Physiotherapy for Impingement
K Roney & L Funk
Physiotherapy is usually the first line of treatment for subacromial impingement (tendonitis, bursitis) of the shoulder; along with anti-inflammatories and analgesia.
Treatment should begin locally and move globally as needed in order to achieve full function and the best result possible. Posture and scapula setting is important to correct in order for the joint and muscles to function in the position and at the length they were designed to therefore improving efficiency and facilitating correct force couples within the joint and surrounding tissues. It improves joint mechanics making it less likely that the greater tuberosity will come into contact with the acromion. Improving capsule flexibility will allow the head of humerus to translate / glide more easily within the joint.
Using the patients own lifestyle and normal demands in order to change posture and strengthen the appropriate muscles is very important because the demands on any one person are very different to the next. It also allows us to address the correct muscles for that individual. By incorporating normal ADL into the exercise regime for example: reaching forward for the telephone or up to a shelf with correct posture / position and facilitation of posterior cuff muscles (eg pretending that they are pushing the back of their hand against a wall at the same time as reaching forward) means that this exercise can be done several times a day without them having to take timeout. You are also building up stamina in a movement they do on a regular basis. Resistance can be added to this in the form of theraband and copying the specific movement pattern.
Taping is an effective way to achieve posture and movement correction. It gives useful proprioceptive feedback for the patient. A lot of the treatment is looking at changing learned movement patterns and posture. This often means a life style change and as the body adapts to pain / functional depends without us being aware of it and becomes an established normal, patients often do not have a clue where their body should be in order to perform the exercises given. Weight bearing activities provide good proprioceptive feedback eg pushing a ball up down a wall. Leaning on a gym ball whilst doing something else with the good hand. Always ensuring good scapula position etc. These are the places to look when progress is not as expected or a plateau has been reached. Particularly the AC joint for that persistent EOR pain. Looking more globally may be the answer but remember ‘Pandora’s Box’ and ‘What is normal?’
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