October 6

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Shoulder Impingement with Wil Seto

By Wil Seto

October 6, 2023

shoulder pain

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver, one of Vancouver's favourite physiotherapy offices. And today we're going to talk about shoulder impingement. How are you doing, Wil? 

Wil: I'm doing really good, thanks. Yeah, Mark, this is a really hot topic. I've been hearing a lot about it from our physio team about different clients and it's always something that I think we see constantly.

Mark: There's, I'm thinking that there's probably a lot of different causes. Can you just go over some of the things that you guys typically see, sort of as the main causes of this feeling of, ah, it just doesn't feel right, or you can't sleep on it, or it hurts all the time when I do certain 

things? 

Wil: So I think talking to our physio group, there's your classic, you know, someone gets an actual acute injury, and it heals. But let's say it's not fully healed yet, but it's no longer painful, but they get back to doing some sport or something like that. And now they start to get this like pain again. They're like, Oh, maybe it didn't fully heal, now they're getting an impingement but they can get sort of an impingement syndrome type of thing happening back in the shoulder. 

So basically what that means, what impingement is, is actually the structure in the shoulder, you have your tendon primarily of the rotator cuff and depending on which one, it's crowded in there. It's crowded from either the mechanics of the way that the motion and range of motion sort of move in there, is now off. So the optimal movements are now no longer optimal and everything is imbalanced. 

So you have a maybe a minor injury strain or whatever. Say you throw the ball a little bit too hard, or you try and reach for that move when you're climbing a little bit too hard, or you're jerking your arm back a little bit too hard, and you feel a little tweak. May just lasted for a day or two and everything seems back to normal. 

But there's a lot of things that can happen if you're not careful and you're not really paying attention to it, is that you can start to develop these imbalances. And these imbalances can be something that's sort of simple as yeah, I just feel a little bit weaker there at first, or I feel a little tighter. Those are usually the common things that you notice. In terms of feeling tighter, or even just a bit more sore is if you do a self assessment, you feel like, Oh, yeah, it's a little more sore you know, on this side. And that's usually kind of a quick indication. You do sort of a self scan on like different muscles around your shoulder. 

And so that acute trauma can lead to that, like it can be minor maybe something more major and then it goes away or doesn't go away. And then it develops into this impingement being that lack of optimal movement in the shoulder.

The other actually common way that you can get an impingement is when it happens gradually. So we had a few physios that were talking about this with patients that came in. Yeah, you know, I just woke up last week with shoulder pain, I don't know why. And you know, like diving into the past and their history. No other injuries, nothing. Perfect bill of health previous. But all of a sudden, three weeks ago, I started getting a shoulder pain and it just didn't go away.

And some of them may sleep on it or not sleep on it. So those are some factors, because sleeping on it can decrease the blood flow in the shoulder. But there's a lot of other factors involved there too, like looking at, you know, as you dive deeper into the history, well, what kind of activities does this person do?

One person that was having this impingement issue, you know, they work on a computer and they think they have good posture, but we never really know. And so that combined with, yeah, you know, and I just started to like pick up a new sport. I started to do a little bit of rock climbing, but it doesn't hurt when I climb, it just started hurting like two weeks ago. And I started climbing like three months ago, it's been three months now. 

Sometimes the changes in the way the muscles work together and the balance of things in the shoulder especially, can gradually change. And if you're operating in terms of how things are coordinated at like even 80 percent and some things start to take over more and others start to slack off a little bit more. And that's just a function of your body. A function of how you hold your posture, how you repeatedly do things, maybe with like your sitting posture or with work. 

There's another gentleman that came in a saw a physio and he's a painter and he's like up and down all day long, with his arms and carrying things. And so you need to do things to really rebalance it if you want to keep doing those activities because they're repetitive. So you have to start looking at what's causing the imbalances. 

So over time, the other thing that can also happen this is where it gets a little bit trickier, is that the impingement with this gradual onset, maybe also influenced by the changes that happened in the tendons. They're getting some changes like calcium deposits. 

So it's interesting because we had a gal that came in that actually had this gradual onset shoulder pain and, you know, she has the impingement, but that's not it. That's just sort of like a real big umbrella term sometimes when we say that you have impingement of the shoulder. And really it's just like saying, I have shoulder pain, but we don't know what's causing it. 

And so she didn't have any other injuries in the past, didn't do any other sports. Her posture isn't great. She has a computer job, and she does occasionally sleep on it, but definitely her posture and then her physiology definitely leans towards that being more compromised in terms of the range and everything.

So, it wasn't getting any better, and also it was really stiff. So those are the other things too, because things tend to stiffen up over time and you don't really notice it unless you actually start to tune into that. And so that stiffness became a huge problem. But then, you know, after working with a few sessions, things were just minimally getting better.

Because if it's just a strict stiffness issue, because for whatever reason we get stiff in the shoulder from like a minor strain that maybe stiffened up from a little scar tissue and it's fully healed. Then it should get back to normal. So we sent this gal in for some scans, or at least I referred her back to her doctor to get the referral for some scans.

Turns out that she actually had a rotator cuff there and she had calcium deposits happening. And she's like 30 something, late 30s. So it's not very common. Usually like stuff like this is usually more at least in your 40s. And there's other things to consider too that are beyond my scope like, how are you feeding yourself? Like, how's your diet? Your body does require proper nutrition to recover and also sleep when think about recovery. 

And if you're training, if you're like an athlete and you're doing things whether it's a throwing sport, hitting sport, or a climbing sport or whatever, if you're not taking the time to recover and recuperate and actually balance things out, then that's another factor.

Now, here's the one thing I think a lot of people have a hard time understanding just because they're not athletes or they're not like competitive athletes. There's this climber that came in, he used to be an avid climber, but he's not a competitive climber, but he's an avid climber likes to climb pretty hard. 

But you're not a weekend warrior. A weekend warrior is technically someone who just does it every weekend, once every week. This person does this sport three times, even four times per week while working full time job. So what does that mean? You really got to focus on recovery. You really got to focus on your rehab. 

And the interesting thing about someone like this that came in is that they had a bit of a past history. So there was some previous things before. And so there's a lot of factors to consider and when we talk about shoulder impingement, it's a little bit of an umbrella thing.

Mark: So, when you're treating this, now of course, it depends on what you're presented with in a diagnosis, but is there a sort of typical course of treatment that you could say, this is the generalized things we always look at or always will prescribe? 

Wil: Yeah, that's a good question. And so it really depends on what we discover in the assessment. So do we rule out that it's a frozen shoulder? Do we rule out like it's an instability from like a torn ligament or something that happened from previous injury. Or that you're just lax in general. And that you have this like failure in your muscles working together and how everything functions because of whatever reason from repetitive, computer work, your work or whatever it is, a sport. 

So, based on what we discover, then we want to treat accordingly. And so we have to find the cause of that shoulder pain. And even to more specifically, if it's stiff, what's causing it to be stiff? And then we would treat that accordingly. 

So we want to address the mobility issue, so whether it's joint related or muscle related. We want to address the strength issues like with the weaknesses. Is it primarily just in the shoulder? Usually not, it's also a core issue. So core being like the stabilizers of the shoulder and the stabilizers of the neck even. 

And then the stability, stability is key. The stability being like how your muscles are stabilizing. But obviously if you have like this ligament and this instability in that way where, you know, your ligaments hold things. It's sort of the check rein, doesn't allow it. Your muscles then are sort of the active, you know, stop the shoulder from going beyond a range to prevent it from becoming injured.

So depending on what's going on, like we had, for example, somebody who has a stiff shoulder and we want to address those mobility issues. And that's going to be the key to jump starting. And then you start addressing the other thing. Or someone that has the range like, Oh, wow, you got a really good range. It's primarily a stability issue. 

So we work on strategies, primarily exercises. And also with the physio can help facilitate that. So this is just tight in the muscle, but the joint feels really good. Everything's moving really well. How do we facilitate that? There's different things that we do to do that? So we work on the joint and the muscle. And then here, just the training and the rehab aspect of it. 

Mark: It's a very complex joint with a lot of muscles, ligaments, tendons, all involved in that impressive range of motion that's built into the shoulder.

Wil: 100 percent. 

Mark: If you're looking for some help with your shoulder impingement, pain in your shoulder, you can't sleep on it. It's hurting all the time. You can't reach like you used to be able to do. You can't throw like you used to be able to do. The guys to see in Vancouver are Insync Physio. You can book on their website insyncphysio.com. There's two clinics that can help you in both Vancouver and in North Burnaby, or you can call them. The Vancouver office is at (604) 566-9716 to book your appointment. Thanks so much, Wil. 

Wil: You're welcome.

Wil Seto

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