Shoulder Impingement Wil Seto

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio. He's the owner. He's the professional. He's the one of the top rated physiotherapists in Vancouver year after year after year as voted by his customers. And Insync is one of the top physiotherapy clinics. We're going to talk about shoulder impingement today. How are you doing Wil? 

Wil: Yeah, I'm doing well. Thanks for having me on, so yeah, shoulder impingement. Well what is it, first of all? So it's like saying like I have shoulder pain, you know, you don't really know, you can Google it, you know, consult Dr. Google, and then they'll give you the definition of what it is. Basically it's like when you have the structures in your rotator cuff and read that sort of bony area getting impinged basically. And, so really, when you look at what that means, it's when you have a lot of imbalance happening in through there.

So, I'm thinking about a specific client who happens to be another rock climber. And she's pretty avid rock climber. She's a boulderer. And, and it wasn't a particularly one incident that happened, she came into the clinic and she was just saying like, yeah, I just noticed gradually my shoulder was starting to get more sore.

And I mean, she was still climbing at the time. And she's a pretty high level, like recreational climber, like doing things that are pretty advanced on a recreational level. And, so anyway, she presented with these symptoms. And, first of all, like, you know, we got also clear other things just to make sure that it's not coming from the neck and all that stuff, because we want to make sure that there's not, you know, issues in terms of radiating down from spinal nerves and all that stuff. So that's a clear little test that I do. 

And then the other thing is really, now that we start to look at, okay, is it really coming from the shoulder? Okay, well, what's causing it. And so there could be many different things causing it, and it could be an underlying, actual pathology or issue with the rotator cuff itself.

So you can get an injury in the rotator cuff without a traumatic injury. And how that looks is that if you have a lot of imbalances there to begin with or if you're doing something, a sport, or even it doesn't even have to be a sport, it can be like, you're a painter and you're an electrician. You're doing stuff overhead all the time. And you're always going to put a lot of stress in your rotator cuff. And so what happens when you do a lot of that stuff overhead, or if you're sleeping on it a lot, you're decreasing the blood flow to the area, and then you're also straining it and stressing it all the time.

So you can have micro strains that happen. So then with the micro strains, then it causes the integrity of that area to be less strong. And then you can have sort of this gradual thing happening, where then you get the muscle imbalances with whatever sport or activity that you're doing that also ended up, you know, causing you to compensate and you start to use those as your strategies for how you use that shoulder. 

So ultimately with this person, She presented with a lot of that cause she liked to do specific types that we call problems in the gym and she was a bowler primarily. And so with her doing these types of specific problems, you know, meant that she was always using these type of muscles.

And also in climbing, you do tend to use a lot more of your lats and teres and so the posterior chain. And so she was very imbalanced there to begin with. So when I did assess her, I was pretty confident that her issue was just a pure impingement thing that it wasn't from like a micro strain of the rotator cuff, because there was specific things that we did that helped me identify that.

And so basically first treatment, we addressed the issues that I thought was causing this and then, gave her some exercises and did the manual therapy to really help guide the shoulder and facilitate a process that was able to bring things back into more normal alignment and better movement.

It was almost night and day. Like she came back to see me the following week. And she reported something like, yeah, it was getting like a three to four out of pain, you know? And it was only coming on right after climbing. And then she's like, yeah, I had no pain whatsoever. But then the thing for me that I was looking for on the second session was how was her strength now?

How was she able to now like maintain this because that's really key. Because I see this kind of stuff and my goal to help her is to not just take away that pain off the first session and be like, Oh wow. You're like, that's like magic. And I'm like, well, no, it's not magic. It's actually, you know, this is what's going on.

And so I really educated her and you know what that means because then, as I helped her in the second session, then I have to give her things that work on the areas that she doesn't know where she's weak. Because there was a lot of areas that she was not recognizing that she needed to actually strengthen in her core stability related to the stabilizing muscles of her scapular and her actual whole shoulder complex.

So, I started progressing her strengthening and her core stability program in a way to really benefited her. And I think she came in for a followup session to progress those exercises. And she didn't have any problems. And then because she's in the climbing community and I'm a rock climber myself, she reached out to me and she hadn't been having any more trouble.

And so that's the kind of thing what I typically see with a shoulder impingement, that's not involving anything more sinister. 

Mark: So without that initial shock traumatic injury, this is just an over use or imbalanced problem basically, it's fairly simple to look after if it's addressed in a timely manner.

Wil: Yeah, exactly. And that's totally bang on. With her, she was just not, actually it's funny, because she was just not even stretching after sessions and she had been pushing the grade a little bit more. And so there's always these little indicators of how it started. And then once it's there and you know, they're like, Oh, well I tried to look up stuff to stretch and then you kind of hit a point of no return where you, you can if it's just tight, but then, you know, sometimes it's hit and miss. So it's tricky that way. 

Mark: If you want to get better fast, if you want an expert help on how to do it, give Insync Physio call. You can reach them in Vancouver, (604) 566-9716. They'll get you feeling better. Or in North Burnaby, (604) 298-4878. Got a call and book ahead. They're busy all the time. Check out the website if you want to book online, makes it easy, insyncphysio.com. They'll get you feeling better and moving well and doing all the activities that you want to pursue in your life. Thanks. Wil. 

Wil: Thanks Mark.