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.
Fit Philosophy: You Were Made to Move
Most of us don’t exercise regularly because we have better things to do, right? Go to work, run errands, meet friends, etc. Yet we fit all of our daily routine activities without second thought. We brush teeth, wash up and groom without hesitation. The reason: we have daily activities that are routine, embedded and taught from a young age. We give our teeth, hair and skin the attention that they need, but often the rest of the body goes neglected.
Your body is a machine.
Everything we do is performed through a series of joint movements initiated by neurological stimulation and executed by muscular contraction. Your body is comprised of multiple pulleys that work together to produce specific movements that allow you to walk, get dressed, etc. It is a complex, sophisticated machine. And like all machines, it requires routine maintenance.
You were made to move.
A body without regular exercise will not optimally function, just as a car will have problems if it hasn’t been used in a while. Muscles will tighten, shrink and weaken, and joints will stiffen from disuse. But since your body is sophisticated, it will improvise by using other muscles and joints to get your day-to-day activities done, feeding into a vicious cycle of compensation, imbalance, and ultimately injury. Bottom line: you were made to move. What muscles were meant to do!
Wear-and-tear is normal.
In time, a car will break down. But slamming the brakes at every stop light or neglecting routine oil change can expedite that process.
Everyone at some point will suffer wear-and-tear of cartilage and joints—a natural degenerative process with aging and use. But with proper body mechanics, this degenerative process can be greatly delayed. Consider the hypothetical athlete at the gym who sacrifices form to push more weight. You may be able to push more resistance and pump out extra reps, but it will land you again into that cycle of compensation, imbalance, and injury. Your body is subject to wear-and-tear, and how you practice body mechanics will ultimately impact the longevity of your physical health. Bottom line: application of proper form will help preserve the integrity of your joints and muscles.
Excuse #1: Not enough time.
Your most time-consuming daily activity is going to work/school. Undoubtedly, work and study are two investments in bettering your financial health. Likewise, exercise is an investment to bettering your physical health. The difference is that exercise is far less time-consuming. Increased fitness also means less susceptibility to long-term diseases and complications that require dipping into your financial savings.
Excuse #2: "It’s boring".
Work is arguably more boring than exercise, yet we do it anyway because it is part of our daily routine. 20 to 30 minutes of moderate physical activity surely beats the 8-hour office grind.
Excuse #3: "I’m thin already".
Exercise is not only directed to those seeking to lose weight. There are plenty who are considered "thin", but still have a low muscle mass/high body fat content. Regardless of weight, practicing altered body mechanics can ultimately lead to excessive loading stress on joints and irreversible arthritic changes.
Excuse #4: "It hurts when I exercise".
That pain may be an indication that something is not working properly. Depending on the source, your pain may be one of many things, such as lactic acid buildup, stretching of a tightened structure, or exacerbation of an irritated body part. A physical therapist will be able to assist you in determining the source of the pain and prescribe therapeutic exercises to help alleviate the symptoms you experience.
Physical activity should be no different from brushing teeth.
No one ever says “brushing teeth is good for you.” It’s a given, and it’s already standardized as part of our daily routine. But “exercise is good for you” comes off as a motivational cliché and sounds more like an optional plus rather than a core component of our daily curriculum. If treated as an option, it will be brushed off.
Exercise should be routine, not optional—a subconscious given in our daily activities.
You were made to move. Make it a given, and your body will thank you.