Shoulder Impingement Syndrome

Shoulder pain is the 3rd most common musculoskeletal complaint in orthopedic practice, and impingement syndrome is one of the more frequent diagnoses.

Shoulder impingement is a clinical syndrome in which soft tissues become painfully entrapped in and around the shoulder joint. It can also commonly be referred to as “rotator cuff tendonitis” or “bursitis”, but the more general term of “impingement syndrome” is probably more accurate, as often it is hard to now exactly what soft tissue structure is causing the pain.

What Are the Symptoms of Shoulder Impingement Syndrome?

Typical symptoms include pain that can affect everyday activities.  Motions such as reaching up overhead or behind your back, also putting on or taking off a coat or sweater.

How Is Impingement Syndrome Diagnosed?

It is important that the person experiencing regular shoulder pain has a thorough physical examination by a doctor or physiotherapist. An Xray alone cannot offer all the information required for such a diagnosis but can help rule out changes to the bony surfaces like arthritis or bone spurs, or calcium deposits in tendons. When a physiotherapist is examining the shoulder, they will look at many aspects of how the shoulder is functioning with its range of motion, strength, and muscle tightness but also how your neck and posture can contribute to the problems of impingement, as there are often many factors that need to be addressed.

How Is Shoulder Impingement Syndrome Treated?

Doctors will commonly prescribe anti-inflammatory medications- such as ibuprophen (Advil), or naproxen for example. The issue with solely relying on medications is that they often only address the pain symptoms associated with the impingement while not properly addressing the underlying problem of WHY you have impingement. Avoiding repetitive activities with your injured arm is also common advice, but again, rest alone rarely resolves the shoulder issue especially if eventually you must do that repetitive activity again in the future.

Physiotherapists are able to develop a personalized rehabilitation program often involving both hands-on (manual) therapy and exercise prescription to address the possible postural influences, muscle balance issues and strength deficits a person has.  I tell my clients all the time, you need to be prepared to put work into proper shoulder rehab, rest and meds will hardly ever be the answer for long term resolution of issues.

Common Exercises Utilized in Rehabilitation of Impingement Syndrome

A personalized assessment is always preferred before exercise prescription is given, but there are often certain exercises that are given early in the process because of frequent patterns of muscles tightness and or weakness that are commonly present.

Postural awareness is often a starting point for helping shoulder impingement pain. Many of us sit for much of the day at the computer, others are often working jobs reaching in front of them doing repetitive work which can also result in poor overall posture, especially in the thoracic spine. Our shoulder blades, which are the base of support for our shoulder joint, are greatly affected by thoracic posture. If you are slumped over a computer or leaning over much of the day, your shoulder blades will also sit more forward on your body. This changes the natural orientation of the shoulder joint, thus limiting its full available range of motion. Poor postures will also lead to certain muscles becoming tight and short and others that become lengthened and weak.

I have included a series of exercises that are often given to clients with shoulder impingement syndrome. The first video series are various muscle releases with the use of a tennis/rubber ball, which help to relieve the tension in shortened muscles and help the scapula and head of the shoulder sit in a more optimized position. The second series are strengthening exercises for muscles that help to pull that shoulders blade back in a better position all while maintaining excellent upper back and neck posture. These help to counter the effects the positions that many of our jobs place us in for much of the day.

Good luck, good posture and live well!

Exercise 1: Tennis Ball to Self Massage

Exercise 2: Deep Tennis Ball Massage Against a Wall

Exercise 3: Rotator Cuff Massage

Exercise 4: Theraband

Exercise 5: Theraband Part 2

Written By: Robin Eisler – Physiotherapist