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1st Jun

2013

Physical Therapy to Stop Shoulder Impingement

Shoulder pain from impingement occurs frequently, as the rotator cuff tendons and at times a bursal sac get pinched, most often under the roof of the shoulder blade, called the acromion. People with a downward slope of this acromion, or who have developed bone spurs from arthritis in the adjacent AC joint, are more susceptible to developing such impingement.

The mechanism causing this disorder may be a gradual or sudden elevation of the ball of the shoulder joint, squishing the described soft tissues against the acromion roof. The rotator cuff muscles are responsible for keeping the ball down and away from the roof as we elevate the arm.

Many people develop weakness of their rotator cuff and muscles which stabilize the entire shoulder blade. This can be sufficient to lead to impingement syndrome if we repeatedly reach up during daily activities, or if we lift or throw overhead. A slouched posture with rounded shoulders also significantly reduces the rotator cuff’s ability to generate strength and power, and can contribute to this condition.

In most cases, physical therapy is the first choice of treatment, with or without prescribed medications or cortisone injection. The initial goal is to reduce the tissue irritation and stop the pattern of continuous impingement. This usually entails instructions in correct posture, with a more erect trunk and shoulder blades pulled back slightly, as needed, and instructions to stop any aggravating activities, such as reaching up or out with the arm, and pain provoking exercises. Such exercises may include overhead throwing or racquet sports, pull-down weight exercises, bench or military presses, push-ups, aerobic exercise classes with hand weights, etc.

In physical therapy, it is common to find lazy and weak muscles which support, or stabilize the shoulder blade, which can be addressed with specific exercise. The rotator cuff itself, and sometimes the long part of the biceps can be exercised with slow, high repetition movements with perfect coordination, and light resistance, without causing pain. Initially, these muscles may have very poor oxygen uptake, and the work load must not cause oxygen debt, or the tissue irritation will increase. This can easily occur with equipment which do not allow for the exercise tension to be precisely measured, such as elastic bands.

As the tissue irritation decreases, and the muscle endurance improves of the shoulder blade muscles and rotator cuff, the exercises can be progressed to strengthening and more functional exercises with the arm elevated more, as long as there is good coordination and no pain. Gradually, the person can return to normal activities, a process which may take 2-3 months. Insufficient improvement may indicate need for decompressive surgery.

These problems are very common, yet often people are told by their doctors to simply rest and take anti-inflammatory medications, which tend to produce temporary results only. If you know someone who is suffering from shoulder pain, you may want to forward this letter to them, and mention the free consultation offer that you can find on our webpage www.mossbergpt.com.

With best wishes for continued good health,

Gunnar

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