SHOULDER IMPINGEMENT SYNDROME

Jesse Totoro

HOW DOES SHOULDER IMPINGEMENT DEVELOP?

Anatomical Mechanisms Biomechanical Mechanisms

GOALS OF TREATING SHOULDER IMPINGEMENT

Short Term:-Rest-Reduce Pain-Reduce Inflammation-Begin ROM exercises-Begin resistance exercises

Long Term-Full ROM-Full Strength-Pain free-Psychologically prepared for safe return

REHABILITATION PROTOCOL

A progressive rehabilitation protocol based on the healing phase should be implemented:

-Inflammatory Phase (0-2 weeks)-Sub-Acute Phase (2-4 weeks)-Tissue Remodeling Phase (4-6

weeks)

INFLAMMATORY PHASE

Goals:-Rest-Reduce pain-Reduce any inflammation-Begin ROM exercises (within pain tolerance)

Modality for pain modulation (Ice and E-Stim) Flexibility Criteria for progression

-Pain starts to decrease-Inflammation becomes reduced-Exercises become too easy for the athlete

FLEXIBILITY

Important factor in the rehabilitation process

Can help decrease the onset of re-injury

Helps to increase performance Should not be performed with acute

pain

FLEXIBILITY

Sleeper Stretch-Can be

performed at 70, 90, and 110 degrees of motion.

Biceps -Make sure

palm is facing up when performing this stretch.

SUB-ACUTE PHASE

Goals:-Continue with stretching protocol-Introduce CV endurance (elliptical for upper

extremity)-Continue to reduce pain/inflammation-Continue to increase strength and ROM

Joint Mobilizations Resistance Training can begin Continue with modalities to modulate pain Criteria for Progression:

-Athlete feels significant reduction in pain-Significant improvements in ROM-Very little to no swelling-Athlete is not challenged by resistance exercises

JOINT MOBILIZATIONS

Swelling reduced Provides a precise stretch Tensile forces applied over time 2-3 oscillations per second Allowing capsular tissue to remodel in

an elongated position. Remember the convex/concave rule!!!

JOINT MOBILIZATIONS

Inferior Glide Posterior Glide Anterior Glide Long Axis Traction

RESISTANCE EXERCISES

Progress from light to heavy resistance Easy to complex exercises Stable to unstable surfaces Do not perform resistance training with

acute pain!!

STRENGTHENING EXERCISES

Theraband/Theratubing Exercises Scapular Stabilizer Strength

MANUAL THERAPY

D1 and D2 patterns

REMODELING PHASE

Goals:-Begin more sport specific exercises-Throwing program-Overhead activities-Acquire full ROM-Pain free-Full strength

Athlete should be preparing for functional testing and RTP

FUNCTIONAL TESTING AND RTP

Functional test should include sport specific maneuvers (throwing, blocking, tackling, etc.)

Athlete should meet the following criteria before RTP:-Ability to have full ROM -Perform all overhead tasks the sport demands -NO PAIN!!-Full strength (specifically rotator cuff musculature)-Should be able to perform all tasks at full speed

CONCLUSION

Don’t do too much too soon!! Stretching, Stretching, and more

Stretching!! Be creative with rehab!!

QUESTIONS

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REFERENCES

Michener L, McClure P, Karduna A. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics. 2003;18:369-379.

Conroy D, Hayes K. The effect of Joint Mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther. 1998;28:3-14.

Bang M, Deyle G. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;30:126-137.