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Shoulder impingement syndrome: everything you want to know about it

Discussion in 'Injuries' started by visor, Jul 19, 2012.

  1. visor

    visor Regular Member

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    Background:

    So, most recently in the past few months I've gradually developed this minor niggling ache in my racket shoulder after playing. Since it didn't hurt when playing and I could still play all my shots, I thought it was just overuse and did what most people would do... ignore it.:eek: I'm a high intermediate level player playing 2-3x per week for the past 3 years more seriously, and I've played on and off for the past 30 years, but I think my age of 46 years is slowly starting to catch up to me. :(

    Then, 2-3 weeks ago, I was going for a big fat juicy midcourt "cha-siu" smash that I was gonna drill into the mat, but ... (you know this part is coming) ... unfortunately I mistimed it and missed it completely. The forces of the swing were transferred back up into my shoulder and I immediately felt a sharp pain inside the shoulder below the AC joint. Needless to say, I couldn't continue playing that night. Despite icing and taking anti-inflammatory meds, the sharp pain continued to show itself whenever I cleared or smashed hard over 70%. Drives, drops, lifts were fine. Completely stopping badminton for a while was being considered, but I just couldn't stop for even 1 week!


    So, after a lot of googling and consulting with a physio friend, I came to the conclusion:
    shoulder impingement syndrome of the supraspinatus tendon.

    [​IMG]


    What's happening is the supraspinatus tendon (labelled rotator cuff tendon above) was getting overused and irritated under the AC joint, but the final blow was when I missed the smash and threw my shoulder forward forcefully and wrenched it.


    Apparently, this is a common injury in throwing sports (eg. baseball, football), and activities requiring much overhead arm motion (eg. swimmers, tennis players, painters). In badminton, it is due to our mostly forehand strokes. These actions cause our shoulder joint to move forward during the activity, and can even gradually cause the shoulder joint to migrate forward at rest due to the higher tone of the front shoulder and chest muscles overpowering the weaker underused rear back and scapular muscles. Additionally, most of our work and hobbies involve working with our arms in front of us (like typing on Badminton Central!) and with our bad habits of slouching our shoulders, there is even more tendency of the shoulder to migrate forward.

    The problem is that our shoulders and its respective tendons were not designed to function well for long in the forward position. The AC space becomes narrower and tendons swell and get impinged more, leading to the impingement syndrome.




    Simple diagnostic tests:

    Hawkins' test:
    [​IMG]


    Neer's test:
    [​IMG]


    Unspecified test, but I thought my arm was going to fall off when I attempted this!
    [​IMG]





    Some exercises:


    As one would expect, the goal of all the rehab exercises for this condition would be to cause the shoulder to go backwards into its more functional position, by stretching and loosening the chest and front shoulder muscles, and by strengthening the rear back and scapular muscles.

    [​IMG]





    Some links that were helpful to me:


    http://www.badmintoncentral.com/forums/showthread.php/14072-General-guide-to-arm-and-shoulder-injury-and-prevention
    by bigredlemon

    http://www.badmintoncentral.com/forums/showthread.php/82337-Recurring-shoulder-pain
    by blindaim

    http://www.pinnacle-ortho.com/what_hurts_specific.php?id=29

    And various posts by Gollum, Fidget, and others.

     
  2. visor

    visor Regular Member

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  3. visor

    visor Regular Member

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  4. visor

    visor Regular Member

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    Pics for above:

    [​IMG]

    [​IMG]

    [​IMG]

    [​IMG]
     
  5. visor

    visor Regular Member

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  6. visor

    visor Regular Member

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    Some excellent videos:

    [video=youtube;yigbS9xZ2W0]http://www.youtube.com/watch?v=yigbS9xZ2W0[/video]

    [video=youtube;LD_5VJ8DNKQ]http://www.youtube.com/watch?v=LD_5VJ8DNKQ&feature=fvwrel[/video]

    [video=youtube;xRrepP3jFFo]http://www.youtube.com/watch?v=xRrepP3jFFo&feature=BFa&list=SPBBBDB98662F 6807B[/video]
     
  7. R20190

    R20190 Regular Member

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    Visor, many thanks for sharing this info.

    When I read your original post, it was as though I had written it myself, about me. I too have this problem. My badminton peaked in 2005 when I was training for a tornament, I went for a hard smash and completely mis-timed it. Arm felt like it had come out of it's socket! I didn't warm up well enough beforehand which was a contributing factor. The pain was a localised point deep inside my shoulder and only when I play a smash. All other shots were generally fine.

    I have tried all sorts of treatments, including physio, accupuncture, chinese massage, chinese "Teet Da" none seemed to help much. Although the chinese Teet Da loosened my shoulder it didn't really rid the problem.

    I've had the problem for 7 years now, not much has improved since then but having recently gotten myself back onto the court, it's sad that what was my favourite and best shot I can now only play what seems little more than a half smash.

    Anyway, I finished 9 months of physio, made no difference. So they sent me back to MRI to find out why. Had my second MRI scan 3 weeks ago, where a junior doctor injected me with a dye to improve the imagery, only to cause me even more discomfort as he struggled with getting the needle inside the joint. He called for the consultant halfway through the procedure, who told him to wiggle the needle around and give me more local so I could bare it. I'm starting to lose confidence in anyone being able to help me now, so I've decided to research it myself and hopefully find a cure.

    In my search for a cure, I came across this book which seemed to have helped a lot of people, but I wasn't sure whether it was the same injury as mine.

    "Treat Your Own Rotator Cuff" by J.Johnson

    Has anyone read this?

    One thing I've noticed that helps with the pain a lot, which I'm sure comes as no surprise is keeping the shoulder warm. I'd often underestimated how much this helps, only doing minimal stretches and playing gentle rallies. I think the key is not to allow the shoulder the chance to cool down, or stiffen up especially between games. I massage my shoulder quite frequently and keep it warm whenever I sit down. This has helped a lot.

    I'm certainly going to try some of the excercises you've posted above and see if there is any difference.

    So, how is your shoulder these days after doing these exercises?
     
  8. Fidget

    Fidget Regular Member

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    Excellent resources, visor. You should win a public service award for this thread. :)The important thing to remember is that one must not wait until serious pain starts before including these stretches and exercises in one's regular regimen.
     
  9. pcll99

    pcll99 Regular Member

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    visor, i recommend the following:

    1. don't play badminton for 2 months. I know, it's very hard, but 2 months are worth it.

    2. accupuncture, during these two months.

    3. physio and rehad as you had suggested.

    4. resume playing badminton, but wear this.

    http://www.lp-support.com/product/con_body.php?MID=2
     
  10. visor

    visor Regular Member

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    Ya, initially I put it up as just overuse, but when I couldn't clear or smash, that was serious problem indeed.

    Who would have known that we have to train the *opposing* muscles too? :(
     
  11. visor

    visor Regular Member

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    2 months!? I couldn't even last 1-2 weeks! :p
     
  12. CanucksDynasty

    CanucksDynasty Regular Member

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    I think you need to give up badminton.

    Sellz me your racketz!!!!!

    ;)
     
  13. visor

    visor Regular Member

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    Ya, I may have to unload my 4u vt80. Need a backup? :p
     
  14. visor

    visor Regular Member

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    R20190:

    I remember chatting with you on another shoulder thread a few months back. :). In a way it's good that no significant pathology was detected on your MRI. Did you try those tests in the first post, especially the third one? That'll help determine your treatment.

    My shoulder is now stronger with those exercises. And my posture is now more "confident" with less slouching. Finally in the past week, I was able to play some less intense games with smashes and clears that were painfree. I just had to consciously remind myself to stretch my shoulder beforehand and to use more forearm/wrist snap and less shoulder.
     
  15. R20190

    R20190 Regular Member

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    I think the idea of the shoulder coming forward with weaker muscles on your back but stronger muscles on your chest makes sense to my simple mind. I've always slouched and spend most of my day sitting in front of a computer. So I'm sure that doesn't help.

    The problem is, orthopedic surgeon told me that I'm hypermobile, meaning that I am a lot more flexible than the average person. So I'm able to do a lot of the "tests" without problems but still have the pain when I play a smash for instance. I've noticed my shoulder has frozen up in the last few years, which the chinese tee da guy really help to loosen.

    I tried the exercise with the theraband last night as I feel that is probably the one that will help strengthen my back muscles. Which exercise do you feel works best?
     
  16. visor

    visor Regular Member

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    Hmmm... I'm quite hypermobile too, but the third test is quite positive for me. With your elbows by your sides, place your racket hand on the opposite shoulder, then gradually raise your elbow while keeping your hand on the shoulder. If the shoulder starts to hurt before you can raise it to 90 degrees, then most likely you have shoulder impingement.

    The shoulder W exercise with a theraband really helps me, I find.
     
  17. R20190

    R20190 Regular Member

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    I tried the theraband exercise for a couple of days, but I think either I'm doing it wrong or it's probably not the right exercise for me as it did aggravate it a little. I'll give it a week to rest then I'll try it again and see. I'm all for trial and error! :)

    Another thing that I'm going to try is using Kinesio Tape. Has anyone tried it before? A lot of athletes swear by it even though there's been no real concrete evidence that it works. May be placebo effect but for the cost of a couple packets of strings, I'm quite happy to give it a go!
     
  18. dimcorner

    dimcorner Regular Member

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    Nice article. I'll probably do more back training now.

    Happened to me on a university tournament when I mist hit something and felt a sting inside my shoulder. My arm went limp and I couldn't do ANY overhead shots.
    Could not lift my arm past horizontal with my thumb pointed down. Unfortunately I didn't go see the doctor but I did stop playing for just under 3 months. I SLOWLY got back into it (took almost another 4 months to try full power swings) and I'm happy to say I feel totally recovered. I do stretch a lot more before playing sessions and I do feel my game has improved since this happened so I'm pretty sure my shoulder is ok (this was 9 years ago! and for reference I'm 36).

    One thing is that I did change my swing to a more overhead type swing (after watching more videos of myself). I also noticed that my shoulder clicks a little more than my left one. I'm guessing MX80 doesn't help much in this department but it feels just awesome. :)
     
  19. visor

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    ^^ I like my mx80 too but I'm switching to mx70 for now as I think the 80 may be too stiff for me. :p
     
    #19 visor, Aug 1, 2012
    Last edited: Aug 1, 2012
  20. visor

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    Make sure you use only your scapular muscles in that exercise. Concentrate on retracting the scapula backwards as shown in the video.
     

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