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Shoulder impingement treatment in Edmonton
Shoulder impingement describes pain on reaching, lifting and lying on that side, though the surgery built on that model performed little better than placebo surgery in two large trials. At our southeast Edmonton clinic, treatment starts with exercise-based care, as current guidelines recommend.
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What is shoulder impingement?
Impingement was the idea that the bony arch above the shoulder pinches the rotator cuff tendons underneath it, and that shaving bone from the arch relieves the pinching. It gave the condition its name and gave surgeons an operation. When that operation was put into randomised trials against placebo surgery, the results did not support the model, and the label is now used more loosely — many clinicians prefer subacromial pain syndrome, which describes where it hurts without claiming to know why.
What the trials found
Two large randomised trials compared subacromial decompression with a placebo operation, in which patients underwent arthroscopy without the bone being shaved. Both groups improved, and the difference between them was small enough to leave the procedure’s specific effect in doubt.
The practical consequence is that clinical guidelines now put exercise-based care first for this presentation, and treat surgery as a later conversation rather than the natural destination.
So what is actually going on?
In most cases the picture matches rotator cuff tendinopathy: tendons loaded beyond what they can currently tolerate, producing pain on reaching, lifting and lying on that shoulder. The rotator cuff tendinopathy page covers that in full, including what a loading program looks like.
Other things can produce pain in the same area and are worth distinguishing at assessment: a stiff, globally restricted shoulder points toward frozen shoulder; pain with a history of dislocation points toward instability; pain referred from the neck is common and is screened as part of any shoulder assessment.
What treatment usually involves
Progressive loading of the rotator cuff and the muscles around the shoulder blade, adjusted to what the shoulder currently tolerates and stepped up over weeks.
Alongside that, changing the loads that keep provoking it — overhead work, sleep position, gym exercises that flare it — so the tendon has a chance to adapt.
Expect this to be measured in weeks to months. Reduced night pain and a longer tolerance before symptoms appear are usually the first signs it is working.
Questions people ask
My doctor said I have impingement — is that wrong?
It is a widely used term and it describes a real, recognisable presentation. What has changed is the confidence that pinching is the mechanism, and the assumption that surgery to relieve the pinching is the answer. The label is fine; the treatment implications have moved.
Is a bone spur causing it?
Acromial shape and spurs are found in plenty of shoulders that do not hurt, and removing them did not separate from placebo surgery in trials. It is one finding among several rather than the explanation.
Should I stop lifting overhead?
Usually not entirely. Reducing the specific loads that flare it while continuing to use the arm is the approach that holds; avoiding overhead work altogether tends to leave the shoulder less able to cope with it later.
Is impingement still a real diagnosis?
The term is still used, but the idea that a bone is pinching the tendon and needs shaving off has not held up. The surgery designed to fix that performs no better than a placebo operation. What most people have is a rotator cuff that is not coping with load, and that is treated with a loading program.
How long will my shoulder take to improve?
Most people notice a real difference within six to eight weeks of consistent exercise, with full recovery over three to four months. Progress is measured at each visit against what you could do at the start, so you can see whether the plan is working.
Can I still go to the gym?
Yes, with adjustments. Overhead pressing and wide-grip pulling are usually the movements to modify for a while. The physiotherapist will go through your program and tell you what to keep, change and pause rather than telling you to stop training.
Book a shoulder assessment
Vertex Physiotherapy is at 6958 76 Ave NW #205, Edmonton, AB T6B 2R2. Call (825) 525-2852 or book online.