One of the most common reasons people seek physiotherapy consultation is as a result of complaints of shoulder pain and a ‘catching’ feeling that they experience at certain arm positions. Shoulder pain can cause high levels of frustration due to the inability to perform daily tasks. People also experience considerable amounts of stress due to beliefs that surgery might be the only option. The most frequent diagnosis for shoulder pain is subacromial pain syndrome accounting for about 44-65% (Michener et al., 2003).
Subacromial pain syndrome, also called subacromial shoulder impingement, is described as an insidious onset of pain in the front and to the side of the shoulder (Image 1). It is a generic term used to describe pain within the subacromial space. This space is between 1-1.5cm (Michener et al., 2003) depending on the position of the arm and it contains many structures including tendons, ligaments and bursa (Image 2)
Image 1: Image 2:
Image sourced: Breathe Physio &Pilates (2022)
Research distinguishes between two types of impingements, namely primary impingement and secondary impingement. Primary impingement can be due to intrinsic or extrinsic factors. Intrinsic factors involve, but are not limited to, problems with the rotator cuff like weakness or inflammation, bursitis and stiffness of the posterior capsule of the shoulder. Extrinsic factors involve bony growths or poor posture. Secondary impingement is described by (Kachingwe et al., 2008) as a relative decrease in the subacromial space due to shoulder instability of poor movement of the scapula. The exact cause of subacromial impingement is still debated but there is a few contributing factors that can predispose someone to this condition like age, genetics, tendon quality, muscle performance, posture and anatomy.
Management includes physiotherapy and in some cases surgery. Physiotherapy is the accepted first line treatment for subacromial pain syndrome (ketola et al., 2017) and consists of a thorough assessment, hands-on treatment, an exercise programme and education. The physiotherapist will tailor the programme to your specific needs using the latest scientific research. Modifiable risk factors for impingement such as posture, muscle strength and/or muscle flexibility will be addressed during treatment to help relieve symptoms and avoid reoccurring injury.
The treatment focus is on symptomatic relief, increase in the range of movement and an improved quality of life. Research by (Land et al., 2019) has shown promising results following physiotherapy treatment for subacromial pain syndrome showing patients had lasting relief of symptoms with improvement in range, and subsequently increased quality of life.
Shoulder pain can be frustrating and debilitating, however, through physiotherapy treatment symptoms can be relieved and quality of life can be improved.
To book for physiotherapy contact Michelle on 031 765 8898 or book online https://www.debbiecameronphysio.co.za/online-booking
References:
Land, H., Gordon, S. and Watt, K. (2019) ‘Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial’, Physiotherapy Research International, 24(2). doi:10.1002/pri.1768.
Kachingwe, A.F. et al. (2008) ‘Comparison of manual therapy techniques with therapeutic exercise in the treatment of shoulder impingement: A randomized controlled pilot clinical trial’, Journal of Manual & Manipulative Therapy, 16(4), pp. 238–247. doi:10.1179/106698108790818314.
Ketola, S., Lehtinen, J.T. and Arnala, I. (2017) ‘Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy’, The Bone & Joint Journal, 99-B(6), pp. 799–805. doi:10.1302/0301-620x.99b6.bjj-2016-0569.r1.
Marc, T. and Morana, C. (2024) ‘Effectiveness of a joint mobilizations protocol for Shoulder Subacromial pain syndrome: A pilot study’, Journal of Bodywork and Movement Therapies, 38, pp. 574–582. doi:10.1016/j.jbmt.2024.03.072.
Michener, L.A., McClure, P.W. and Karduna, A.R. (2003) ‘Anatomical and biomechanical mechanisms of subacromial impingement syndrome’, Clinical Biomechanics, 18(5), pp. 369–379. doi:10.1016/s0268-0033(03)00047-0.
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