Effective Exercises For Young Adults With Shoulder Impingement

Shoulder injury can be debilitating, painful and have a direct effect on a person’s quality of life. Unfortunately shoulder injuries are still quite common, both in athletes and the general population. A majority of these cases stem from either chronic overuse or acute trauma to the shoulder, arm, neck or upper back. This results in a wide variety of possible injuries and the need for an even wider variety of effective treatments.

One of the most common conditions seen in people who present with shoulder pain is known as shoulder impingement syndrome. Impingement accounts for 74% of chronic shoulder pain.
Impingement is often persistent and recurrent, with 40%-50% of sufferers having symptoms that last over 6 months, and 14% of sufferers continuing treatment after 2 years.

groupboxingThe cause of shoulder impingement is still hotly debated, although most agree that it involves a number of contributing factors and structures. Several suggestions for the cause of shoulder impingement include a lack of space between the humeral head and the acromion, rotator cuff injury or abnormality, muscular imbalances, glenohumeral instability and postural considerations.

The treatment of shoulder impingement is a highly diverse area. A majority of cases will be managed with physiotherapy in the early stages.

Evidence suggests that motor control and strengthening exercises can significantly improve a patient’s functional movement and decrease pain. There are many more physiotherapy based treatments which are still in the process of being assessed for their effectiveness though randomised controlled trials. If physiotherapy is not effective in resolving shoulder pain and restoring function, surgery is often indicated. As surgery carries with it the inherent risks associated with any invasive procedure and is likely to produce results that are similar to physiotherapy treatment, it is essential to ensure that all treatment modalities have been explored before surgery is undertaken.

A study has assessed the effectiveness of using motor control retraining exercises to restore function, improve muscle activation patterns and develop efficient biomechanics in the treatment of shoulder impingement syndrome. This study involved retraining the muscles around the shoulder and scapula (shoulder blade) in order to keep the scapula in an optimal position during movement though a range.

 

scapuladyskinesis

In this study patients were given muscle retraining exercises that were completed while adjusting for feedback received via either a mirror, a physiotherapist or kinaesthetically. Specific exercises for the retraining of trapezius and serratus anterior were also given to patients as these muscles were noted to have abnormally delayed activation and early termination when observed using electromyography.

Both scapulothoracic muscle retraining exercises were completed for two minutes, twice per day, for a period of 10 weeks. Patients were observed by a physiotherapist once every 2 weeks to ensure that the exercises were completed correctly. Physiotherapists also utilised mobilisation techniques to correct soft tissue imbalances that may have affected the position on the scapula.

 

An exercise based physiotherapy intervention was effective in significantly reducing chronic pain associated with shoulder impingement. Post-intervention tests showed a mean decrease of 3.4 points on the Visual Analogue Scale (measuring pain), a mean improvement of 10 points in the Shoulder Pain and Disability Index. Electromyography results suggested that the effects of early muscle termination and delayed muscle activation were significantly decreased in the serratus anterior and trapezius muscles.

Overall this study serves to provide strong evidence for the use of specific exercise in the treatment of shoulder impingement syndrome. It also highlighted the need for further research into the mechanism of recovery, as it appears to involve improvements in muscle recruitment patterns, scapular kinematics, muscle strength and neurological control.

Worsley, e. a. (2012). Motor control retraining exercises for shoulderimpingement: effects on function, muscle activation,and biomechanics in young adults. Journal of Shoulder and Elbow Surgery, 1-9.

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