Physical Therapy for Shoulder Impingement Syndrome

Physical therapy for shoulder impingement syndrome is a great conservative option that you can start at any point in your recovery process. Whether it’s a new injury, chronic issue, or you have decided to have surgery, there are benefits to treatment throughout each stage. Not sure if physical therapy (PT) is for you? The short answer is YES, even if you have a rotator cuff tear it should always be your first line of defense in treatment. Keep reading to determine just what you have to gain.

Why Physical Therapy?

By now, you have probably realized that the coordination of your shoulder is off due to your rotator cuff injury. This is due to imbalances with posture, strength, flexibility, joint range of motion, coordination, and other lifestyle factors. A physical therapist will help you pinpoint exactly what caused and is perpetuating your current symptoms via an in depth analysis. This information will help you get the root cause of your problem and make sure you are taking appropriate steps to start the healing process.

What to Expect from Physical Therapy

Physical therapists are well versed in their anatomy and movement science. Thus, an initial assessment will help reveal your unique issues that need to be addressed. The initial session typically takes about 60 minutes. You will answer questions about your lifestyle, symptoms, and pain beliefs in addition to a full physical exam. This exam will rule out other possible issues and most likely confirm your shoulder impingement diagnosis (if you already have the diagnosis). Today, you can go directly to a PT without seeing an MD first in most states to save time and money in the treatment process. While it depends on the severity of your injury, you can typically expect to see a PT for around 12 weeks (but up to 24 weeks) for 1-3 visits per week.

Physical Therapy Techniques

A well-tailored PT program will include a wide variety of options that optimize the healing of your shoulder. Here is what you can expect to be included in your treatment sessions.

Personalized Home Exercise Program

This is probably the most important aspect of your PT sessions. It will provide you the steps you need to treat yourself at home. A physical therapist’s ultimate goal is always to empower you to be independent with the treatment process. You can expect to receive a resistance band and home program with a mix of personalized strength and stretching exercises to restore function to the shoulder muscles. Typically, simple pain-free (relatively) exercises that require minimal coordination are initiated first. Then, you will be progressed as you start to gain strength, flexibility, coordination and experience less pain. These exercises will address the rotator cuff muscles in addition to the upper back, shoulder blades, and core muscles.

Strengthening Exercises for Shoulder Impingement

Stretches for Shoulder Impingement

Manual Therapy

Physical therapists are trained to assess tissue restrictions in the shoulder joint itself, ligaments, muscles and more. Additionally, they can pinpoint tender areas in the rotator cuff tendons, surrounding scapular and neck muscles, and bursae (cushions in the shoulder that help reduce friction with movement). Once these problem areas have been identified, specialized manual treatment can be initiated to address impingement symptoms. This may include joint mobilization, soft tissue massage, myofascial release, and targeted friction massage to the rotator cuff tendons (where they attach to the humeral head). If you respond well to manual treatment, the next step would be to learn some modified techniques that you can do you on your own at home. A massage cane can help allow those with limited reach to massage shoulders effectively.

Massage for Shoulder Impingement

Ergonomics Assessment

Poor posture and repetitive motions (resulting in overuse) that you do each day play a large role in your shoulder health. If your posture is hunched (head, shoulders, and upper back slumped forward) this changes the natural position of the acromion (the tip of the shoulder blade). Ultimately, it narrows the subacromial space available for your tendons and bursa while putting your entire upper body at a mechanical disadvantage. Good posture is vital in all positions including sitting, standing, and sleeping. You and your physical therapist can identify ways to modify and promote optimal muscle balance with any prolonged positions you are in each day, in addition to high risk movements (overhead activities, throwing, swimming, etc).

Sometimes, posture training can be fatiguing and frustrating. Thus, a PT may use other tools to optimize your ergonomics and retrain your postural muscles (especially in the scapula). These options include k-tape or a posture corrector (to be worn for a prescribed amount of time each day).

K-tape for Shoulder Impingement

Best Sleeping Position for Shoulder Impingement

Use of Modalities

Providing adjunct therapies that promote pain relief, reduce inflammation, and increase relaxation and circulation can help treat your shoulder pain. A physical therapist can select what will best suit you. If you have good results in the clinic, a lot of these can then be done at home as well.

• Ice and heat

  A physical therapist can help you determine how long, exact placement, and how often you should apply ice and/or heat to your shoulder.

• Ultrasound

  This is typically an in-clinic option only that can be used for the first several weeks to kickstart the healing process. Ultrasound is a great option for a localized and very specific source of pain, such as with rotator cuff tendinitis or bursitis.

• Light therapy

  Low-level laser therapy, or LLLT, is another in-clinic option. This option utilizes specific light wavelengths to optimize healing.

• TENS unit

  Use of a TENS unit can be initiated in the PT clinic to help relieve pain and improve tolerance for the rest of the treatment session.  A PT will show you where to put the pads for maximal comfort. If you are getting good results, they can then recommend what options are best for you to use at home.  

Lifestyle Education

After all of the above treatment options are addressed, it is always important to keep them relevant to your lifestyle. For example, no amount of stretching and strengthening will help you if you don’t know how to apply the gains you make to your daily activities and habits. There may also be little nuances in your daily movements and posture that you don’t realize are aggravating your shoulder that PT can help you identify. Plus, certain lifestyle choices such as poor diet, little exercise, poor sleep, and smoking can also be discussed and addressed as needed. Making sure your recovery is functional and related to your actual daily life will make it easier to stay on track, heal well, and hopefully prevent future issues.

Other Treatment Options

Outside of physical therapy, there are other great options to optimize healing. PT is most likely to help you identify the cause and underlying issues associated with your shoulder. Yet, other conversative treatments can give you quick pain relief to make sure you can adequately complete your exercise and stretching program (the most important part of your long term recovery). These include acupuncture, massage therapy, and chiropractic care.

Safety with Physical Therapy

If you are having trouble with your program due to aggravation of symptoms, always make sure your physical therapist knows exactly what’s going on so they can adjust your treatment sessions and home programs. If you do not make progress as expected, there may be more damage than initially thought to the shoulder or upper arm. Thus, a PT may refer you to (or refer you back to them, if you already saw them) an orthopedic doctor for further assessment. An MD may order imaging such as x-rays or MRIs to assess bone, muscle and other connective tissue damage. Injections, medications, and arthroscopy surgery are all possible more invasive options that you may discuss with your doctor as needed.

Sources:

https://www.physio-pedia.com/Subacromial_Pain_Syndrome