Once a physical therapist has determined that your shoulder pain is being caused by the irritation of the muscles, tendons or bursa of the shoulder then a specific plan for your shoulder issue will be devised based on your degree of shoulder irritability and contributing postural faults. The acromion is the bone you can feel at the top of your shoulder. Tendons of the rotator cuff and the bursa can get pinched or impinged under this bone as you raise your arm, resulting in shoulder pain, inflammation and possibly a rotator cuff tear. The primary focus of physical therapy intervention is to increase or “clear” the subacromial space by stretching tight structures and strengthening muscles that assist in proper shoulder motion. Using the theory of “regional interdependence”, the therapist will apply hands on manual therapy techniques to the shoulder and structures around the shoulder including the neck, back, and shoulder blade to restore proper mobility, decreasing the likelihood of impingement. An exercise plan will also be devised based on your shoulder issue to strengthen the rotator cuff and the muscles of the shoulder blade to help heal the injured tissues and improve muscle control to reduce irritation under the acromion with reaching activities.
Evidence based interventions for shoulder impingement have been proven to be effective in reducing pain and improving shoulder function by research studies. Manual therapy, including mobilizations or manipulation to the shoulder and surrounding joints with exercise has been proven by many studies to be effective in restoring function and improving pain in patients with shoulder impingement (1,2,3,4,5,6,7,8). Exercises that have been designed specifically for patients with shoulder impingement include: stretches to restore anterior and posterior shoulder flexibility, strengthening exercises for the rotator cuff and stabilizing muscles of the shoulder blade, and progression to functional exercises that are specific to the task the patient needs to perform (6,9). These exercises are designed to restore proper balance in muscle tension and proper motion of the shoulder and shoulder blade which work together to allow for pain free reaching. Proper muscle or “motor” control is facilitated by specific exercises designed to make the muscles around your shoulder work together to prevent impingement. These interventions and exercise progression are designed by your physical therapist specifically to address your individual needs.
References 1. Kachingwe et al, 2008; 2. Boyles et al, 2008; 3. Strunce et al, 2010; 4. Ludwig et al, 2004; 5. Bang et al, 2000; 6. Tate et al, 2010; 7. Kramer et al, 2009; 8. Michener et al, 2004; 9. Reinold et al, 2009