Shoulder Impingement Recovery:
Acupuncture, Chinese Medicine & Rehab
Shoulder impingement is an injury where the tissue between the acromiom and humerus of the shoulder become impinged in certain ranges of motion, usually involving the supraspinatus tendon , the sub-acromial bursa and/or the biceps tendon. Inflammation and swelling of these tissues cause a narrowing of this space that is aggravated by raising the shoulder above shoulder height. It is common with activities involving overhead movements such as tennis and swimming, but can occur just as often in non-athletic populations.
An imbalance of the rotator cuff muscles causing the humeral head to move improperly in the shoulder joint, leads to irritation and eventually inflammation of these tissues and so is often a root cause that needs to be addressed. Left unchecked, the muscular imbalances and inflammation can increase the risk of a supraspinatus tendon tear (a key muscle of the rotator cuff).
Standard care for this kind of injury will be physiotherapy to address underlying rotator cuff imbalances, and if needed cortisone injections to reduce inflammation.
So how could acupuncture and Chinese medicine help your recovery process?
At Village Remedies clinics in Sydney CBD and Balmain, we work with a wide range of people recovering from various injuries such as shoulder impingement. This page is a resource of recovery advice and exercises for those concurrently undergoing treatment with us or another healthcare professional. It is important you take your shoulder injury recovery seriously as a poorly rehabilitated shoulder will be prone to injury, so make sure you're working with a professional who can tailor the advice to your specific circumstances.
Our goal with acupuncture and Chinese medicine is to help support your recovery process and hopefully speed things up for you. At Village Remedies we use a very safe style of acupuncture where points distant to the injured area are used to trigger the body's innate healing response. This means that during the initial phases of healing and inflammation, we can still safely treat the injured shoulder without causing further trauma to the area by working on it directly. As treatments and your recovery progress, we may layer on other techniques to address imbalances and further promote tissue healing.
Your practitioner will also be looking to treat you as whole person, rather than just an impinged shoulder. This means we look at how we can help support your body's overall ability to heal by looking to reduce the stress response (which is often elevated in pain and injury), improve sleep quality and promote health digestion. To help support this and your shoulder impingement recovery, your practitioner may also recommend Chinese herbs. The benefit here is that you'll be getting a little treatment daily from the inside, and we find that it can help boost the effects of acupuncture.
Watch the videos below for an idea of what the treatment and recovery process is like if you were to come and work with us at Village Remedies, as well as simple assessment and an acupressure point for pain:
Below we will summarise the different phases of recovery you can expect to go through and the associated exercises to work on. Depending on the severity of your shoulder impingement and any complicating factors (such as rotator cuff tears), full recovery can be anywhere from 2 weeks to 3 months or more, which is why it's important to work under the guidance of your acupuncturist or other trained health professional, progressing through phases gradually as you can perform the exercises consistently without pain.
PHASE 1: DAMAGE CONTROL
This phase is for recent acute or particularly painful chronic shoulder impingement injuries (7 or more out of 10 on a pain scale in the painful arc assessment and unable to raise to shoulder height).
The goals initially are:
To reduce pain and inflammation
Improve range of motion
In the clinic we'd be using distal acupuncture (points distant to the injury) to stimulate your body's natural healing processes. Our goals will be to help reduce pain and swelling. Certain Chinese herbs can also be useful in reducing pain and swelling, and promoting circulation.
Outside of the clinic you want to start working on balancing out the key rotator cuff muscles responsible for keeping the humerus in the correct position (infraspinatus and subscapularis muscles). You can do this with light free weights or resistance bands working with internal and external shoulder rotation, see video below for more details.
The main thing to keep in mind is to use pain as your guide. If you are experiencing shoulder pain (other than general muscle soreness from exercise) during an exercise or you pain flares within 24 hours afterwards, then what you're doing is too much load for now. It will get better, but not if you keep pushing through it, so do a little less or give yourself more time to recover in between.
When you can raise your arm to shoulder height without major pain, you are ready to move onto phase 2.
PHASE 2: RESTORING RANGE OF MOTION
By this stage you've managed to reduce pain levels (5/10 or less with painful arc assessment) and increase your range of motion to be able to raise your arm to shoulder height without pain.
Phase 2 goals are:
Eliminate pain and inflammation
Restore full range of motion
Address shoulder imbalances
In the clinic we'd be using distal acupuncture again, combined with gentle movement of the injured leg with the goal of helping to rebuild neuromuscular connections. We may also be incorporating some local acupuncture with electro stimulation to restore healthy muscle function to the rotator cuff muscles and treat other affected muscles and tendons. Tendons are do not have good circulation and so are naturally slow to heal, but they are electrically conductive so we find electro acupuncture useful in encouraging tendon repair. Chinese herbs can also be useful to help support overall health and recovery.
Outside of the clinic we still want you to continue on working with your shoulder internal and external rotation, but now to also start working on being able to get into and maintain some degree of an overhead hang. This advice comes from Dr John M. Kirsch, an orthopaedic surgeon who wrote the book "Shoulder Pain: The Solution & Prevention" where he outlined his theory for the cause of shoulder impingement and how he used this simple exercise to help his patients out of pain and avoid surgery. For more detailed information, his book is a good reference, but the exercise is described in the video below.
Essentially you want to spend just 10-30 seconds in an overhead hanging position at time, rest for a minute, then repeat for 10-15 minutes daily. It may be painful to get into the overhead position initially, but the pain should subside in the position and afterwards. Remember to not start out with a full body weight dead hang, you want to work up to it. If you are finding your pain is increasing with this exercise, you should stop and consult with a healthcare professional.
Once you have restored your range of motion and are pain free, you should consider continuing to do some of these exercises as maintenance.
SHOULDER IMPINGEMENT PREVENTION & SHOULDER HEALTH
If you've had a history of shoulder impingement it is important to continue to take particular care of your rotator cuff muscle strength and balance, and the overall mobility and stability of your shoulder.
We recommend continuing to perform overhead dead hangs (though no longer needed daily or for as long) to maintain your shoulder's healthy range of motion and to decompress the joint. You may also continue to use exercises involving internal and external rotation as warm up for other training and exercise to maintain healthy rotator cuff balance and strength.
In addition to your exercises, you'll also want to make sure you're getting enough quality rest and quality nutrition, as lack of sleep will leave you more prone to injury and lack of certain vitamins and minerals will make you more prone to inflammation and compromise the quality of your tissues.
Regular check up sessions for acupuncture or with your healthcare professional can be useful to make sure things are keeping in good condition, giving you a chance to catch any imbalances or issues early. The main focus will be on rotator cuff balance, thoracic and neck mobility.