by John Perone, BKin., RMT, MPHTY
A recent study by Canadian researchers proves what kinesiologists and physiotherapists have known for some time; exercise therapy helps patients with shoulder impingement syndrome recover pain-free movement.
Researchers discovered, however, that the effects of exercises quickly diminished after 24 hours suggesting that single training sessions in the beginning are simply not enough. In order to have a permanent effect the exercises must be practice many times over.
It is estimate that near 50% of all patients seeking medical help for shoulder pain have some sort of impingement syndrome. The muscle most commonly implicated is the supraspinatus followed closely by the infraspinatus and subscapularis muscles. Impingements can happen under several of the boney structures of the shoulder.
Very commonly patients with this syndrome also have very weak shoulder stabilizers. This causes the scapula to sit improperly on the upper rib cage and leads to postural imbalances resulting in the entrapment of the muscle tendons under the shoulders various boney structures. Improper shoulder stabilization is termed scapular dyskinesis (see picture to the right) and is often a cause of scapular winging.
This mal-alignment of the scapula can lead to pain when lifting the arm overhead or lowering from an overhead position and in common reaching tasks. If it becomes chronic patients may also experience pain while at rest. In many cases the mal-alignment of the scapula can be in response to a direct-blow or injury, whereby the stabilizer muscles of the shoulder lose their stability role, but it can also and often does precede injuries.
The impingement or constant wearing of the tendons of the muscles of the rotator cuff can eventually lead to tears and further shoulder damage causing excessive inflammation and more of the pain cycle. Left unchecked this will eventually require surgery, and a very involved rehabilitation process. The obvious implication is preventing this occurrence is of utmost importance in those who are already experiencing consistent shoulder pain, or those with pain upon movment; particularly with arm movements overhead and with reaching and lifting tasks.
This can be accomplished with an appropriate thorough assessment by your physiotherapist or kinesiologist, followed with a clearly outlined and progressed shoulder stability training routine.
Training is maximized when your therapist involves visual, manual and verbal feedback on specific shoulder and arm movements to properly entrain the correct movement sequence for shoulder stability, and as the study below confirms regularity with your training schedule is imperative to return the shoulder to proper function. Therefore a well designed home-routine that patients can carry out independently should be a part of every shoulder training regimen.
If you are experiencing regular shoulder pain, or pain with arm movements overhead and in common reaching tasks, schedule an appointment to see your registered physiotherapist at Cross Roads Physiotherapy and Massage Therapy today at (604) 568-1337.
1. Roy JR, Bradford HR, McFadyen J, Lirette R (2009). Impact of movement training on upper limb motor strategies in persons with shoulder impingement syndrome. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 1(1), 1-8.