Quote Originally Posted by Lgodin View Post
Hi, I find that we have to go to the source of the problem to get results. Find the source of impingement. Why do we have an irritation of the rotator cuff in the first place? Look at the glides of the G/H joint as well as the resting position of the humeral head in the glenoid cavity. Is there limitation of the inferior and posterior glides? Do we have a resting position which is anteriorly? There will be weakness of the cuff, no doubt but go to the source and don't get fooled by the obvious.

Louis Godin RPT, FCAMT
I couldn't agree with you more. One must really look at 95% of should injuries as some for of impingement. What therefore is the cause. To consider this one has to look at all joints involved in shoulder motion including, stenoclavicular, acromioclavicular, glenohumeral (least likely problem!) scapulothoracic, thoracic spinal extension, upper lumbar extension, spinal rotation etc. Then of course look at what the body does with the available motion that it is presented with. i.e. To have mobility does not mean that you will use it effectively. What about the recruitment timing and patterning of the involved muscles.

Then we must consider diet, physiology, training/over training, equipment and it's suitability to the client (e.g. tennis racket or golf club). The list goes on and perhaps we could and many have write dedicated books to should assessment and treatment alone.

I find perhaps the biggest hurdle is that shoulder symptoms often develop over a long time. Thus their causes are fundemental movement patterns in the patient. Once the issue turns to pain the resolution of that pain is not as overnight as the onset. Education is very important for the client in this reguard.