Physiotherapy for Sub-acromial Impingement
Background treatment and self-physiotherapy
Physiotherapy
Physiotherapy has a fundamental role in the background treatment of subacromial impingement, whether pre-operatively or after surgical intervention.
Chronic shoulder pain tends to create diffuse muscle contractures of peri-scapular muscles notably at the expense of the trapezius, latissimus dorsi, pectoralis minor but also teres minor and major.
These chronic muscle contractures can be at the origin of a vicious shoulder position with a tendency most often to a shoulder displaced forward and upward.
This is a true vicious circle since the pseudo analgesic position of the shoulder (itself related to subacromial impingement pain) will stimulate and maintain this same subacromial impingement.
The goal of physiotherapy will therefore be to get out of this painful and inflammatory vicious circle to find good shoulder positioning and thus stop abnormal friction of tendons against the deep face of the acromion.
The main goal of physiotherapy will be shoulder recentering work.
At the same time it will be fundamental to work the balance between different shoulder muscles, the goal being to find coordination and muscle and motor synchronization that will allow harmonious movement performance during arm elevation.
Note that this is a long-term work for which patience will be necessary, indeed as it is most often a chronic problem, physiotherapy will also need to be performed for several months.
Self-Physiotherapy
Self physiotherapy corresponds to all active or passive mobilization activities that the patient will be able to perform by himself outside conventional physiotherapy sessions.
The goal is absolutely not to substitute for classic physiotherapy sessions but it is a fundamental complement for shoulder function recovery in the context of subacromial impingement, whether pre-operatively or after surgical intervention.
Fundamental principles
Work without pain
This is a crucial element. Shoulder physiotherapy work must be done with quasi-total absence of pain. In case of pain during an exercise, the exercise performed must be stopped, try another exercise that will be less pain-producing or retry the exercise after a few hours.
Very regular work
We most often advise to work minimum 5 minutes 5 times per day every day. It is important to perform short-duration exercises but in a multiple daily manner to avoid occurrence of painful phenomena and progress in the best conditions.
Work guided by the physiotherapist
Do not hesitate to ask the physiotherapist for exercises to perform at home but also confirm with him the good performance of these movements. The physiotherapist must show, explain and control that exercises are performed correctly and without pain.
Passive or Active-Assisted Mobilization Exercises
The pendulum
Bent forward, the operated (or pathological) arm is left in vertical position then light circular movements are performed. The goal being relaxation of different muscles around the shoulder notably the trapezius, latissimus dorsi and pectoralis minor. There is strictly no interest in performing wide movements or large circles.
Self-elevation of the arm
In lying position, the hand or wrist of the operated side is grasped with the other hand, then elevation movements of the hand and arm are performed first vertically then progressively trying to pass behind the head. Beyond 100° of elevation, the weight of the arm will help elevation above the head.
Neck/shoulder mobilization
This is active mobilization both at cervical level but also at shoulder level. For cervical mobilization, the head will be turned slowly from left to right and from top to bottom to relax para-cervical muscles as well as the trapezius.
Active shoulder centering work
Pulling exercises between shoulder blades
A soft low-resistance elastic will be used that will be attached to a fixed point (for example a door handle). The goal will be to perform pulls on this elastic with both arms at the same time. The work will be centered essentially on muscles between shoulder blades, the back must be kept straight.
External rotation work
Still with a low-resistance elastic attached to a fixed point, position yourself sideways relative to the fixed point. Grasp the elastic in the hand on the operated side then perform external rotation movements with the elbow remaining against the body.
Fight against vicious positions and self-massage
Abnormal shoulder positions must be avoided most often with the shoulder displaced upward and forward. Work on opening the thoracic cage and scapular chain. Use of a self-massage roller can allow relaxation notably at the level of the latissimus dorsi muscle behind the shoulder but also tennis ball type balls for self-massage of the pectoralis minor in front.