Author: Neil Patel
Shoulder complaints are very common in the active population. Subacromial Pain Syndrome (SAPS) is the most common form of shoulder pain, accounting for 65% of all shoulder complaints. It is defined as non-traumatic shoulder pain that usually presents on the top of the shoulder joint.
Essential Anatomy
To better understand the contributing factors to your pain, you need awareness of the common structures of your shoulder.
The shoulder joint is a very mobile structure formed by your humerus (upper arm) and scapula (shoulder blade). The scapula has two bony protrusions called the acromion and coracoid. These bony points are important as they form the roof of a tunnel through which tendons - the part of the muscle that attaches to the bone - travel. The base of this tunnel is formed by your shoulder joint.
As the shoulder joint is very mobile, it requires a lot of active support to ensure stability. This support comes from a group of muscles called the rotator cuff. These muscles attach to the top of the arm and originate from the scapula. One particular muscle named supraspinatus lays close to this tunnel while its tendon passes within the tunnel before reaching your upper arm, helping to move your arm upwards.
The shoulder has many fluid-filled sacs called bursa that protect the tendon from hard bony surfaces and help to facilitate movement. For example, the subacromial bursa surrounds the supraspinatus tendon as it passes through the tunnel.
What causes SAPS?
Pain in this region is often linked to the narrowing of the tunnel, and hence the compression of the structures that pass within it. The flexibility of muscles around this joint as well as the dynamic performance of the rotator cuff muscles all influence the mechanics of the tunnel.
Prolonged inadequate ergonomics, also known as posture, are also thought to narrow the tunnel through its influence on anatomical factors.
Treatment
First, we have to find out what causes your pain. Hence the importance of consulting with your Physiotherapist.
Your Physiotherapist can provide you with specialised education that addresses all of your individual contributing factors. They can analyse and correct both environmental and behavioural factors. In addition, they can also advise you on proper load management strategies to combat one of the most common causes of injury - too much, too soon.
Manual therapy is often applied during initial management as this helps improve the flexibility of muscles and thus reduces their influence on the mechanics of the tunnel. This is usually paired with mobility exercises; these add to the flexibility component of treatment by helping to improve range of motion.
Motor control is an important part of body awareness. In the shoulder, this is essential as the shoulder joint is extremely mobile. The rotator cuff muscles ensure stability of the shoulder as it moves. The back and chest muscles can also influence the shoulder joint, and therefore you need to have the ability to activate and control these muscles. Inadequate activation or control leads to sub-optimal shoulder movements, which may lead to the narrowing of the tunnel and the presence of pain. Specific exercises can be applied to your rehabilitation to assist your shoulder to regain pain-free motion and ensure optimal muscular stabilisation of the shoulder to prevent the future incidence of pain.
Lastly, strength is very important as it reflects the capacity of the overall structure. The stronger the muscles around a joint, the better it moves and handles load. Strengthening exercises, when performed correctly, can also positively influence flexibility and motor control.
Summary
Key take-home messages:
- Subacromial pain syndrome is the most common type of shoulder pain
- This pain is contributed to by the narrowing that occurs in the tunnel, as a result of inadequate flexibility, motor control, strength, or ergonomics.
- Physiotherapy can help with education, mobility, motor control, and strength to help you remove the cause of your shoulder pain.
If you are experiencing shoulder pain, book in with your Physiotherapist for a thorough assessment using this link – FREE INITIAL ASSESSMENT. Once the contributing factors have been identified, the road to recovery can begin.
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