Shoulder - Understanding Sub-Acromial Impingement

Shoulder - Understanding Sub-Acromial Impingement

Breathe Life Into Your Shoulder: Physiotherapy for Impingement Pain

Shoulder Pain can disrupt even the simplest of daily activities, from brushing your hair to reaching for an item on a shelf. One common culprit behind this discomfort is Sub-Acromial Impingement. It is a common shoulder condition that occurs when the tendons of the Rotator Cuff  or the Bursa (fluid filled sac in the joint) in the shoulder become irritated or compressed by the surrounding bones. It can result in pain, limited movement, and difficulty performing daily activities. 

What is a Sub-Acromial Impingement?

Sub-Acromial Impingement refers to the mechanical compression of soft tissues - specifically, the Rotator Cuff tendons and the Sub-Acromial Bursa - between the acromion (part of the shoulder blade) and the humeral head (top of the upper arm bone). This pinching can lead to inflammation, pain, dysfunction of the shoulder and, over time, may lead to tears in the Rotator Cuff or Bursitis (inflammation of the Bursa).

Who Is at Risk?

There are different types of people who are more likely to experience Sub-Acromial Impingement and they can be categorized as:

• People with Poor Posture: People engaging in a lot of desktop based roles along with an incorrect posture.

• Athletes: Especially those involved in sports that require repetitive overhead motions (e.g., swimming, tennis, cricket).

• Manual Labourers: Workers who perform overhead tasks regularly, such as decorators, painters, tree surgeons, construction workers, electricians or warehouse employees.

• Older Adults

How Does Impingement Happen?

Several factors contribute to the development of Sub-Acromial impingement:

• Repetitive Overhead Movements: Frequent overhead motions, such as those seen in athletes (e.g., swimmers, cricket players, and tennis players), can increase the risk of impingement.

• Poor Posture: Slouching or rounded shoulders can reduce the space in the subacromial area, increasing pressure on the Rotator Cuff tendons.

• Shoulder Instability: Individuals with weakened and tightened tissues or imbalanced shoulder muscles are more likely to develop impingement due to instability in the shoulder joint.

• Age-Related Degeneration: Over time, the tendons of the Rotator Cuff may weaken, failing to support the joint properly thereby leading to a higher risk of impingement, especially in individuals over the age of 40.

• Structural Abnormalities: A hooked acromion or other structural variations like extra bony growths in the shoulder joint can increase the likelihood of impingement.

Signs and Symptoms

The most common symptoms of Sub-Acromial Impingement include:

• Shoulder Pain: Pain in the front or outer part of the shoulder, especially when reaching overhead or lifting the arm.

• Pain and Weakness: Pain that intensifies and a noticeable decrease in shoulder strength with overhead movements, such as reaching, lifting, or throwing.

• Limited Range of Motion: Difficulty raising the arm above the head or reaching behind the back causing stiffness.

• Night Pain: Discomfort or pain in the shoulder while lying on the affected side, often interfering with sleep.

The Role of Physiotherapy in Treatment

At Chester’s Best Physiotherapy Clinic for Shoulder Pain, we understand that Physiotherapy plays a vital role in the conservative treatment of Sub-Acromial Impingement by focusing on pain management, restoring function, and preventing recurrence. The following Physiotherapy strategies can help:

1. Manual Therapy

• Joint mobilisations: Gentle manipulation of the shoulder joint can help improve mobility, reduce pain, alleviate stiffness and restore proper function.

• Soft Tissue massage: Myofascial release and other targeted soft tissue techniques help relax tight muscles and improve blood flow around the shoulder, speeding up the healing process.

2. Pain Management

• Rest: In the early stages, it’s essential to rest the shoulder and avoid activities that provoke pain, especially overhead movements - allowing the shoulder to heal.

• Ice application: Applying ice packs for 15-20 minutes several times a day help reduce inflammation and pain in the shoulder.

• Ultrasound Therapy: Uses soft sound waves for a localised effect and promote healing in inflamed or damaged tissues.

3. Taping and Bracing

This helps stabilize the shoulder, improve alignment, and reduce strain during activity.

• Kinesiotaping: Taping can provide additional support to the shoulder, reducing strain on the tendons and helping to relieve pain during movement.

• Shoulder braces: For more severe cases, a brace may be used to support the shoulder and restrict movement, allowing the tissues to heal.

4. Advanced Techniques 

• Injections: Corticosteroid injections is used for reducing the inflammation and pain faster thereby helping one push their limits with manual and exercise therapy and work on the root cause of the pain.

• Acupuncture: Reduces pain, inflammation, and muscle tension, while improving circulation and range of motion in the shoulder. It also promotes healing through the release of endorphins, enhances overall mobility hence supporting the rehabilitation efforts.

• Surgery: In persistent cases, arthroscopic surgery may be considered.

5. Exercise Therapy

• Strengthening Exercises: Focused on the Rotator cuff and Scapular (shoulder blade) stabilizers to support the joint, improve overall shoulder stability, reduce stress on the Rotator Cuff tendons and prevent further impingement.

• Stretching: Designed to improve flexibility in the chest, shoulder, and back, reducing strain on the sub-acromial space.

• Range of Motion (ROM) Exercises: To gradually restore full, pain-free shoulder movement without stressing the tendons in the shoulder.

6. Posture, Ergonomics and Modifications

• Addressing poor posture is key to improving shoulder alignment and increasing space in the subacromial area. Our Physiotherapists help correct poor posture by recommending exercises and strategies to promote a more neutral shoulder position.

• Activity modification and proper ergonomics is often key to long-term management. This includes proper ergonomics and workstation adjustments or techniques for lifting and carrying objects to reduce strain on the shoulder. 

• Gradual return to activities is encouraged.

7. Functional Rehabilitation

For those looking to return to sports or physically demanding work, our Physiotherapists provide sport-specific or task-specific training to enhance performance while minimising stress on the shoulder.

Self-Management and Prevention

Hydrotherapy: Exercises performed in water to reduce joint stress while promoting movement.

Maintain Proper Posture: Avoid slouching and ensure your workstation is ergonomically friendly.

Perform Gentle Exercises: Engage in pain-free movements to keep the shoulder active without exacerbating the condition.

Warm-Up Before Activities: Prepare your shoulder muscles before engaging in sports or strenuous tasks.

Avoid Overuse: Give your shoulder adequate rest between repetitive movements or heavy lifting.

With a combination of self-care, Physiotherapy, and medical interventions, Sub-Acromial impingement is highly manageable, allowing individuals to return to pain-free movement, regain the quality of life and prevent recurrence. Early intervention and a personalized rehabilitation program are key to achieving long-term shoulder health and function.

Happy recovery!