Physical Therapy Guide to Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs as the result of chronic, repeated compression of the rotator cuff tendons. These include the long head of the biceps tendon, the bursa, or the ligaments in the shoulder. This impingement causes pain and movement problems. An injury to the shoulder also can cause this condition. People who do repeated overhead arm movements are most at risk for developing a shoulder impingement. It occurs more often among manual laborers and athletes. Poor posture also can contribute to its development.

What Is Shoulder Impingement Syndrome?

Shoulder impingement syndrome develops when tendons, ligaments, or bursa in the shoulder are repeatedly compressed or “impinged.” This causes pain and movement problems. The shoulder is made up of three bones, called the:

• Humerus (the long bone of the upper arm).

• Scapula (shoulder blade).

• Clavicle.

Shoulder impingement syndrome also may be called "subacromial" impingement syndrome. The rotator cuff tendon and the bursa sit beneath the acromion (a bony, bump-like prominence at the tip of the shoulder). Over time, these tissues can become compressed or pinched under the acromion:

• Rotator cuff tendons. These tendons are often the most affected by this condition.

• Long head of the biceps tendon.

• Ligaments.

• Bursa (a fluid-filled sac that provides a cushion between the bony acromion and the rotator cuff tendon.

Impingement symptoms also can occur when compression and microtrauma harm the tendon.

How Can a Physical Therapist Help?

It is important to get proper treatment for shoulder impingement syndrome as soon as it occurs. If left untreated, secondary conditions can result from it, including:

• Irritation of the bursa.

• Rotator-cuff tendinitis or tears.

Physical therapy can successfully treat shoulder impingement syndrome. Your physical therapist will work with you to devise a treatment plan that is specific to your condition and goals. Your personalized treatment program may include:

• Patient education. Your physical therapist will educate you about your condition. They will work with you to identify any external factors causing your pain. They may recommend changes to the type and amount of exercises you perform, your athletic activities, and your home or work activities. They will develop a personalized exercise program to help ensure a pain-free return to your desired activities.

• Pain management. Your physical therapist will design a program to address your pain that includes applying ice to the affected area. They also may recommend changing some activities that cause pain. Physical therapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medicines, including opioids.

• Range-of-motion exercise. The mobility of the shoulder joint and scapula can be limited. This causes increased stress to various structures. Your condition may be forcing the shoulder to work at a disadvantage. Your physical therapist may teach you self-stretching techniques to decrease tension and help restore normal motion of the shoulder region and arm function.

• Manual therapy. Your physical therapist may treat your condition using “hands-on” treatments (manual therapy) to gently move your muscles and joints. These techniques help improve motion. They also may be used to guide the region into a less stressful movement pattern.

• Muscle strengthening. Muscle weaknesses or imbalances can contribute to impingement of the shoulder joint as the scapula deviates due to weakness. Based on the level of your injury, your physical therapist will design a safe, personalized, progressive resistance program for you. It may include your core (midsection). You may begin by performing strengthening exercises lying on a treatment table or at home on the bed or floor. You then may advance to exercises in a standing position. Your physical therapist will choose what exercises are right for you, based on your age and physical condition. Your plan may include using resistance machines at the clinic. Your physical therapist also will determine if going to a gym is appropriate.

• Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the stress to the shoulder joint, it is important to teach your body safe, controlled movements. Based on your movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely. These may include retraining of activities such as throwing, swinging a racket, or a work activity.

Can This Injury or Condition Be Prevented?

Shoulder impingement syndrome can be prevented by:

• Maintaining proper strength in the shoulder and shoulder-blade muscles. A healthy shoulder relies on the proper balance of muscle strength in the shoulder region. If there is an imbalance in muscle strength, over time, there is an increased risk for impingement and injury.

• Maintaining proper shoulder, neck, and middle-back range of motion and mobility. The shoulder relies on the mobility of neighboring joints to maintain healthy, proper function.

• Keeping proper posture and using proper shoulder mechanics when reaching and throwing. This reduces the likelihood of shoulder impingement and reduces excessive stress on the shoulder.

• Avoiding forward-head and rounded-shoulder postures (such as spending a lot of time hunched over, sitting at a computer). Poor posture habits put the shoulder in positions that increase the chances for an impingement.

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