Physiotherapist Advice for a Shoulder Impingement

Posted by kalen mok on September 7th, 2021

What have I done?... Long standing shoulder pain, caused by shoulder impingement, is one of the most common complaints that a Physiotherapy encounters. It usually manifests as a slight ache in the shoulder that worsens over time, and can become painful enough that it begins to affect function. In many cases, this type of condition can follow a previous acute injury of the shoulder. However it is also common for no obvious reason for the pain. Pain is commonly felt upon raising the arm in an arc; in other words, feeling the pain at a certain point and then discovering that it reduces once that point has passed. The area of pain can also be felt down the arm - which can lead to people thinking that it is their upper arm that is the problem, not the shoulder.

So what does my diagnosis actually mean? When elevating the arm, structures within the shoulders space are compressed together. Impingement of the shoulder refers to the compression of structures such as tendons. There can be two reasons why this occurs. The more common is that of poor biomechanical action about the shoulder. For the shoulder to work properly, the shoulder\'s blade (scapula) and the arm have to work in unison to allow movement without pain. When the muscles about the scapula do not do their job properly, the scapula does not move in the correct pattern, resulting in impingement and therefore pain. The space can also be reduced in size structurally. This can occur when the flat protruding part of the scapula at the top of the shoulder can over time degenerate, resulting in protrusions of bone into the space. This limited space results in impingement, which can need surgery to rectify.

What do I need to do? STAGE 1: ACUTE MANAGEMENT (0 DAYS - 1-2 WEEKS) Avoid movements of the shoulder that aggravate pain - no doing so will only prolong the inflammation. Use ice: When the pain is severe and to settle inflammation, use ice 15-20 minutes, 2-3 times a day. Start treatment as soon as possible. Physiotherapy treatment will usually begin by working on the tight muscles and structures in the area, concurrently using a basic corrective exercise programme.

What next? STAGE 2: SUB-ACUTE MANAGEMENT (1-3 WEEKS) During this stage the pain should be noticeably reduced. The exercise programme will look to utilize the ground work achieved through the basic exercises. The programme will continue to focus on restoring the correct biomechanical function of the shoulder. Manual therapy can be used as required, but should become less of an emphasis. STAGE 3: RETURN TO NORMAL FUNCTION (3-10 WEEKS) As the normal biomechanics of the shoulder return, pain should largely resolve. The exercise program will become the main focus of treatment, and treatment frequency will also decrease. The exercises will increase in difficulty ensuring that the strength of the scapula muscles are able to withstand daily activity, and sporting activities if required. It is possible that Physiotherapy is no longer required and that the task of completing the assigned program is handed to the patient. The exercise can be continued for a few months after the conclusion of treatment, therefore preventing any chance of the condition returning.

A final word... As each of us is different, you will progress at a different pace to someone else. Your rehabilitation program will differ from others due to your individual goals. Each stage has certain goals that your Physiotherapist will help you reach before commencing the next stage. As a team, you and your Physiotherapist will generate the best result for your specific injury. Should you have any queries about your rehabilitation program just discuss them with your treating Physiotherapist at your next visit.