by Jason Nenzel | Jul 13, 2023 | news
Debunking the Myths with Evidence
When it comes to upper body exercises, few movements rival the effectiveness and versatility of the chin-up and pull-up. These compound exercises engage multiple muscle groups in the upper body, including the back, arms, and shoulders. However, a common question arises: Which one is better? In this comprehensive blog post, we will delve into the debate surrounding the chin-up vs pull-up, examining the benefits, debunking the myths, and providing evidence-based insights to determine which exercise reigns supreme.
Understanding the Differences
Before we compare the two exercises, it is crucial to understand their fundamental differences. The primary distinction lies in the grip. In a chin-up, the palms face the body (supinated grip), while in a pull-up, the palms face away (pronated grip). This seemingly subtle variation alters the recruitment of muscles and places different emphases on specific muscle groups.
Muscle Activation
To evaluate the benefits of chin-ups and pull-ups accurately, it is essential to examine the muscle activation patterns involved in these exercises. Numerous studies have investigated the activation of various muscle groups during chin-ups and pull-ups, shedding light on their respective benefits:
- Latissimus Dorsi (Lats): The latissimus dorsi muscles, commonly referred to as the lats, play a significant role in both chin-ups and pull-ups as the primary muscles responsible for the pulling motion. Research indicates that both exercises elicit high levels of lat activation, with no significant difference between the two grips. However, some studies suggest slightly greater lat activation during pull-ups due to the wider grip typically used.
- Biceps Brachii: The biceps brachii, located in the upper arms, are more actively engaged during chin-ups due to the supinated grip. Several studies consistently demonstrate increased biceps activation during chin-ups compared to pull-ups. This heightened biceps involvement makes chin-ups an excellent choice for individuals seeking to specifically target and develop their biceps.
- Brachialis: The brachialis muscle, situated beneath the biceps, experiences greater activation during chin-ups. This muscle contributes to forearm flexion and benefits from the supinated grip utilized in chin-ups. Consequently, chin-ups can provide additional benefits for forearm and overall arm strength.
- Upper Trapezius and Deltoids: The upper trapezius and deltoid muscles are activated to a similar extent in both exercises, irrespective of grip. These muscles play vital roles in shoulder stabilization and are effectively targeted by both chin-ups and pull-ups.
- Other Muscles: In addition to the aforementioned muscles, chin-ups and pull-ups also activate other muscle groups to varying degrees, including the rhomboids, infraspinatus, teres major, and posterior deltoids, all of which contribute to upper body strength and development.
Targeting Weaknesses and Goals
Choosing between chin-ups and pull-ups can depend on individual goals and weaknesses. Consider the following factors when determining which exercise aligns best with your objectives:
Biceps Development
If your primary goal is to build biceps strength and size, chin-ups may be the better choice due to their increased biceps activation. The supinated grip of chin-ups allows for greater emphasis on the biceps, leading to enhanced development in this muscle group.
Grip Strength and Muscular Balance
Pull-ups, with their pronated grip, place greater demand on forearm and grip strength. They can also help achieve a more balanced development of the upper body muscles. The pronated grip engages the forearm muscles more intensely, leading to improved grip strength and overall muscular balance.
Individual Preference and Comfort
Personal preference and comfort should not be overlooked when deciding between chin-ups and pull-ups. Some individuals may simply prefer one exercise over the other due to comfort, biomechanics, or personal enjoyment. It is essential to choose an exercise that feels natural and allows for proper form and execution.
Variations and Progressions
One advantage of both chin-ups and pull-ups is the ability to modify and progress these exercises to suit individual needs. By incorporating variations and progressions, you can continually challenge your muscles, break through plateaus, and optimize your training:
Grip Variations: Both chin-ups and pull-ups offer various grip options that alter muscle activation and difficulty. Wide grip variations further target the lats and increase exercise intensity, while narrow grip variations place greater emphasis on the biceps. Mixed grip, where one hand is supinated and the other is pronated, provides a compromise between the two exercises and offers a unique stimulus.
Weighted Exercises: Once bodyweight chin-ups or pull-ups become less challenging, incorporating weighted versions can further enhance strength gains. Adding additional weight through a weighted vest, belt, or dumbbell increases resistance and promotes progressive overload, a key driver of muscle adaptation and growth.
Assisted Versions: For beginners or individuals working on building strength, assisted variations can be beneficial. Resistance bands or an assisted pull-up machine can reduce the amount of body weight lifted, allowing for controlled progression towards unassisted chin-ups and pull-ups.
Conclusion
In the debate of chin-ups vs pull-ups, understanding individual goals, muscle activation patterns, and preferences is key. While chin-ups offer superior biceps activation, pull-ups target grip strength and muscular balance. However, both exercises effectively engage the lats, upper back, and shoulders, promoting overall upper body strength and development.
To maximize the benefits, it is recommended to incorporate both chin-ups and pull-ups into your training routine. By combining these exercises with grip variations, weighted progressions, and assisted versions, you can achieve a well-rounded upper body development and continual strength gains.
Remember, the key to progress and success lies in consistency, proper form, and gradual increases in difficulty over time. Whether you choose chin-ups or pull-ups, or incorporate both, enjoy the journey towards a stronger, more sculpted upper body, and celebrate the remarkable capabilities of your own physicality.
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FAQ
1. What is a pull-up and a chin-up?
A pull-up is an upper-body exercise that requires you to pull your body up towards a pull-up bar with palms facing away from each other. A chin-up is a similar exercise, but with palms facing towards you.
2. Which muscles are worked during a pull-up or chin-up?
Pull-ups and chin-ups work several muscle groups in your upper body, including your back muscles, biceps, and forearms.
3. What is the main difference between a chin-up and a pull-up?
The main difference between a chin-up and a pull-up is the hand position. During a pull-up, your palms are facing away from you, while during a chin-up, your palms are facing towards you.
4. Which exercise is better for building muscle – chin-ups or pull-ups?
Both chin-ups and pull-ups are effective bodyweight exercises for building upper-body strength. It really depends on personal preference and goals.
5. Does the line of pull differ between chin-ups and pull-ups?
Yes, the line of pull is slightly different for chin-ups and pull-ups. During a chin-up, the line of pull is closer to the center of your body, while during a pull-up, the line of pull is slightly further away.
6. Are wide grip pull-ups better than regular pull-ups or chin-ups?
Wide grip pull-ups are a great variation to regular pull-ups and chin-ups, as they put more emphasis on your upper back muscles. However, they are not necessarily “better” than other variations.
7. Which exercise is more difficult – chin-ups or pull-ups?
It really depends on the individual. Some people find chin-ups more difficult due to the different hand position, while others find pull-ups more difficult as the line of pull is slightly further away from the body.
8. Can pull-ups or chin-ups help you build muscle even if you can’t do many?
Yes, pull ups and chin ups can build muscle even if you are not able to do many. There are a variety of modifications one can make to increase rep volume such as bands or boxes to make training more productive in the early stages of exercise.
If you’re looking for a Victoria Physiotherapy clinic, you can book an appointment with us online here.
by Jason Nenzel | Jun 26, 2023 | news
Strengthen Your Glutes and Improve Stability
Maintaining an active lifestyle requires strong and stable muscles, and one crucial muscle often overlooked is the gluteus medius. The gluteus medius, located in the buttocks, plays a key role in hip stability and overall lower body strength. In this blog post, we will explore the five best exercises to target the gluteus medius, including squats, lateral movements, one-legged exercises, and side planks. By incorporating these exercises into your routine, you can strengthen your glutes and improve stability effectively.
1. Squats
Squats are renowned for their effectiveness in targeting the glute muscles. Though squats will effectively engage the gluteus medius muscle, you might want to consider adding a theraband to promote further targeting. To engage the gluteus medius specifically, perform squats with a band around your knees to encourage abduction. Start by standing with your feet hip-width apart. As you squat down, keep your knees stacked on top of your ankles (don’t let the knees fall inwards). Return to the starting position, making sure you reach full hip extension, then repeat on the other leg. This exercise combines the benefits of squats with targeted gluteus medius activation through abduction.
2. Lateral Band Walks
Lateral band walks are simple yet powerful exercises that specifically target the gluteus medius. Place a resistance band around your lower thighs or ankles, and assume a slight squat position. Step to the side, keeping tension on the band, and then bring the other foot towards the first foot. Repeat this lateral movement for a set number of repetitions. Lateral band walks effectively engage the gluteus medius, helping to strengthen and stabilize the muscles.
3. One-Legged Squats
One-legged squats, also known as pistol squats, challenge your balance and target the gluteus medius on each leg individually. Stand on one leg with the other leg extended forward. Slowly lower your body into a squat position, ensuring that your knee stays aligned with your toes. Push through your heel to return to the starting position. This exercise effectively engages the gluteus medius while improving single-leg strength and stability.
4. Side Plank with Hip Rotation
Side planks are excellent exercises for engaging the entire core, including the gluteus medius. Begin by lying on your side and supporting your body with one forearm, while your feet are stacked on top of each other. Lift your hips off the ground, creating a straight line from your head to your feet. From this position, rotate your top hip towards the ceiling, then return to the starting position. Repeat this rotational movement for the desired number of repetitions. Side planks with hip rotation effectively engage the gluteus medius and promote stability in the hips.
5. Clamshells
Clamshells are a classic exercise specifically targeting the gluteus medius. Start by lying on your side with your knees bent and your feet together. Keeping your feet together, lift your top knee as high as possible while maintaining alignment of your hips. Slowly lower the knee back down and repeat for the desired number of repetitions. Clamshells effectively activate the gluteus medius and can help improve hip stability.
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Frequently Asked Questions (FAQ):
If you’re looking to strengthen your gluteus medius muscles, you’ve come to the right place! Here are some FAQs to get you started:
1. What is the gluteus medius?
The gluteus medius is a muscle located on the side of your hip and is responsible for stabilizing your pelvis and rotating your thigh.
2. Why is it important to strengthen the gluteus medius?
A weak gluteus medius can cause back pain, knee pain, and other injuries. Strengthening this muscle group can help prevent these issues and improve your overall performance in activities such as running and jumping.
3. What are some exercises to target the gluteus medius?
Some of the best gluteus medius exercises include side lunges, lateral band walks, side planks with abduction, and standing hip abduction with a resistance band.
4. How can I strengthen my glutes?
The best way to strengthen your glutes is to perform exercises that specifically target this muscle group, such as squats, deadlifts, and hip thrusts. However, it’s important to also work on your gluteus medius muscles for optimal performance.
5. How many reps should I do?
It’s recommended to perform 8-12 reps per set for gluteus medius exercises and to complete 2-3 sets per workout. However, the exact number of reps and sets you should do will depend on your fitness goals and current fitness level.
6. Can I work on my weak gluteus medius muscles with one leg?
Absolutely! One-leg exercises, such as single-leg squats and step-ups, can be very effective for strengthening weak gluteus medius muscles.
7. How can I activate my gluteus medius muscles?
All the exercises above are designed to activate your gluteus medius muscles. To strengthen your glutes and improve stability, incorporating these five best gluteus medius exercises into your routine is highly recommended. Squats with abduction, lateral band walks, one-legged squats, side planks with hip rotation and clamshells target the gluteus medius muscle group effectively.
Remember to start with proper form, gradually increase intensity, and listen to your body. By giving attention to your gluteus medius, you can enhance lower body strength, stability, and overall physical performance.
At South Island Physiotherapy, we offer physio, kinesiology, and massage therapy services to help you reach your health and fitness goals. We are committed to providing top-quality care and personalized treatment plans tailored to your specific needs. Contact us today to book an appointment and start your journey towards a stronger and healthier you!
by Jason Nenzel | May 31, 2023 | news
Understanding The Care Path Through Physiotherapy And What It Means For You. How can Physiotherapy help with a torn rotator cuff problem?
Physiotherapy plays a crucial role in the rehabilitation of rotator cuff tears, helping individuals regain strength, restore range of motion, and improve shoulder function. Shoulder injuries account for a large portion of physiotherapy visits and a rotator cuff tear may be the reason for your appointment. Causes of rotator cuff injuries include sudden and unexpected loads above the supply of the cuff (generally happens in a younger population) or repetitive overload (a common cause in older populations). Symptoms of rotator cuff tears may include: pain, limited range of motion, a reduced ability to lift and accomplish activities of daily living, and more. In this blog post, we will explore the typical care path in physiotherapy specifically tailored to rotator cuff injuries. By understanding the stages of treatment, the techniques utilized, and the importance of evidence-based practices – you can have a clear roadmap towards optimal recovery.
Initial Assessment and Evaluation
The first step in the physiotherapy care pathway for rotator cuff tears is the initial assessment and evaluation. A rotator cuff tear may be confirmed with an MRI and the quality of this tear (whether partial tear or complete) can be visualized with the use of imaging. This is more relevant if the condition may require surgery. However, data suggests that conservative care for partial thickness tears can be equally as effective as surgical management. Either way a physiotherapist will conduct a comprehensive evaluation to gather information about your injury, medical history, symptoms, and functional limitations. This assessment helps in developing an individualized treatment plan.
The assessment may involve physical exam, range of motion testing, strength assessment, shoulder stability evaluation, and special tests specific to rotator cuff tears. The physiotherapist may also use subjective questionnaires and outcome measures to assess pain and disability levels, functional abilities, and overall well-being.
This thorough assessment helps identify common symptoms, determine the severity and specific characteristics of the torn tendon, identify contributing factors, and establish baseline measurements for tracking progress throughout the treatment.
Goal Setting and Treatment Planning
Once the assessment is complete, the physiotherapist collaborates with you to set goals and develop an individualized treatment plan. The treatment plan outlines the best treatment options including: specific interventions, techniques, and exercises that will be used to address your injury and achieve the desired outcomes.
The goals set during this stage typically include reducing pain, improving range of motion, restoring strength and stability, and returning to functional activities. These goals should be centred around your joy and provide a clear direction for your recovery.
Treatment options may involve a combination of evidence-based interventions, including therapeutic exercises, manual therapy techniques, and education regarding self-management strategies.
Active Rehabilitation and Therapeutic Exercises
Active rehabilitation through therapeutic exercises is a cornerstone of physiotherapy for rotator cuff tendon injuries including a tear of the rotator cuff. These exercises aim to restore strength, flexibility, and stability in the shoulder joint, promote tissue healing, and return to activities of daily living.
The rotator cuff is a group of four muscles and tendons that hold the humerus (upper arm bone) centred in the joint; working together to provide stability while you move the shoulder. Injuries to the tendons and muscles of the rotator cuff are common shoulder complaints, however partial or complete tears are relatively uncommon with a rate of 4% in patients under 50. This increases to 25% over the age of 60. When one suffers partial-thickness tears, full-thickness tear or a complete rotator cuff tear your physiotherapist will guide you through a series of exercises tailored to your specific goals and present limitations. Whether a partial or complete tear, this group of muscles and tendons responds quite favourably to progressive exercise. Initially, the focus may be on pain management, gentle range of motion exercises, and scapular (shoulder blade) stabilization. As your condition progresses, the exercises will gradually advance to include strengthening exercises targeting the rotator cuff muscles and the surrounding shoulder girdle muscles.
Therapeutic exercises for shoulder injuries may include external and internal rotation exercises, shoulder abduction and adduction exercises, scapular retraction exercises, and shoulder stabilization exercises. As you improve, these can progress to compound lifts such as: the bench press, overhead press, power clean and pull-ups. The physiotherapist will provide detailed instructions on the correct technique, frequency, and intensity of each exercise. They will also monitor your progress, provide feedback, and modify the exercises as needed to ensure ongoing improvement.
Research consistently supports the effectiveness of therapeutic exercises in the management of rotator cuff tears. A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy concluded that exercise-based interventions, including specific rotator cuff exercises, can lead to improved pain, function, and strength in individuals with rotator cuff tears.
Manual Therapy Techniques
Manual therapy techniques are an integral part of physiotherapy for shoulder pain, post rotator cuff surgery or in the acute stages of a torn rotator cuff. These techniques aim to reduce pain, improve joint mobility, and optimize tissue healing.
Our Victoria based physiotherapists may employ various manual therapy techniques, including:
- Soft tissue mobilization: This technique involves applying pressure and gentle movements to the soft tissues around the shoulder, such as muscles, tendons, and ligaments, to reduce muscle tension, alleviate pain, and improve tissue flexibility.
- Joint mobilization: This technique focuses on restoring normal joint mechanics and mobility by applying controlled movements to the shoulder joint. It can help reduce stiffness, improve range of motion, and enhance shoulder function.
- Manual stretching: The physiotherapist may move your shoulder to perform specific manual stretching techniques to target tight shoulder muscles and tendons of the rotator cuff and improve flexibility. These stretches aim to maintain or restore the optimal length-tension relationship of the muscles around the shoulder joint.
The use of manual therapy techniques should be individualized based on your specific condition, preferences, and response to treatment.
Gradual Return to Functional Activities
As you progress through the care path, your physiotherapist will guide you towards a gradual return to functional activities. This stage focuses on restoring the strength, stability, and mobility required for your specific daily and recreational activities.
Our physiotherapists at South Island Physiotherapy will design a personalized exercise program that mimics the demands of your functional activities, such as reaching, lifting, and overhead movements. This program may include sport-specific exercises, work-specific movements, and activities aimed at improving proprioception and coordination of the arm and shoulder.
Your physiotherapist will provide guidance on proper body mechanics, ergonomic modifications, and strategies to prevent re-injury. They will also emphasize the importance of ongoing self-management strategies, such as home exercises, stretching routines, and maintaining a healthy lifestyle to improve recovery time and make a full recovery without surgery.
Conclusion
Physiotherapy for rotator cuff tears involves a systematic approach tailored to your specific needs. Through initial assessment and evaluation, goal setting, active rehabilitation exercises, manual therapy techniques, and a gradual return to functional activities, physiotherapy aims to reduce pain, restore mobility, resolve shoulder weakness, and restore overall shoulder movements and function, getting you back to your best life.
It is essential to work closely with a qualified physiotherapist like the ones at South Island Physiotherapy who utilizes evidence-based practices to ensure optimal, and durable outcomes. By actively participating in your treatment plan and following the guidance of your physiotherapist, you can pave the way towards a successful and durable recovery.
Rotator Cuff Tear FAQs
What is a rotator cuff tear?
A rotator cuff tear is a tear of the rotator cuff tendon, which is a group of muscles and tendons that connect the shoulder blade to the arm bone.
What causes a rotator cuff tear?
A rotator cuff tear may be caused by injury, degeneration of the tendon due to aging, or repetitive overhead activities such as pitching or throwing. It is a common cause of shoulder pain.
What are the symptoms of a rotator cuff tear?
The symptoms of a rotator cuff tear may include pain in the shoulder, weakness in the arm, and difficulty with range of motion of the shoulder. A partial tear may not cause as much pain or weakness as a full-thickness tear.
How is a rotator cuff tear diagnosed?
A rotator cuff tear may be diagnosed through a physical exam and an MRI to confirm the diagnosis.
What are the treatment options for a rotator cuff tear?
The treatment for a rotator cuff tear may depend on the severity of the tear. Research has consistently shown that most rotator cuff injuries respond well to conservative care such as physiotherapy.
Do all rotator cuff tears need surgery?
No, not all rotator cuff tears need surgery. The majority of rotator cuff injuries have been shown to improve through conservative management such as physiotherapy.
How long does it take to recover from a rotator cuff injury
The timelines for recovering from a rotator cuff injury are specific to the individual. Following an initial assessment, your physiotherapist should be able to provide you with an expected timeline for healing and recovery.
by Jason Nenzel | May 5, 2023 | news
From Shoulder Tendinopathy to Achilles Tendinopathy: What You Need to Know
Tendon pain and injury can be a confusing topic, particularly when you’re the one suffering. With various ‘quick fix’ options being advertised, as well as online fitness gurus proclaiming one approach over another, we find that patients are often left perplexed. This blog post is meant to simplify the complex topic of tendon pain, injury, and rehabilitation.
So what is a tendon? Simply put, a tendon is the structure that attaches your muscle to bone. It helps to transmit force produced by your muscle(s), to your bone(s), so that you can move. Dig a little deeper and you’ll find that tendons are composed of type 1 collagen and proteoglycan, which enable them to store and release energy, stretch, and adapt to stress.
What is Tendinopathy?
Tendinopathy is a fancy five-syllable word we use to define tendon pain and/or injury. It occurs when the tendon is exposed to an unfamiliar amount of activity without being given an appropriate amount of time to adapt or due to sudden compression (a hard fall). When one or both of these situations arise, the tendon will communicate its displeasure through the medium of pain and perhaps swelling.
What are the Different Tendon Conditions?
Though tendinopathy is a broad term used to define tendon pain and/or injury, we do have more specific categorizations for determining the severity of tendon injury. These categories help to make sense of terms like tendonitis, tendinosis, tendon pathology and degeneration, and other materials focused on tendon healing. These include having a normal tendon, reactive tendon, tendon in dysrepair, and degenerative tendon. To determine what stage of tendinopathy you might be suffering from, continue reading.
Normal Tendon
A normal tendon is optimal. It has been given enough time to adapt to a given training volume or level of physical activity. It has upregulated its ability to store and release energy so that you can engage in the activities you love. We all want normal tendons. They aren’t at risk for injury, inflammation or tendon rupture.
Reaction Tendon
A reactive tendon is the first step in developing acute tendon-related pain. It’s usually a product of abrupt overload but can also occur due to sudden compression (i.e., falling on your knee or elbow). The tendon experiences a non-inflammatory cell response and an increase in water content. There is a short-term adaption which thickens and stiffens the tendon to reduce stress or protect the tendon from further irritation. You’ll likely experience pain and a restriction in pain-free movements.
Tendon in Dysrepair
A tendon in dysrepair is another step away from having a normal tendon. It’s usually a product of chronic tendon overload. This is common in endurance athletes that suffer through training blocks despite having received multiple signals from their tendon(s) to reduce training volume. A tendon in dysrepair has attempted to heal, but the demands placed on it have interrupted the tendon repair process. During this phase, there is tendon tissue matrix breakdown, collagen separation/ disorganization, and possible vascular and neuronal ingrowth (things we don’t want to happen). At this point, the tendon may appear swollen and thick. It will be painful and limiting.
Degenerative Tendon
A degenerative tendon is the final stage of tendinopathy. It’s characterized by the progression of collagen matrix breakdown and intracellular changes (more of what we don’t want to happen). At this stage, cell death has occurred within the tendon and there’s an increased risk of rupture (try not to YouTube achilles tendon or patellar tendon rupture). Those with a degenerative tendon usually have a history of repeated bouts of tendon pain that reduces along with load management (slowing down from the activities that cause pain). Though this might provide intermittent relief, it’s not an optimal approach for the treatment or management of tendinopathy.
So what do we do about tendinopathy (particularly during the later stages)? First, it’s important to know that regardless of your stage of tendon injury, you can always progress towards having a normal tendon. Second, you want to make sure that you’re progressing into activities gradually. Enthusiasm is great, but we want to avoid overuse injury. Third, if you’re experiencing tendon related pain or injury, you should contact an experienced healthcare practitioner. At South Island Physiotherapy, our team of Physical Therapists, Massage Therapists, and Kinesiologists specialize in the treatment of tendinopathy or tendinopathies.
Tendinopathy FAQs
Where does tendinopathy occur?
Tendinopathy can occur in various parts of the body where tendons attach muscles to bones, such as the shoulders, elbows, wrists, hips, knees, and ankles. Examples include rotator cuff tendinopathy, tennis elbow, golfer’s elbow, achilles tendinopathy, patellar tendinopathy, gluteal tendinopathy, and so many more.
Can tendinopathy be permanent?
Yes, tendinopathy can be permanent if it is not properly treated or if it has been present for a long time. Chronic tendinopathy can lead to degenerative changes in the tendon and result in permanent damage. However, with appropriate management, such as rest, physical therapy, and medication, it is possible to improve symptoms and reduce the risk of long-term damage.
How to prevent tendinopathy?
1. Gradual Progression: Gradually increase your exercise program or activity level at a slow and steady pace.
- Proper Equipment and Form: Make sure that you use the proper equipment, including shoes, and maintain proper form while exercising.
- Warm-up and Cool-down: Always perform a proper warm-up and cool-down before and after any activity or exercise.
- Rest and Recovery: Take adequate rest and recovery time between workouts to allow your body to recover fully.
- Proper Nutrition: Ensure that you maintain a balanced and healthy diet, including sufficient amounts of vitamins and minerals.
- Adapt to Age: Adapting your activity/program to your age is very essential.
- Strength Training: Engage in strength training programs to build up your muscles and tendons.
- Appropriate Exercises: Choose exercises that are appropriate for your fitness level, age, and overall health.
- Seek medical advice: If you have pain or discomfort in your tendons, seek medical advice to prevent further injury.
If you’re suffering from tendon pain or injury, don’t let the confusion and conflicting advice leave you feeling helpless. Take control of your recovery by understanding tendinopathy and the treatment options available to you. At South Island Physiotherapy, our team of experienced healthcare practitioners specialize in the treatment of tendinopathy. Contact us today to learn more about how we can help you progress towards having a normal tendon and get back to doing the activities you love. Feel free to book an appointment online or you can find us here.
by Jason Nenzel | Apr 19, 2023 | news
What You Need to Know About Shoulder Impingement Syndrome
Shoulder impingement syndrome is one of the most common complaints we see in the clinic. It’s also one of the most misunderstood by patients. Impingement suggests that something is pinching, and it is commonly explained this way. This may be true in some cases but we need to ask a bigger question:
Why is the tendon pinching in the first place and how relevant is this?
If we look at the condition as a symptom rather than a cause, it opens up a myriad of possibilities for treatment that may produce more durable results. So without further ado, let’s have a look at 3 categories of shoulder dysfunction, how shoulder impingement may manifest in each, and how to begin the process of recovering from the shoulder pain.
3 Types of Shoulder Pain
- The Stiff and Painful Shoulder
Limited shoulder motion due to joint changes causes a stiff and painful shoulder. Physical examination will often show the shoulder’s inability to move freely and fully; both by the patient and the therapist. This inability to fully move the shoulder is often found with conditions like Frozen Shoulder (Adhesive Capsulitis) or Osteoarthritis.Both types of shoulder conditions create changes in the joint and tissues that can limit the range of the shoulder joint and consequently cause the scapula (shoulder blade) to rotate early. Over time, this inefficient arm movement can irritate structures in the shoulder (like a tendon or bursa), which can cause pain.To treat the cause of shoulder pain in this category of conditions, our focus is to improve the quality of shoulder mobility and use exercises to strengthen the supporting muscles.In the long term addressing the underlying causes of disease states like arthritis should be of interest for injury reduction….. but that’s a post for another time.
- The Weak and Painful Shoulder
This category of shoulder pain is the broadest. It includes everything from rotator cuff injuries (which is a broad category in itself) to bursitis, ligament sprains or any other trauma that may reduce the shoulder’s ability to produce or tolerate force. In this presentation of shoulder impingement, physical exam often reveals that full passive movement can be achieved, but active cannot.Your physiotherapist will perform specific testing for shoulder function to target exercise strategies and customize pain relief efforts. The structural diagnosis doesn’t have a significant effect on the treatment plan in this category unless surgical intervention is a possibility. People with shoulder impingement in this category do best with a focus on pain relief followed by a customized and progressive exercise strategy.One of the most important indications of impingement is the “Cuff Strength Ratio,” used to assess the relative strength of the rotator cuff muscles. Cuff strength needs to be 1:1 internal to external rotation, meaning the patient must have equal parts strength in these ranges of movement. If not, the shoulder cannot centre in the joint properly which can cause mechanical compression in the subacromial region (the area underneath the acromion), and shoulder impingement occurs. Dedicated retraining exercises to resolve this deficit can greatly improve persistent symptoms.
- The Unstable and Painful Shoulder
This injury carries the most trauma but isn’t necessarily the most complicated. Injuries in this category are represented by shoulder dislocations, subluxations or anatomical anomalies that may present a higher risk for instability of the shoulder. Common symptoms with these types of injuries often include fear, pain, and a sense of instability that can lead to guarding behaviours which manifest as impingement syndrome of the shoulder.The clinical term for this is “scapular dyskinesia,” which means abnormal movement or positioning of the shoulder blade during movement. It presents as shoulder shrugging and lifting the upper arm to achieve the desired motion. Unfortunately, this movement pattern can cause irritation to a rotator cuff tendon and create pain in the shoulder. The treatment for shoulder impingement here is to restore confidence in movement through gentle exercises to explore ranges of motion, followed by progressive strengthening exercises to get the shoulder more stable in its socket.Shoulders are one of the most common injuries we see in our line of work, and understandably so. They are the most mobile joint in the body, and tendons of the rotator cuff undergo many forms of stress. They need to be prepared to meet the demands of their life and although the injury process is complicated, the treatment plan doesn’t have to be!
Shoulder Impingement Syndrome FAQs
Does shoulder impingement go away on its own?
It is possible for shoulder impingement to go away on its own, but it depends on the severity and cause of the impingement. In many cases, reducing or modifying irritable activities for a period of time then strategically re-introducing them can help resolve symptoms. In rare cases, impingement symptoms may need further medical support and a physical therapist is perfectly equipped to help determine if this is required.
Does shoulder impingement require surgery?
It is rare for shoulder impingement to require surgery. Treatment options for shoulder impingement can include activity modification, physical therapy, anti-inflammatory medications, and corticosteroid injections. In some cases where conservative treatment does not improve symptoms, surgery may be indicated but this is a last resort. The decision to have surgery will depend on the severity of the impingement and the individual patient’s needs and goals.
Will shoulder impingement show on MRI?
Shoulder impingement does not show up on an MRI as it is the consequence of movement. MRIs take pictures while the patient is still. MRIs can visualize soft tissues such as tendons, muscles, and ligaments and can detect potential abnormalities in these structures that may influence impingement. Having said that, MRIs do now show pain and the findings must be taken into account with patient experience to determine their relevance. A clinical exam by a physical therapist is usually the first step in diagnosing shoulder impingement, and an MRI may be ordered to confirm or further evaluate the diagnosis.
We hope you have gained a better understanding of shoulder impingement syndrome and how it can be effectively managed. At South Island Physio, we offer a wide range of treatment options for shoulder impingement syndrome, including physical therapy, manual therapy, Shockwave Therapy, IMS/dry needling and exercise programs tailored to your specific needs. If you are experiencing shoulder pain or discomfort, we encourage you to book an appointment with one of our experienced therapists today. Our team is here to help you get back to doing the things you love, pain-free.
Your best days are ahead of you! Make your move and let’s get your shoulder serving you and your joy!
