RMT Physiotherapist benefits

Shoulder Pain Treatment: Shoulder Impingement P2

Kim Physiotherapy

Physiotherapists are very well equipped with knowledge and experience to provide conservative shoulder pain treatment from shoulder impingement syndrome and treating the injured structures and more importantly, addressing the underlying cause of your shoulder pain.

Shoulder impingement syndrome or rotator cuff impingement is one of the most common causes of shoulder pain and understanding shoulder anatomy and how this pathology perpetuates is important in addressing its causes. Here we’ll discuss some shoulder pain treatment  options.

This is part 2 of “Shoulder impingement syndrome” blog series. In part 1, we discussed the symptoms, anatomy and potential causes of this shoulder pain condition – shoulder impingement syndrome or rotator cuff impingement.

As in most things in life, individualized plans ensure the most optimal and efficient journey to the end goal! Road to life without shoulder pain means adjusting and progressing treatment techniques to match stage of healing, sensitivity of the injured / healing structure(s), and individual needs of each person, as life demands continue or change, and sometimes we just can’t help ourselves but decide to sabotage our progress.

Some principles for shoulder pain treatment include:

  • RICE (“relative” rest being quite important)
  • Activity modification (as continually re-aggravating the structure makes it difficult for it to heal)
  • Postural correction / education
  • Rotator cuff strengthening
  • Scapular muscle strengthening
  • Improve neuromuscular control – enhance scapulohumeral rhythm. It is important that the shoulder blade movement is co-ordinated with arm movement to ensure sufficient space is provided for those rotator cuff tendons and bursa.

Acute Phase of shoulder pain treatment

  • EDUCATION
  • Relieve pain & inflammation; prevent muscle atrophy; re-establish painfree ROM (range of motion)
  • Eliminate activities that ↑ symptoms (no movements/resistance with arms above shoulder height)
  • Pendulum ROM (range) exercises & AAROM (active assisted range) exercises
  • Strengthening exercises – isometric (focus on ER, IR, biceps, deltoid, scapular stabilizers)
  • Taping, Ice, ultrasound, interferential current (interferential current stimulation), acupuncture

Sub-Acute Phase (fibroblastic) & Remodelling Phase of shoulder pain treatment

  • Additional EDUCTION
  • Normalize ROM; start symptom-free ADLs (activities of daily living); improve neuromuscular control & muscle strength
  • Progress ROM exercises to active exercises (all planes)
  • Self-stretching
  • Strengthening exercises – isotonic
    • IR, ER, prone extension, flexion to 90°, abduction to 90°
    • Shoulder shrugs, rows, pull-downs
  • Note: athletes – get them back to throwing (strength, power, endurance, sport-specific)
    • Also include eccentric exercises in diagonal patterns
    • Progress to isokinetic and plyometrics slowly near end of phase

Maintenance Phase of shoulder pain treatment

  • Education on prevention of repeat injury and warning signs of early impingement
  • Importance of home exercise program for proper ‘co-ordination’/ motor control, strengthening, and mobility.

Bones of the shoulder

If conservative treatment is insufficient in getting your shoulder pain better, your medical co-ordinator (GP, etc) can suggest these other shoulder pain treatment options :

Corticosteroid Injections

  • Into subacromial space

Surgical Intervention

When?   Usually after 3-6 months of unsuccessful conservative management

Who?     Beneficial for those patients with significant functional impairments; full thickness rotator cuff tear (as seen on MRI)

Type?     Subacromial decompression (with coracoacromial arch cut/loosening) / anterior acromioplasty (remove part of acromion)

Thanks for reading this two part jam-packed (and loooong) blog! Hopefully you found it helpful. If you’re someone suffering with shoulder pain, please go see a registered physiotherapist to start the process of stopping this very treatable condition!

Our therapists at Van Sports and Physiotherapy Clinic can assess and get you started on an individualized treatment plan to live life active! Call 604.661.8878.

If you have any comments, questions, tidbits of great info – please feel free to comment or send an e-mail to info@vansportsphysio.com and we’ll address them the best we can.