Shoulder impingement treatment

Full Treatment Plan and Details

Who is this treatment for?

If any of the following apply to you, then this treatment plan is for you.

Signs and Symptoms

You can potentially suffer from a wide range of signs and symptoms as there are multiple types of shoulder impingement.

Some of the more noticeable symptoms are:

• Pain[1–3].
• Weakness[4, 5].
• Changes in Range of Motion[5].
• Shoulder fatigue[5–8].

You Tried Conventional Physio, but Are Unhappy with the Results or it did not Work for You

Our research shows that it can be difficult to correctly diagnose the type of shoulder impingement and the underlying cause. Therefore, it is difficult to prescribe optimal conventional physiotherapy individualised to you and thus it is likely you were not given a very well defined exercise program[9]. However, our technology eliminates the need to detect the type of impingement, but can better detect underlying causes, especially if it is rotator cuff related. Therefore, our treatment plan can be better individualised to you and properly target muscles and areas of concern.

Similarly, one of the highly recommended exercises patterns for shoulder impingement syndrome are based on proprioceptive neuromuscular facilitation (PNF)[10]. These are very difficult to perform outside a controlled setting. Therefore, there was no way to ensure you were performing your home exercises correctly. A study by Faber et al.[11] showed that only 24% of subjects who were all student physiotherapists performed exercises correctly. Our Smart devices, ensure you perform your exercises correctly, by guiding the actual motion and timing of each rep.

You Want to Avoid Undergoing Surgery for Shoulder Impingement

The usual step after conventional physiotherapy failure is surgery of some sort. One of the main surgeries for shoulder impingement syndrome is known as subacromial decompression[1]. This involves a permanent change to the tip of your shoulder blade. The underside of the tip is shaved away to make more room inside your joint.

This type of surgery doesn’t always work and patients have reported to continue to suffer from pain or even require further surgery[12, 13]. In addition a review in 2015 showed that surgery is not more beneficial than conservative treatment[14].

We provide an alternative treatment plan that is designed to be far more effective than conventional physiotherapy with the aim to avoid surgery and restore good shoulder health.

You Want to Get Better and Get Better Quickly

You would not be here if you didn’t want this.

Who is this Treatment Not Suitable For?

You Have Not Yet Been Diagnosed to Have Shoulder Impingement

Ideally, you should have been diagnosed with shoulder impingement before you come to us for treatment. However, it is not necessary as our treatment package includes an in-depth assessment of your upper quadrant. This will identify weaknesses and other problems that can be rectified with an individualised treatment plan.

Designed to be Better and Quicker than Conventional Physiotherapy

Best Practice

A multitude of studies have suggested many different types of conservative treatment protocols for shoulder impingement. The most effective protocols include those exercises that are based on PNF, neuromuscular control or motor learning, eccentric loading, stretching and scapulothoracic muscle strengthening[10, 16–20]. Some suggest that neuromuscular control exercises are the best in comparison to the other exercises types[21, 22].

The exercise programs need to be individualised to the patients[23]. Our technology allows for very specific exercise and motion definitions to ensure every exercise prescribed is individualised to you.

References

1. Neer, C. S. I. (1972). Anterior Acromioplasty for the Chronic Impingement Syndrome… : JBJS. American Journal of Bone & Joint Surgery, 54(1). Retrieved from http://journals.lww.com/jbjsjournal/Abstract/1972/54010/Anterior_Acromioplasty_for_the_Chronic_Impingement.3.aspx
2. Castagna, A., Garofalo, R., Cesari, E., Markopoulos, N., Borroni, M., & Conti, M. (2010). Posterior superior internal impingement: an evidence-based review. British Journal of Sports Medicine, 44(5), 382 LP-388. Retrieved from http://bjsm.bmj.com/content/44/5/382.abstract
3. Dines, D. M., Warren, R. F., Inglis, A. E., & Pavlov, H. (1990). The coracoid impingement syndrome. The Journal of bone and joint surgery. British volume, 72(2), 314–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2312576
4. Ginn, K., Cools, A., Lewis, J., & Roy, J.-S. (2015). Shoulder impingement syndrome: how does opinion regarding aetiology influence treatment? Physiotherapy, 101, Suppl, e21–e22. doi:http://dx.doi.org/10.1016/j.physio.2015.03.029
5. Escamilla, R., Hooks, T., & Wilk, K. (2014). Optimal management of shoulder impingement syndrome. Open Access Journal of Sports Medicine, 5, 13. doi:10.2147/OAJSM.S36646
6. Braman, J. P., Zhao, K. D., Lawrence, R. L., Harrison, A. K., & Ludewig, P. M. (2014). Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy. Medical & Biological Engineering & Computing, 52(3), 211–219. doi:10.1007/s11517-013-1074-1
7. Lewis, J. S., Green, A. S., Dekel, S., Kennedy, J., Kennedy, R., Matsen, F., & Staff, P. (2001). The Aetiology of Subacromial Impingement Syndrome. Physiotherapy, 87(9), 458–469. doi:10.1016/S0031-9406(05)60693-1
8. Jobe, F. W., & Jobe, C. M. (1983). Painful athletic injuries of the shoulder. Clinical orthopaedics and related research, (173), 117–24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6825323
9. Toigo, M., & Boutellier, U. (2006). New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. European Journal of Applied Physiology, 97(6), 643–663. doi:10.1007/s00421-006-0238-1
10. Al Dajah, S. B. (2014). Soft Tissue Mobilization and PNF Improve Range of Motion and Minimize Pain Level in Shoulder Impingement. Journal of Physical Therapy Science, 26(11), 1803–1805. doi:10.1589/jpts.26.1803
11. Faber, M., Andersen, M. H., Sevel, C., Thorborg, K., Bandholm, T., & Rathleff, M. (2015). The majority are not performing home-exercises correctly two weeks after their initial instruction—an assessor-blinded study. PeerJ, 3, e1102. doi:10.7717/peerj.1102
12. Chin, P. Y. K., Sperling, J. W., Cofield, R. H., Stuart, M. J., & Crownhart, B. S. (2007). Anterior acromioplasty for the shoulder impingement syndrome: Long-term outcome. Journal of Shoulder and Elbow Surgery, 16(6), 697–700. doi:10.1016/j.jse.2007.02.116
13. Stuart, M. J., Azevedo, A. J., & Cofield, R. H. (1990). Anterior acromioplasty for treatment of the shoulder impingement syndrome. Clinical orthopaedics and related research, (260), 195–200. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2225624
14. Saltychev, M., Äärimaa, V., Virolainen, P., & Laimi, K. (2015). Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disability and rehabilitation, 37(1), 1–8. doi:10.3109/09638288.2014.907364
15. Rockwood Jr., C. A., Matsen III, F. A., Wirth, M. A., & Lippitt, S. B. (2009). The Shoulder (Fourth.). Philadelphia: Saunders Elsevier.
16. Roy, J.-S., Moffet, H., & McFadyen, B. J. (2010). The effects of unsupervised movement training with visual feedback on upper limb kinematic in persons with shoulder impingement syndrome. Journal of Electromyography and Kinesiology, 20(5), 939–946. doi:http://dx.doi.org/10.1016/j.jelekin.2009.10.005
17. Paterson, C., & Sparkes, V. (2006). The effects of a six week scapular muscle exercise programme on the muscle activity of the scapular rotators in tennis players with shoulder impingement—A pilot study. Physical Therapy in Sport, 7(4), 172. doi:http://dx.doi.org/10.1016/j.ptsp.2006.09.004
18. Ortega-Castillo, M., & Medina-Porqueres, I. (2016). Effectiveness of the eccentric exercise therapy in physically active adults with symptomatic shoulder impingement or lateral epicondylar tendinopathy: A systematic review. Journal of Science and Medicine in Sport, 19(6), 438–453. doi:10.1016/j.jsams.2015.06.007
19. Turgut, E., Duzgun, I., & Baltaci, G. (2017). Stretching Exercises for Shoulder Impingement Syndrome: Effects of 6-Week Program on Shoulder Tightness, Pain and Disability Status. Journal of Sport Rehabilitation, 1–20. doi:10.1123/jsr.2016-0182
20. Kamkar, A., Irrgang, J. J., & Whitney, S. L. (1993). Nonoperative Management of Secondary Shoulder Impingement Syndrome. Journal of Orthopaedic & Sports Physical Therapy, 17(5), 212–224. doi:10.2519/jospt.1993.17.5.212
21. Cho, C.-H., Kim, D.-H., & Lee, Y.-K. (2016). Serial Comparison of Clinical Outcomes After Arthroscopic Capsular Release for Refractory Frozen Shoulder With and Without Diabetes. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(8), 1515–1520. doi:10.1016/j.arthro.2016.01.040
22. Moezy, A., Sepehrifar, S., & Solaymani Dodaran, M. (2014). The effects of scapular stabilization based exercise therapy on pain, posture, flexibility and shoulder mobility in patients with shoulder impingement syndrome: a controlled randomized clinical trial. Medical journal of the Islamic Republic of Iran, 28, 87. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25664288
23. Kromer, T., Bie, R., & Bastiaenen, C. (2013). Physiotherapy in patients with clinical signs of shoulder impingement syndrome: A randomized controlled trial. Journal of Rehabilitation Medicine, 45(5), 488–497. doi:10.2340/16501977-1142