As a complex joint, the shoulder can be injured in various ways. Subacromial impingement syndrome is considered one of the most common shoulder injuries³. Considering the many repetitive elevation movements performed by the upper limbs as part of everyday life, shoulder pain is often associated with injury to the rotator cuff. Impingement occurs in cases of mechanical conflict between the tendons of the rotator cuff and the acromion; space is reduced when the shoulder is raised. If this impingement persists, the individual may suffer from tendonitis of the rotator cuff. The supraspinatus is the rotator cuff muscle most often injured during repetitive elevation, abduction and external rotation movements causing it to abut against the bony point of the acromion.
Factors that increase the risk of impingement
Stiffness of the posterior glenohumeral capsule
Poor positioning or decreased mobility of the shoulder blade
Postural changes, such as cervical protraction (Forward Head Posture) or thoracic kyphosis
These changes affect the biomechanics of the shoulder when the humerus is elevated, irritating the subacromial tissues. In physiotherapy, we assess the entire upper quadrant: the cervical and thoracic regions, including the ribs, the shoulder complex (the acromioclavicular, sternoclavicular, scapulothoracic and glenohumeral joints) and the other joints of the upper limb (elbow and wrist). The most commonly used diagnostic tests for shoulder impingement syndrome are the Hawkins-Kennedy test, the painful arc test, and the resisted external rotation test.
Manual therapy combined with supervised exercises yields better results (increased strength, decreased pain and improved functional status) than exercises alone¹.
Mobilizations: specific and global joint mobilizations
Given the research results proving the importance of trying conservative treatment options, such as physiotherapy, before considering surgery², consult the professionals at Kinatex for a detailed assessment of your condition and a customized treatment plan!
1. BANG md, Deyle GD, Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome, Journal of Orthopaedic & Sports Physical Therapy 2000; 30(3) : 126-127.
2. Komer TO, Tautenhahn UG, Bie RA, Staal JB, Bastiaenen CH, EFFECTS OF PHYSIOTHERAPY IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A SYSTEMATIC REVIEW OF THE LITERATURE, J Rehabil Med 2009; 41: 870-880.
3. Lewis, JS, Wright, C, Green A, Subacromial Impingement Syndrome: The Effect of Changing Posture on Shoulder Range of Movement, Journal of Orthopaedic and Sports Physical Therapy 2005; 35(2): 72-87.
4. Ellenbecker TS, Colls A, Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review, British Journal of Sports Medicine 2010; 44: 319-327.