Outline of a rehabilitation program for shoulder impingement syndrome.
Aims of rehabilitation
The aim of a shoulder impingement syndrome rehab program is to reduce pain and inflammation, improve or maintain mobility of the shoulder, strengthen any weak muscles and correct postural problems before returning to full fitness.
Reducing pain and inflammation
- Rest from all aggravating activities, especially those involving overhead movements. Every time you catch the tendons in the joint causing pain you may be making the condition worse. Maintain aerobic fitness on a stationary cycle.
- NSAID's (Non-Steroidal Anti-Inflammatory Drugs) e.g. Ibuprofen may be prescribed by a doctor. Athletes with asthma should not take Ibuprofen. The drugs may help in the early stages of rehabilitation (first few days) but longer term is unlikely to help as much.
- Apply ice to the painful area for the first few days. 15 minutes at a time, every 2-3 hours.
- This period of rest, icing and anti-inflammatory medication should last up to a week.
Mobility & stretching
- Full mobility of the shoulder joint is key in the rehabilitation of this injury. If there is insufficient mobility in the joint then the condition is likely to reoccur as the shoulder will not function correctly and allow enough space for the tendons to exist.
- Mobility exercises should begin as soon as pain will allow and should avoid any areas of movement that do cause pain.
- Generally, any movements that involve lifting the arm out to the side (abduction) above horizontal should be done with the arm rotated outwards. The same applies to movements lifting the arm up forwards (flexion).
- Stretching is also very important. Stretches should be held for 30 seconds at a time.
- Sports massage can be used to help relax any tight muscles, such as the rotator cuff and upper back muscles.
- These exercises can begin after 2-3 days, provided they are pain-free.
- They should continue throughout the rehabilitation programme and beyond.
- Strengthening the rotator cuff muscles is the key to strengthening the shoulder.
- It is important to get an equal balance of strength between the external and internal rotators at the shoulder. It is thought that an imbalance of strength here will contribute to the likelihood of impingement.
- Strengthening exercises can begin after a week or so's rest and mobility exercises, provided they are pain-free.
- You should start with gentle rotator cuff strengthening exercises, with the arm by your side.
- Strengthening should be progressed gradually throughout the programme as pain allows.
Correcting postural issues
- Shoulder impingements are common in individuals with poor posture and scapula (shoulder blade) movement dysfunctions.
- This is commonly caused by tightnesses in the chest muscles (especially pectoralis minor), which pull the shoulder blade forward.
- Also, weakness in the upper back muscles, particularly serratus anterior, which allows the shoulder blade to be pulled forward by the chest muscles.
- Working on improving the posture can begin from day one, through demonstrations of good posture and chest stretching.
- This can be progressed to include scapula setting and stabilisation exercises.