Why You Should Seek Treatment For Subacromial Impingement Syndrome

Shoulder pain is a common problem among adults and is often a symptom of an underlying shoulder condition such as subacromial impingement syndrome. When left untreated, degeneration of the rotator cuff tendons and aberrant muscle patterning can progress, leading to more joint pain and restricted range of motion that can reduce one’s quality of life. Thus, early detection and prompt rehabilitation of the causes of shoulder dysfunction is vital for the management of subacromial impingement syndrome.

Natural history of subacromial impingement syndrome:

Subacromial impingement syndrome is generally caused by dysfunctional overhead arm movements. This shoulder condition is closely linked to the deterioration of the rotator cuff and surrounding tissues and incidence progresses with age. Work or athletic activities characterised by repetitive overhead arm movements such as weight lifting, swimming, tennis, painting, mechanical repair and stocking shelves can increase one’s risk of developing shoulder impingement syndrome. The following stages are based on Dr Charles Neer’s now outdated model. For a more modern perspective click here.

Stage 1: Impingement can initially involve acute bursitis or inflammation of the bursa, the fluid-filled pocket below the acromion which facilitates joint movement at the shoulder. It is accompanied by oedema and haemorrhage under neath the acromion. If extrinsic (subacromial) compression of the rotator cuff and bursa continues, bursal adhesions and rotator cuff tendinopathy will ensue.

Stage 2: The second stage most commonly involves injury to the supraspinatus tendon, which makes up the top portion of the rotator cuff. When the fibres of the tendon become frayed, a partial-thickness tear may develop.

Stage 3: Over time, the partial thickness tear can progress to full-thickness or complete tear of the tendon that can disable movement of the affected shoulder.



Subacromial impingement syndrome can be treated both conservatively, through specific exercise or via arthroscopic shoulder surgery to minimise the effects of any mechanical obstacles under the acromion, for example bones spurs, inflamed bursa or partial thickness cuff tears or fraying tendon. Physiotherapy through a supervised exercise programme is ideally the first treatment option that when undertaken at an early stage, can be an effective treatment plan that may eliminate further need for surgery. A physiotherapist supervises a series of exercises aimed at helping the patient to:

  • Relearn normal movement patterns while elevating the arm
  • Reduce subacromial stress loading and remodel collagen tissue
  • Retrain conscious rotator cuff and scapular muscle activation to avoid unwanted joint motion
  • Low load endurance training to strengthen shoulder muscles and tendons of the rotator cuff

The physiotherapist will gradually incorporate home or gym based self-directed exercises that the patient can perform to boost rehabilitation. Improvement can occur after several weeks of consistent treatment sessions but for longer lasting results a graduated rehabilitation program of at least 3 months is required.

Shoulder pain arising from subacromial impingement syndrome can lead to more serious damage in and around the shoulder joint. Prompt treatment and rehabilitation can prevent further degeneration of damaged tissues and tendons and restore the shoulder’s range of motion for a pain-free way of life.

One such treatment program with proven results is SuperFastShoulders


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