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Internal vs. External Shoulder Impingement Syndrome

8 Dec

Most adults will experience shoulder pain at some point during their lifetime, and it’s estimated
that nearly one-third of adults are affected each year. Among the many possible diagnoses, shoulder
impingement syndrome accounts for roughly half of all shoulder pain cases. However, current
understanding indicates that shoulder impingement syndrome is not a single diagnosis, but rather a cluster
of symptoms that can arise from multiple anatomical and biomechanical factors. The condition is
typically classified as either internal or external, depending on where and how the impingement occurs.
The shoulder complex functions as an integrated system of four joints that together allow for an
exceptional range of motion. The glenohumeral joint that joins the humerus (upper arm bone) with the
glenoid fossa of the scapula is the primary joint responsible for most shoulder movement. It is stabilized
by the rotator cuff muscles, labrum, and surrounding ligaments. Under ideal conditions, this joint moves
freely to perform tasks like lifting, throwing, or reaching overhead. But when mechanical forces, either
within the joint itself or external to it, disrupt that motion, the result may be pain, inflammation, and
limited movement. Over time, chronic irritation may lead to scar tissue formation and even degenerative
changes.
External impingement occurs when the acromion or coracoacromial ligament compress the
rotator cuff during arm elevation. While anatomical variations such as a hooked acromion can predispose
some individuals to impingement, the most common contributors are poor scapular control, forward
shoulder posture, rotator cuff weakness, or degenerative changes from repetitive overhead activity or
aging.
Internal impingement, on the other hand, occurs when the humeral head pinches the rear portion
of the rotator cuff between the greater tuberosity and the posterior glenoid rim during high-velocity
overhead movements such as throwing or serving. Contributing factors often include posterior capsule
tightness, shoulder instability, scapular dyskinesis, excessive external rotation, and repetitive overuse.
Internal impingement is more common among younger, athletic, or physically active individuals.
While surgery is occasionally indicated as a first-line intervention in specific cases (such as
significant structural damage or full-thickness rotator cuff tears), clinical guidelines overwhelmingly
recommend conservative management as the initial approach, with chiropractic care serving an excellent
choice! Treatment typically aims to restore normal movement patterns within the shoulder complex
through a multimodal approach that may include manual therapies, joint mobilization, specific exercises,
physiotherapy modalities, traction, and postural retraining. The goal is to reduce inflammation, restore
joint motion, release adhesions, address trigger points, and strengthen weakened muscles.
The good news is that conservative care has a high success rate for both internal and external
impingement—especially when treatment begins early—helping most patients recover without the need
for surgery.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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What Is Iliotibial Band Syndrome?

10 Nov

Up to one-in-five adults experience knee pain each year, and many seek chiropractic care to find relief from both pain and disability. While knee pain can have many causes, when discomfort is concentrated on the outside of the knee in active adults, iliotibial band syndrome (ITBS) is an important condition to consider.

The iliotibial band is a tough, fibrous band of fascia that runs from the iliac crest at the top of the pelvis down to the outer surface of the tibia just below the knee. It serves as a dynamic stabilizer of both the knee and the hip during walking and running, and research has shown that it also stores and releases elastic energy during these activities, much like a spring.

Pain from ITBS rarely begins with a single traumatic event. Instead, it typically develops after a gradual increase in running loads, such as taking on longer distances or increasing speed. The condition is estimated to account for up to 14% of all running-related injuries, but there is still debate about the exact mechanism of injury. The traditional explanation is that the band becomes irritated as it rubs back and forth over the bony prominence of the lateral femoral epicondyle as the knee bends and straightens. More recent studies, however, suggest that the band is firmly anchored to the femur and that repetitive knee motion instead compresses the soft tissues beneath it, leading to pain. A third view emphasizes the role of weak hip muscles, which reduce pelvic control and place greater strain on the ITB, creating a sprain-like overload.

Because there is no blood test or imaging procedure that can definitively diagnose iliotibial band syndrome, clinicians rely on a combination of history and physical examination while ruling out other potential causes of lateral knee pain such as meniscus injury, synovial plica syndrome, or bone stress fracture. Iliotibial band syndrome is most strongly suggested when tenderness is present directly over the lateral femoral epicondyle, when pain worsens with prolonged running, downhill activity, or stair descent, and when there is no evidence of catching, locking, or clear trauma that would indicate another problem. Findings on clinical tests such as Noble’s compression test, Ober’s test, or Renne’s test can further support the diagnosis.

Treatment of ITBS usually requires a multimodal approach. Patients often need to modify their activity levels to reduce strain on the ITB, while also addressing underlying inflammation. Rehabilitation exercises to strengthen the hip and core muscles and improve posture can restore balance, while manual therapies may be used to improve the movement of joints and soft tissues. In some cases, orthotics or footwear changes are recommended to correct ankle or foot mechanics that place additional stress on the knee. As with most musculoskeletal conditions, the earlier care is initiated, the better the outcomes. With prompt attention, patients can usually expect a satisfactory recovery that allows them to return to their usual recreational and occupational activities without lingering limitations.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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The Most Common Cause of Hip Pain in Active Adults

9 Oct

Femoroacetabular impingement (FAI) is a painful hip condition that occurs when there is abnormal contact between the femoral head/neck junction and the rim of the acetabulum (hip socket) during certain movements, especially hip flexion, internal rotation, and adduction (inward motion). While hip problems are often associated with older adults, the vast majority of FAI cases occur in active young and middle-aged individuals.

Essentially, the condition results from bone shapes that disrupt the normal smooth motion of the hip joint. The most common type is called cam morphology, in which the femoral head/neck junction is not perfectly round, creating a bony prominence that interferes with joint motion. Cam morphology accounts for roughly two-thirds to three-quarters of symptomatic FAI cases and is most common in active young men. Another type, pincer morphology, occurs when there is excess coverage of the socket’s rim and is seen more often in active middle-aged women. These morphologies usually develop during puberty, and while they are often symptom-free, they can lead to impingement when the hip is subjected to repetitive, high-force movements such as running, jumping, or kicking—which is why active individuals are more prone to the condition.

Surgical intervention may be considered as an early option, particularly in young athletes with severe, function-limiting symptoms and clear imaging evidence of impingement. However, randomized controlled trials show that while surgery can offer faster symptom relief in the short- to mid-term, the long-term differences compared to structured non-surgical care are small, and surgery carries greater cost and risk. For this reason, clinical guidelines recommend conservative care as the first-line approach, with surgery reserved for cases that do not improve.

Conservative chiropractic management of FAI may include activity modification, anti-inflammatory measures (such as ice, dietary adjustments, or supplements), and rehabilitative strategies like stretching tight hip flexors, strengthening the core and hip extensors, and improving postural control. Chiropractors may also employ modalities such as ultrasound, electrical stimulation, laser therapy, or pulsed magnetic field therapy, along with manual techniques to restore motion in the hip. A comprehensive evaluation also considers the kinetic chain—since altered mechanics in the feet, ankles, knees, or lower back can increase stress on the hip and worsen FAI.

As with most musculoskeletal conditions, early intervention improves outcomes. Addressing FAI promptly not only reduces the risk of joint degeneration but also prevents compensatory movement patterns that can strain other areas of the body and contribute to additional painful conditions.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Shoulder and Elbow Injuries in Baseball Players

8 Sep

Overuse injuries in baseball—particularly in the shoulder and elbow—are a significant problem at both amateur and professional levels. Studies have shown that shoulder pain is one of the most common complaints among amateur baseball players, with a prevalence ranging from 13.4% to 20.6% of players. Elbow injuries are also very common and affect from about a fifth to a quarter of all players, with youth players at greater risk. While all position players can develop upper-extremity injuries, these injuries tend to occur more frequently and severely in the dominant arm of pitchers.

Despite advancements in medical management and increased knowledge about preventive care, the rates of shoulder and elbow injuries in baseball players are on the rise. The consequences of these injuries can be significant, leading to time lost from the sport, reduced performance, the need for surgical interventions, and giving up the sport entirely.

Researchers have identified several potential risk factors for shoulder and elbow injuries in baseball players including increased mechanical load (measured by pitch count or training hours), higher pitching velocity, and decreased shoulder range of motion (ROM), particularly in flexion, internal rotation, and horizontal adduction. While the perceived stress of throwing curve balls is thought to increase the risk for arm injury, it’s not currently demonstrated in the data that this is the case. There’s limited evidence that weakness of the shoulder abductors and external rotators can contribute to shoulder pain, as can scapular dysfunction. Despite the clinical emphasis on the role of lower limb and trunk function in injury prevention and rehabilitation, there isn’t much research to support this strategy.

A study that included 60 active young adult baseball players may have uncovered a strategy for preventing upper extremity injuries. In the study, researchers assigned half the players to a stretching group and the other half to a stretching plus manual therapy group with the goal of addressing range of motion deficits between their dominant and non-dominant sides. After a single treatment session, both groups demonstrated improved range of motion (internal rotation, total arc of motion, and horizontal adduction), but the stretching plus manual therapy group experienced greater improvement. Because the loss of motion is a known risk factor for arm-related injuries, the authors reported that this combined approach should be used to prevent future injury.

Chiropractors utilize manual therapies more than any other healthcare profession with goal of breaking up scar tissue and adhesions, promoting circulation to the region to facilitate healing and strengthening of muscles and tendons, and restore normal motion to affected joints.

Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

What Is Tennis Leg?  

15 Oct

The term tennis elbow is widely known because it’s a common malady associated with tennis (and more recently, pickleball), primarily due to the use of a back-hand stroke. For those who play racquet sports, there’s another common orthopedic condition that includes the word tennis: tennis leg. 

The condition is characterized by a popping noise in the calf during a movement associated with the leg pushing off during a jump, sprint, or sudden change of direction followed by a sharp, burning sensation that makes it difficult to bear weight on the leg. Though it may not initially be observed, tennis leg can lead to superficial bruising, swelling, limitations in knee and ankle range of motion, and increased calf pain at the end-range of ankle dorsiflexion (bringing the toes toward the nose) and with manual palpation. It’s important to note that like tennis elbow, tennis leg is not just a sport-related injury but can also occur in non-athletes.

If you hadn’t heard the term before, you may be surprised to discover it was first clinically described way back in 1883! The condition was initially attributed to rupture of the plantaris muscle tendon in the calf region of the lower leg.  However, more recent studies using ultrasound and MRI have shown that in nearly all cases, tennis leg is the result of injury to the gastrocnemius and/or soleus muscles in the calf. In one study, researchers evaluated MRIs of 58 patients with tennis leg and observed that edema or disruption of the medial head of the gastrocnemius at the muscle-tendon junction in 55 cases (90.2%); fluid collection between the medial head of the gastrocnemius and soleus in 44 cases (72.1%); injury to the soleus muscle (which is deeper to the gastrocnemius) in 22 (36.1%) of the cases; and plantaris muscle disruption in 7 cases (11.5%). In rare cases, tennis leg may be due to deep venous thrombosis posing as a muscle injury, which may require prompt medical attention.

Treatment generally follows the PRICE (Protect, Rest, Ice, Compress, Elevate) protocol and may include the use of a boot, modalities to reduce inflammation and promote healing (like laser or pulsed magnetic field), passive range of ankle/knee motion within pain boundaries, and manual therapies to address any musculoskeletal disorders in adjacent parts of the body that may have preceded and contributed to the injury. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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How Older Individuals Can Manage Hip Pain  

15 Sep

Hip pain is a condition that becomes more common with age. It’s reported that 1 in 7 seniors experience significant hip pain on most days, particularly with simple movements such as sitting and standing. In addition to being painful, these individuals are also likely to report a diminished ability to carry out their regular activities. As such, it’s not unusual for a hip pain sufferer to schedule a visit with a doctor of chiropractic to see if a conservative course of care can benefit them without the need for medications, injections, or surgical intervention.

When a patient first presents for chiropractic care for hip pain, they will be asked to complete paperwork to describe both their past medical history and their current hip pain. This may also include questionnaires using diagrams and scales to assess pain and disability. The information provided will be useful to rule out red flags (fracture, infection, malignancy, and/or acute nerve injury) that may necessitate referral to a specialist or emergency services. The data will also provide insights as to the potential cause/s of the patient’s hip pain. 

The possible causes for hip pain are myriad. In addition to trauma, arthritis, congenital defects, and other issues that can affect the soft tissues and bones that comprise the hip joint, the pain experienced as “hip pain” may actually be referred pain from the low back or buttocks. Or the patient might not even have hip pain but may be mistaking pain from nearby locations as hip pain. There may even be indication that the underlying cause is not musculoskeletal in nature and part of a larger issue that may need to be co-managed with the patient’s medical physician. 

Once a chiropractor has reviewed the information provided by the patient, they will conduct a physical examination of the hip joint that may include analysis of gait or walking, sitting, and standing; ability to stand on one leg; range of motion (ROM) from seated and recumbent positions; leg length variance; muscle length checks; and neurovascular assessments in the lower limbs. This may also involve evaluation of the feet, ankles, knees, and lower back, as musculoskeletal disorders in these areas can place added stress on the affected hip during movement and would need to be treated to provide a satisfactory outcome for the patient.

While the specifics of treatment will vary from patient to patient, as well as the chiropractor’s training and clinical experience, care may involve a multimodal approach that includes manual therapies, exercise training, nutrition recommendations, and physiotherapy modalities aimed at restoring normal movement to the hip and other joints that could play a role in the patient’s chief complaint. As with many conditions, the longer it persists, the more time it can take to achieve a complete recovery, if at all. If you’re currently experiencing hip pain, call your doctor of chiropractic sooner rather than later. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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