Physical Therapy for Shoulder Impingement - Jaco Rehab (2022)

Physical Therapy for Shoulder Impingement

Physical Therapy for Shoulder Impingement - Jaco Rehab (1)

Have you been experiencing more pain and discomfort in your shoulder lately, especially while doing any overhead motions?

Shoulder pain is one of the most common body parts that physical therapists treat at JACO Rehab. Whether you are a construction worker, overhead athlete, or an office worker, you can fall victim to shoulder pain for various reasons.

One of the most common diagnoses of shoulder pain is called shoulder impingement. In this blog, we will describe shoulder impingement and why it occurs. We will also discuss treatments for this type of shoulder pain and the “dos and don’ts” to make sure your recovery goes smoothly.

What is Shoulder Impingement?

The term shoulder impingementis a simple way of describing this shoulder injury, although it can be more complex than just an “impinged” joint.

The shoulder joint is made up of two connecting bones: the shoulder blade (scapula) and the humerus. They work together to allow you to move your arm in many different directions – the shoulder is a very flexible joint.

Flexibility is good, but too much movement isn’t stable. Your shoulder joint has muscles called the rotator cuff to ensure joint stability when you reach and lift.

The shoulder is also surrounded by other muscles, many of which fit into small spaces and grooves around the joint.

Shoulder impingement occurs when the shoulder joint’s surrounding muscles aren’t promoting the best alignment. The result is excessive friction on the muscles or soft tissues in the nooks and crannies, causing pain with certain arm movements like overhead reaching.

Too much friction can cause frays or tears in the involved structure, so best not to ignore it.

(Video) Shoulder pain? Try these three stretches to improve mobility and possibly prevent re injury

If you have an impingement, it usually refers to the irritation of the muscles above the humerus and below the acromion of the shoulder blade due to a space issue. The soft tissues involved can be the:

  • Supraspinatus (a rotator cuff muscle)
  • Long head of the biceps tendon
  • Subacromial bursa

The space between the humerus and the acromion can be influenced by inflexibility, weakness of surrounding musculature, bone spurs/osteophytes, or arthritis.

Structures of the Shoulder Beneath the Acromion (acromion highlighted) | Images courtesy of Complete Anatomy

Symptoms of Shoulder Impingement

A shoulder impingement causes pain during or after overhead reaching, lifting, and sometimes pushing. It is acquired over time and usually does not have a specific cause like a fall or trauma.

Depending on the injured structure, your pain can be located in the front or top of the shoulder.

If pain becomes so severe that it is difficult to sleep, reach, or lift the arm overhead without weight, this may be signs of a tear in the rotator cuff or biceps tendon.

Rotator cuff tears can be treated conservatively or surgically depending on the size and loss of function.

Do I need an MRI?

An MRI assesses the structural integrity of your shoulder and is great at capturing soft tissue injuries, unlike an x-ray. However, they’re not always necessary right away.

Shoulder impingements are usually acquired over time with repetitive overhead activities. If you’ve fallen on your arm or endured some type of trauma, an MRI may be more appropriate.

If conservative care hasn’t improved your shoulder impingement, your doctor may order an MRI to determine the integrity of the soft tissue structures.

At that point, the MRI could help identify why the shoulder isn’t responding to treatment. It can guide your clinicians in formulating a treatment plan for your specific needs. (1)

(Video) Shoulder Pain Self Help

And yes, that could mean surgery if there is a large tear impeding your arm function and causing significant pain.

How Can Physical Therapy Help with Shoulder Impingement?

Physical therapy is the conservative option for treating a shoulder impingement. In most cases, therapists can treat your shoulder before it endures further injury.

A physical therapist is able to assess your shoulder and formulate an individualized program that will help with the recovery process.

Patients will restore their pain-free mobility and strength with hands-on treatment, often involving stretching and strengthening of targeted areas.

A postural assessment can also help reduce the stress on the shoulder during stationary activities. In fact, posture plays a large role in shoulder positioning when reaching overhead during dynamic activities, too.

Improving muscle coordination and strength around the shoulder joint, such as the rotator cuff and upper back, can help address the muscle imbalances that cause symptoms.

Once the pain, mobility, and strength have improved, a physical therapist can help you gradually return to the challenging activities. You’ll practice how to reach and lift safely while reducing stress on the shoulder.

Let’s learn how physical therapists help treat impingement.

How to Fix Shoulder Impingement

Treatment should aim to improve shoulder alignment and muscle coordination during overhead reaching and pushing. The goal is to allow irritations to subside, create adequate space for surrounding structures with specifically-targeted exercises, and prevent further injury.

Although everyone’s circumstance is different, there are similarities between shoulder impingement cases. This includes postural deficits and poor muscular coordination around the shoulder, which often go hand-in-hand.

Depending on your presentation, therapists will often address these things first (as tolerated):

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  • Lengthen typically shortened muscles, like the pecs
  • Strengthen typically weaker muscles, like the upper back and rotator cuff
  • Apply coordination and strength gains to overhead movements and lifting

Your therapist knows how to tailor your exercise program specifically to your symptom presentation. If you’re not sure what to do, don’t hesitate to reach out to JACO Rehab!

3 Exercises to Start Now

Until you see physical therapy, you can start with these light exercises that involve gentle stretching or strengthening of the shoulder.

Doing these alone will not eliminate the problem. Make sure you’re still planning to get an evaluation.

Perform the following exercises gently. Do not push past pain. If it’s painful, stop and talk to your therapist.

Blade Squeeze

1. Sit up straight and pinch your shoulder blades back and down. Do not shrug.
2. Hold for about 5 seconds. Release and repeat for 10 more repetitions.
3. Perform exercise 3-5x a day.

This is best to incorporate into breaks during seated work on the computer.

Pec Stretch


1. Find a doorway and place the hand of your affected arm on the doorframe. A 45 degree angle is a good position to start.
2. Gently turn your body away from the doorway and hold for about 30 seconds. You should feel a stretch in the front of the chest.
3. Perform this exercise about 3-5x a day.

(Video) Shoulder Strengthening Exercises

Whatevers


1. Keep your arms close to your body and pull your shoulder blades down and back.
2. Raise your forearm to 90 degrees and only move the forearms to the side until you feel tension in the back of your shoulder blades. You do not need to go very far out with your forearms.
3. Hold for 5 seconds, then release and repeat for 10 more repetitions.
4. Perform this exercise 3-5x a day.

BONUS: To make this a rotator cuff strengthening activity, hold a band in both hands and pull it apart. Hold for 3 seconds, then release. Repeat 8-10 times without pain.

Exercises to Avoid with a Shoulder Impingement

If you’re attending rehab for your shoulder, the last thing you want to do is undo any progress by doing painful activities.

You want to avoid anything that will cause more pain to that shoulder. That includes activities that places stress on the front of the shoulder or could enclose the space under the shoulder blade’s acromion, like overhead lifting.

Here are some activities you’ll want to avoid until your symptoms are under control:

  • Performing any repetitive overhead movements, such as throwing and freestyle swimming
  • Weightlifting exercises that involve lifting overhead and pushing
  • Triceps dips, chest flies/presses, or wide pushups

Good Luck!

Your shoulder can recover if you catch this problem early! Make sure you talk to your doctor about seeing a therapist at JACO Rehab. We will guide you in the right direction.

Written by Joey Torigoe, DPT

Citations

1. “Shoulder Impingement and Associated MRI Findings.” JAOCR, https://jaocr.org/articles/shoulder-impingement-and-associated-mri-findings.

FAQs

Can physical therapy heal shoulder impingement? ›

Almost every case of shoulder impingement responds well to physical therapy. These exercises will focus on the shoulder muscles and will include strengthening exercises and range-of-motion exercises. Pain management is also provided by the physical therapist with the use of various modalities.

Can you ever fully recover from shoulder impingement? ›

While shoulder impingement can be painful and affect your daily activities, most people make a full recovery within a few months. In many cases, you'll just need some rest and physical therapy. If those don't provide relief, you may need surgery, which can add a few months to your recovery time.

How long does it take to rehab a shoulder impingement? ›

Most cases will heal in three to six months, but more severe cases can take up to a year to heal.

What is the fastest way to heal a shoulder impingement? ›

Treatments for impingement syndrome include rest, ice, over-the-counter anti-inflammatory medications, steroid injections and physical therapy.
  1. Physical therapy is the most important treatment for shoulder impingement syndrome. ...
  2. Ice should be applied to the shoulder for 20 minutes once or twice a day.
5 Jan 2021

How do you know when physical therapy is not working? ›

Physical therapy might stop if the patient isn't seeing results or making progress within the time-frame their physical therapist thinks they should be. After all, it can be frustrating to attend regular appointments, perform all the instructed exercises and still not make progress toward your goals.

Why do I feel worse after physical therapy? ›

Discomfort and soreness are to be expected, because physical therapy, in order to work, must train your body. This is the same principle that applies when building strength through exercising or working out. The muscles must experience a certain amount of stress, which can lead to irritation and soreness.

What should you not do with a shoulder impingement? ›

Avoid Reaching, Lifting, Pulling, or Pushing

For about 4-6 weeks, avoid any movements with the affected shoulder that require exertion and effort. During your shoulder impingement treatment, use only your unaffected arm when opening doors, reaching for things and lifting items (such as bags).

Is shoulder impingement permanent? ›

It affects the rotator cuff tendon, which is the rubbery tissue that connects the muscles around your shoulder joint to the top of your arm. An impinging shoulder will often improve in a few weeks or months, especially with the right type of shoulder exercises, but occasionally it can be an ongoing problem.

What happens if physical therapy doesn't help shoulder pain? ›

If therapy doesn't help, a steroid injection is sometimes the next step. The injections can help when the shoulder pain interferes with daily activities, but are not a long-term solution since patients can only receive so many steroid injections before they lose their effectiveness.

Can you make shoulder impingement worse? ›

If I keep impinging my shoulder, can it get worse or turn into a tear? Yes! Tissues do not like repetitive compression. And when this goes on for a long time, degenerative rotator cuff tears and tears to the biceps tendon can occur.

How often should you do shoulder impingement exercises? ›

These muscles function together and are all strengthened during rehabilitation. Strengthening exercises are performed 3-4 times per week. Start with a weight that allows you to perform 12 to 15 repetitions for 3 sets.

How serious is shoulder impingement? ›

If left untreated, a shoulder impingement can lead to more serious conditions, such as a rotator cuff tear. Physical therapists help decrease pain and improve shoulder motion and strength in people with shoulder impingement syndrome.

Does shoulder impingement cause pain down the arm? ›

The main shoulder impingement syndrome (SIS) symptom is pain that occurs when the person lifts his or her arms overhead or reaches backwards. The pain can be at the shoulder, near the top of the arm, or down the outside of the arm, and it frequently happens at night or when the person lies on the affected shoulder.

Does shoulder impingement get worse before it gets better? ›

Putting the arm over the head or behind the back may become increasingly difficult. Without treatment, the tendons in the rotator cuff may wear down or tear, which can lead to worse pain, shoulder weakness, and difficulty lifting or using the shoulder at all.

Is shoulder impingement the same as rotator cuff tear? ›

Two of the most common problems occur in the narrow space between the bones of the shoulder. Irritation in this area may lead to a pinching condition called impingement syndrome, or damage to the tendons known as a rotator cuff tear. These two problems can exist separately or together.

What is the next step if physical therapy doesn't work? ›

Worse, when traditional physical therapy does fail, most people go back to their doctors hoping for a different solution. Many times, the next step for these folks involves unwanted procedures or surgery.

Can physical therapy do more harm than good? ›

“No.” “No” is the simple answer. Physical therapy patients often fear that their discomfort will worsen as a result of their treatment. But, as long you and your physical therapist agree, there should never be any painful or incontinental treatment.

How do I get the most out of physical therapy? ›

Tips to get the most out of physical therapy
  1. Be a good historian. ...
  2. Set goals. ...
  3. Commit to your appointments. ...
  4. Do the homework. ...
  5. Find a dedicated space to do the work. ...
  6. Don't skip. ...
  7. Speak up and ask questions. ...
  8. Stick to the topic.
30 Oct 2018

How many days a week should you do physical therapy? ›

How long does physical therapy treatment take? A typical order for physical therapy will ask for 2-3 visits per week for 4-6 weeks. Sometimes the order will specify something different. What generally happens is for the first 2-3 weeks, we recommend 3x per week.

What can you not do in physical therapy? ›

Physical therapy never includes sex. It also never includes verbal sexual advances or any other kind of sexual contact or behavior. Sexual contact of any kind in the course of a physical therapy treatment is illegal and unethical.

Can you overdo physical therapy? ›

Balancing Physical Therapy and Rest

While your recovery is heavily influenced by your strength and mobility, it is still possible to overdo it if you aren't careful. Your physical therapist will talk to you about ways to balance physical therapy exercises and activities with proper amounts of rest.

How long does physical therapy take for shoulder? ›

Your physical therapist will discuss these findings with you and your physician in order to develop the best plan. Oftentimes people with rotator cuff tears respond very well to 6-8 weeks of physical therapy and non-surgical treatments.

What happens if physical therapy doesn't help shoulder pain? ›

If therapy doesn't help, a steroid injection is sometimes the next step. The injections can help when the shoulder pain interferes with daily activities, but are not a long-term solution since patients can only receive so many steroid injections before they lose their effectiveness.

What should you not do with a shoulder impingement? ›

Avoid Reaching, Lifting, Pulling, or Pushing

For about 4-6 weeks, avoid any movements with the affected shoulder that require exertion and effort. During your shoulder impingement treatment, use only your unaffected arm when opening doors, reaching for things and lifting items (such as bags).

What muscles strengthen shoulder impingement? ›

They are the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles function together and are all strengthened during rehabilitation. Strengthening exercises are performed 3-4 times per week. Start with a weight that allows you to perform 12 to 15 repetitions for 3 sets.

How often should I do shoulder impingement exercises? ›

3 - 5 times a day, perform the following series of exercises
  1. Blade squeezes. Sitting or standing up straight, pinch shoulder blades together as if pinching a peanut between them. ...
  2. Rotations. ...
  3. Pec stretching. ...
  4. Distraction. ...
  5. Theraband rows. ...
  6. Theraband external rotation.

Should you stretch shoulder impingement? ›

It's best to rest your shoulder, but you can do some light exercises to stretch the muscles in the arm, shoulder, and chest in conjunction with strengthening your rotator cuff. These exercises will help to avoid worsening shoulder pain impingement.

How many days a week should you do physical therapy? ›

How long does physical therapy treatment take? A typical order for physical therapy will ask for 2-3 visits per week for 4-6 weeks. Sometimes the order will specify something different. What generally happens is for the first 2-3 weeks, we recommend 3x per week.

How many times a week should you do rehab exercises? ›

Performing Exercises On Your Own

For the treatment to be effective, we highly recommend performing these exercises around 3 to 5 times a week for 2 to 3 weeks. In order to stick to this plan, we'd like to lay out the below advice: Block off 30 minutes in your calendar on days you'd like to perform these exercises.

What can I expect from shoulder physical therapy? ›

5 Things to Expect While Undergoing Physical Therapy for Shoulder Pain
  • RICE Therapy.
  • Strengthening Exercises.
  • Stretching.
  • Hands-On Therapy.
  • Ultrasound Therapy.
16 Sept 2021

Can you make shoulder impingement worse? ›

If I keep impinging my shoulder, can it get worse or turn into a tear? Yes! Tissues do not like repetitive compression. And when this goes on for a long time, degenerative rotator cuff tears and tears to the biceps tendon can occur.

Can physical therapy make a shoulder injury worse? ›

We know many patients out there are afraid of physical therapy because they assume it will make them feel worse than they already do. This is not true, as physical therapy is actually designed to strengthen the muscles around your injury or medical condition to make you feel better over time.

Does impingement go away? ›

It affects the rotator cuff tendon, which is the rubbery tissue that connects the muscles around your shoulder joint to the top of your arm. An impinging shoulder will often improve in a few weeks or months, especially with the right type of shoulder exercises, but occasionally it can be an ongoing problem.

Can you massage shoulder impingement? ›

Shoulder impingement syndrome is often a precursor to bursitis, tendinopathy and rotator cuff injury. As in the previous examples, relaxing and reducing the tension in the muscles with deep tissue massage techniques can reduce this compression and allow more space for the shoulder joint to move freely and not impinge.

Is heat good for shoulder impingement? ›

Heat may soothe aching muscles, but it won't reduce inflammation. Use a heating pad or take a warm shower or bath. Do this for 15 minutes at a time. Don't use heat when pain is constant.

How should I sleep with impinged shoulders? ›

Shoulder impingement is commonly associated with rotator cuff problems, and in this case you need to avoid causing further damage to your rotator cuff. To sleep with a rotator cuff injury, stick to sleeping either on your back, or on your non-affected side.

Videos

1. JACO REHAB Hawaii:The best physical rehab in Hawaii, Taizo Braden learns why on Island Style on KITV
(ISLAND STYLE)
2. Overcoming Shoulder Pain & Stiffness Webinar with Jacob Connelly, MD
(South Florida Orthopaedics and Sports Medicine)
3. Two 60 Second Exercises That Took AWAY My Shoulder Pain in 2 Weeks (Impingement)
(Bob & Brad)
4. Rotator Cuff Rehab | Shoulder Pain With Dips
(Dr Jacob Harden)
5. 3 Keys to Rehab a Rotator Cuff Tear & AVOID Surgery [UNIQUE EXERCISES]
(Precision Movement)
6. Top 3 Shoulder Bursitis Exercises and Stretches to Eliminate Pain.
(Bob & Brad)

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