Shoulder impingement: exercise versus exercise and manual therapy
What is the best course of action for shoulder pain caused by subacromial impingement? This article compares exercise alone versus exercise and manual therapy on addressing this particular issue.
Shoulder impingement syndrome (SIS) is a common problem derived from repetitive use of the arm at or above shoulder level. While there is proven success on the management of SIS through conservative treatment, researchers and physical therapists still debate the best course of action to most efficiently address this problem.
The study:
Camargo et al performed a randomized controlled trial in 2015, comparing two approaches in managing patients with SIS:
Group 1 was given exercise alone.
Group 2 was given the same exercise program as Group 1, plus a manual therapy regime.
Outcome measures included pain, mechanical sensitivity, and changes in scapular kinematics. Post-intervention measures were taken after the 4-week intervention.
The results:
No significant changes in scapular kinematics were found with both groups pre- and post-intervention.
Both groups experienced significant decreases in pain at rest and during movement when comparing pre- and post-intervention, but had no significant differences between groups.
Both groups experienced increased mechanical sensitivity when comparing pre- and post-intervention, but had no significant differences between groups.
Limitations of the study: 1.) participants did not have acute SIS, and therefore the results do not pertain to a more recent flare-up of SIS, and 2.) no long-term follow-up, as results were only taken after the 4-week intervention.
What’s most noteworthy of this study, however, is that despite improvements in pain and mechanical sensitivity, scapular kinematics have not significantly changed even after intervention. This suggests that improvements in pain and mechanical sensitivity cannot be explained by changes in scapular motion.
What this means:
With respect to this study, the addition of manual therapy did not provide any additional benefit in improving scapular kinematics, pain levels or mechanical sensitivity for patients with shoulder impingement syndrome. This suggests that exercise alone may suffice in addressing the issue. Segueing to some helpful exercises below:
REFERENCES:
Camargo PR, Alburquerque-Sendín F, Avila MA, Haik MN, Vieira A, Salvini TF. Effects of Stretching and Strengthening Exercises, With and Without Manual Therapy, on Scapular Kinematics, Function, and Pain in Individuals With Shoulder Impingement: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2015 Dec;45(12):984-97. doi: 10.2519/jospt.2015.5939. Epub 2015 Oct 15. PMID: 26471852.
Shoulder impingement: lifting things the right way
We emphasize the importance of scapular stabilization with particular attention to the serratus anterior to treat and/or prevent shoulder impingement syndrome.
No one ever taught us to walk, stand up, reach overhead, or pick up objects in any specific way. The goal is always to just do it and go about your life. Our movement strategy choices in all of these day-to-day activities accumulate towards longevity or degeneration of musculoskeletal health. The serratus anterior is a key muscle when it comes to treating/preventing shoulder impingement and related injuries.
The serratus anterior muscle is important particularly in its role of posteriorly tilting the scapula, which prevents “winging” and decrease in the subacromial space when raising the arm up. In other words, this muscle should be strong and engaging whenever you reach overhead, load the arm, lift or carry objects above the waist. Escamilla et al states that “if normal scapular movements are disrupted by abnormal scapular muscle firing patterns, weakness, fatigue, or injury, the shoulder complex functions less efficiency and injury risk increases”.
See below for examples of neuromuscular activation and strength training of the serratus anterior.
REFERENCES:
Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-685. doi:10.2165/00007256-200939080-00004.