact conditions, not always hitting the intended target.2,4 In addition to this, multiple studies questioned the safety of the injections on the ground of the possible suppression of collagen formation, granulation of tissue, and release of noxious or harmful chemicals from damaged cells, which will limit the body’s ability to heal itself.
Surgery can be recommended for some patients who do not respond to 6 months of conservative care. The procedure generally includes shaving down the acromion process of the scapula. In previous years, complications developed from the procedure because the acromion normally serves as a spot of attachment for the deltoid muscle. This caused a disruption in deltoid function and leads to more shoulder problems; recent advances in technology have attempted decrease the occurrence of any such problems. The estimated recovery time from a shoulder surgery is 4 – 6 months.
What is the best treatment for Impingement Syndrome?
The first treatment option should be one that is the least invasive and the most cost effective. The best treatment should be considered as the one that yields the fastest results. Luckily, Active Release Techniques® (ART®) fills both of these criteria. ART® is considered the “Gold Standard” of soft tissue techniques; it is the most sought after treatment by world-class athletes and average Joes for quick results. ART® is so precise that it specially addresses over 300 soft tissue structures in the body, based upon their biomechanical actions and orientation in the body.
How does Active Release Techniques® permanently fix Impingement Syndrome?
Active Release Techniques® is a great and relatively new way to quickly decrease shoulder pain and addresses any muscular issues, which are commonly found in patients with Impingement Syndrome. As stated before, Impingement Syndrome is commonly caused by previous injuries and overuse, which leads to scar tissue build-up within the soft tissues surrounding the shoulder. Scar tissue is the body’s natural way of healing from slight tears. The problem with scar tissue is that when it is being laid down, it occurs in a haphazard fashion causing adjacent structures to stick to one another. This means one muscle might be stuck to other muscles, causing a dysfunction in the shoulder biomechanics, ultimately leading to Impingement Syndrome.
Providers of this type of soft tissue treatment are trained to feel abnormal texture and tension within muscles, ligaments, tendons and nerves. This leaves these structures in the optimum state for strength training, which is the best long-term treatment for any type of injury. Many times patients experience a dramatic change with in 3-4 treatments.
For more on Active Release Techniques® or to find a provider in your area: www.activerelease.com
1) Fongenie, Allen. Buss, Daniel. Rolnick, Sharon. "Management of Shoulder Impingement Syndrome and Rotator Cuff Tears." 15 February 1998. American Family Physician. 16 Jun 2008 <http://www.aafp.org/afp/980215ap/fongemie.html>.
2) Henkus, Hans-Erik . "The Accuracy of Subacromial Injections: A Prospective Randomized Magnetic Resonance Imaging Study. " Arthroscopy: The Journal of Arthroscopic & Related Surgery Volume 22 , Issue 3(2006): 277 – 282.
3) Raskin, Jeffrey B. "Gastrointestinal Effects of Nonsteroidal ." The American Journal of Medicine Volume 106(1999): 3S – 12S.
4) Yamakado, Kotaro . "The targeting accuracy of subacromial injection to the shoulder: An arthrographic evaluation." Arthroscopy: The Journal of Arthroscopic & Related Surgery Volume 18 , Issue 8(2002): 887 – 891.
