It’s early summer here in the UK and despite the current downpours, the steady hum of bees and happy gardeners is in full throat. In fact, the rain is making the grass and garden plants grow with even more vigour. For Osteopaths, this is a busy time of year too, with all sorts of strains, injuries and sometimes very inventive ways of hurting oneself presenting to us.
I tend to see winter as ‘aches & pains’ and spring/summer as ‘strains & sprains’, because, while the total numbers of patients doesn’t change, the injury types very certainly do! So what’s typical?
Lower back problems from digging and planting. Achilles tendon pains from crouching and squatting for too long doing the borders. Neck pains and strains from pruning higher plants and shrubs and, of course, shoulder problems.
I want to talk about the warning signs that might help you avoid Impingement Syndrome in particular.
Sub acromial impingement as a problem is as ‘common-or-garden’ as it gets, with 30% of the over 40′s suffering it to some degree of impingement or rotator cuff tear.
Neer ** classifies shoulder impingement in the following way
Type I: <25 years old, Reversible, swelling, tendonitis, no tears – Leads to conservative treatment
Type II: 25-40 years old, Permanent scarring, tendonitis, no tears – Leads to sub-acromial decompression surgery
Type III: >40 years old, Small Rotator Cuff Tear – Leads to SAD surgery with debridement/repair
Type IV: >40 years old, Large RTC tear – Leads to SAD with repair
One way to view impingement syndrome is to understand the anatomy. Most texts will give you very detailed descriptions of which bit goes where, what lies above or below what, which nerve serves it and where the blood supply comes from and goes to. All well and good and, if you can remember it all, it will allow you to think about the function.
However, what I rarely see described is the phenomenon of ‘potential space’. It might be described as a space, cavity or area that can, (potentially), exist between two structures, BUT, which in reality does not exist in normal anatomical function. To many the term potential implies a roomy area with space to spare.
An example is the two layers of the pleura, the sack that surrounds the lungs – the layers are touching one another, but slide over one another because of the fluid that separates them. That space can, however, be filled with fluid, (pleurisy) or blood, (haemothorax).
The subacromial space is an example of a potential space that is full of stuff – the supraspinatus tendon, blood vessels, nerves, a fat pad and the subacromial bursa for starters!
Warning Signs!
So what to expect if you are experiencing impingement?
- Reaching out and up produces a sharp pain over the outer tip and front of the shoulder.
- It may be sharp enough to make you drop the arm to your side.
- As the shoulder drops, you may feel the need to drop your whole body, grasp the affected forearm and draw the arm into a ‘cuddle’.
- Pain is most prominent when reaching directly ahead of you.
- Weakness as well as pain is usual.
- Simple tasks such as reaching for the kettle or changing gear may be sharply painful.
- Leaning on your elbow or direct upward pressure will probably be painful.
- Night pain, especially if you lie on the affected shoulder.

NB. If the tip of the shoulder is red and swollen, you may be experiencing bursitis – get it checked out.
Also very important is the need to keep your shoulder blade, or scapula, moving well. Poor scapular motion can come from many things, but in this context my feeling is that we are often doing a task that is too heavy when the arm is reaching out, (e.g., hedge trimming,), or when spending too long at a task and fatigue sets in.
Imagine opening that bottle of beer at the end of you task! The opener ‘impinges’ on the rim of the bottle neck and levers the top off. Your shoulder, if abused, is not so different and I can promise a slow recovery from this painful condition.
So rather than dwell on the injury, try and look at the prevention – keep your shoulders, upper back and core strong – maintain good scapular motion by doing extension exercises which work the rhomboids and traps – don’t overreach, either physically or in terms of your ambition and take regular rest breaks.
You will find other shoulder related articles on this blog and elsewhere on the web – do the research, but mainly use your common sense, trust your own judgement and stop when you think you should, not when others tell you must.
Last, in the inimitable words of Sgt. Phil Esterhaus, “Be careful out there”, and especially look after your shoulders!
** http://www.rotatorcuff.net/impingement.htm






The London Golf Show 2011 – November 11th-13th at Earls Court
October 31st, 2011 No comments »The London Golf Show 2011 – November 11th-13th at Earls Court
ShoulderCentric is going to be at The London Golf Show with The Rotater, the shoulder rehab and performance device. We are very pleased to be invited to share a stand with the premier UK provider of Trigger Point Therapy products and rehabilitation training in the UK, Balance Performance. The professional expertise, experience and enthusiasm of our two companies complement one another well, with the emphasis of the staff on the stand as much about information and promoting good health as it is about products.
The Rotater is the ideal device for enhancing shoulder performance and preparation for sports such as golf, rehab & recovery from injury and improved performance for golfers looking for enhanced range of shoulder motion (and maybe swing as well!), flexibility and protection from injury.
Especially useful in a golfing context for improving the top end of the back swing and used by *Gerry James, PGA Professional & Tour Trainer, 2 times World Long Drive Champion and *Mike Dobbyn, 2007 RE/MAX Long Drive Champion, the Rotater can also help you as well by;
Where coaches and golf pro’s can influence your technique and therapy and therapists can control your rehab and recovery, The Rotater gives you a new type of control – a simple, reproducible and scalable method of self-treatment and keeps control quite literally in your own hands.
We are introducing this deceptively simple-looking device to the wider UK Golfing community for the first time at The London Golf Show and we would love to have the opportunity to show you how much it can change both your range of motion and shoulder flexibility, but also potentially improve your game by giving you a ‘cushion’ of flexibility that will reduce the chances of injury. The Rotater is portable, easy to master and inexpensive.
Scalability in training and rehabilitation is critical both for development of your skills and physical ability, but because no one person is the same as the next, devices like The Rotater and TPT tools can be infinitely tweeked to serve the needs of each individual.
You do not have to be injured to benefit, but, our **staff may well be able to spot where your general posture and shoulder bio-mechanics difficulties that may be holding you back.
So if you’re in London on the weekend of Nov 11-13, come and visit our stand at The London Golf Show, try out The Rotater and Balance Performance’s Trigger Point Performance Therapy tools for yourself. Let your golfing friends or coach know about us too. If you’re going with a mind to test and try out golf clubs come to the stand and try out TPT & Rotater and move easier before you go in search of a Callaway or Taylor Made.
Follow us on Twitter @shouldercentric for regular updates and @londongolfshow.
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Golfing Endorsements for The Rotater
*Gerry James – PGA Tour Trainer
Chris I received the Rotater today. Thank you very much.
As a pro athlete, and trainer to other pro athletes, I have a lot of training stuff come my way. This is one of the best well thought-out devices I have ever used.
Every serious athlete should have one of these. As I stated on the phone I train a PGA Tour player that just had surgery for a labrum tear. Had he had it before I started working with him, I just can’t help but think he would not have had any such injury.
You can use my endorsement if you wish.
Gerry James
PGA Professional, 2X World Long Drive Champion – PGA Tour Trainer
**DISCLAIMER – we cannot give medical advice without a full history and physical examination, but we may suggest that you take further advice from a medical or other professional.
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