Treating Shoulder Impingement Syndrome with Physical Therapy
Shoulder impingement syndrome develops due to chronic, repeated compression of the rotator cuff tendons and bursa under the acromion, causing pain, swelling, and movement issues. Shoulder impingement can result from repetitive overhead movements such as throwing the baseball, but may also occur due to a fall, muscle weakness in the shoulder joint, or postural abnormalities. Physical therapy can decrease shoulder impingement-related pain and improve shoulder motion and strength through targeted strengthening of the shoulder and upper back.
Anatomy of the Shoulder
The shoulder joint is comprised of the scapula (the shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The humerus bone forms a ball at the shoulder that meets the socket that is formed by the shoulder blade. The rotator cuff muscles come together as tendons to form a covering around the head of the humerus and attach the humerus to the shoulder blade. This stabilizes the shoulder joint and allows you to lift and rotate the arm. At the tip of the shoulder lies the acromion, a bony bump-like prominence under which the rotator cuff tendons and bursa sit. Bursa is the lubricating sac between the rotator cuff and acromion that allows the rotator cuff tendons to glide freely when moving the arm.
What is Shoulder Impingement Syndrome?
Shoulder impingement syndrome develops due to chronic, repeated compression of the rotator cuff tendons and bursa under the acromion, causing pain and movement issues. Shoulder impingement accounts for nearly one-third of all shoulder pain.
Symptoms normally develop over weeks or months due to chronic overuse and compression. Common symptoms of shoulder impingement syndrome include:
Restricted shoulder motion with weakness when reaching overhead, behind the body, or out to the side
Shoulder pain when moving the arm overhead or to the outside of the body
Pain and tenderness in the front of your shoulder or that moves from the front of the shoulder to the side of your arm
Swelling of the rotator cuff tendons and bursa that further narrows the space between the rotator cuff, bursa, and acromion
Pain and discomfort when attempting to sleep on the involved side
Pain when throwing and engaging in other dynamic overhead movements
Shoulder impingement syndrome can be caused by a variety of factors. One of the most common factors is repetitive overhead movements during golfing, throwing (baseball/softball), racquet sports, swimming, and frequent overhead reaching or lifting such as painters and manual laborers. The shoulder can also become compressed after a fall or due to osteoarthritis in the shoulder.
Poor rotator cuff and shoulder blade muscle strength can also cause the humeral head to move abnormally, or when tightness develops in the soft tissue around the shoulder joint, contributing to shoulder impingement syndrome. Postural abnormalities such as scoliosis or rounded shoulder posture can also affect spinal alignment and resting and dynamic scapula position, leading to shoulder impingement.
Physical Therapy for Shoulder Impingement Syndrome
Physical therapy can decrease shoulder impingement-related pain and improve shoulder motion and strength in those with shoulder impingement syndrome. After a thorough evaluation of the patient’s condition, the physical therapist designs a comprehensive rehabilitation program to help the patient regain full range of motion, reestablish dynamic rotator cuff stability, and implement a progression of strengthening exercises to restore strength and muscular endurance to the rotator cuff and scapular muscles.
Physical therapy for shoulder impingement syndrome can include:
Pain management using first ice to minimize swelling and pain, then moist heat to prepare the soft tissues for stretching and manual therapy.
Range of motion exercises and stretching techniques to decrease tension and restore normal motion of the shoulder and arm.
Manual therapy involves gentle joint and soft tissue mobilizations to gently move the shoulder muscles and joint and improve movement.
Targeted muscle strengthening: The physical therapist designs a progressive resistance program to strengthen the shoulder, upper back, and core. The therapist specifically targets the rotator cuff and scapular muscles to help position the head of the humerus bone correctly and ease the impingement.
Proprioceptive training to restore neurosensory properties of the shoulder joint capsule and heighten sensory awareness.
Functional training to regain the ability to engage in daily activities, work, and sport and teach the body safe, controlled movement without placing additional stress on the shoulder joint.
Interval throwing training program to gradually increase the quantity, distance, intensity, and type of throws that are needed to facilitate the restoration of normal throwing biomechanics.
To prevent shoulder impingement, it is essential to maintain proper strength in the shoulder and shoulder-blade muscles as a healthy shoulder relies on a proper balance of muscle strength in the shoulder region. It’s also critical to maintain proper shoulder, neck, and mid-back posture for good mobility and range of motion.
Keep proper posture and use proper shoulder mechanics when reaching and throwing, which reduces the likelihood of shoulder impingement and minimizes excessive stress on the shoulder. Avoid forward head and rounded shoulder postures. Throwing athletes should also be instructed on a conditioning program throughout the year to prevent overtraining and ensure proper throwing technique
