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Shoulder pain can be a persistent issue for many individuals, from athletes to those with desk jobs. Shoulder impingement syndrome (SIS) is one of the most common conditions that leads to this type of discomfort. Characterized by pain during overhead activities, weakness, and limited range of motion, SIS can significantly impair your daily function. However, there are effective ways to manage and treat this condition.

This article covers the causes, diagnosis, and evidence-based treatments for shoulder impingement syndrome, drawing from the latest research to guide your recovery.

What is Shoulder Impingement Syndrome?

Shoulder impingement occurs when the tendons of the rotator cuff become compressed as they pass under the acromion, part of the shoulder blade. This compression, often exacerbated by repetitive overhead movements or structural abnormalities, can lead to inflammation, pain, and even tendon tears. The condition is particularly common in athletes who frequently use their arms overhead, such as swimmers, baseball players, or tennis players, but it can affect anyone whose shoulder mechanics are impaired by muscle imbalances or posture issues (Lo et al., 2022; Gismervik et al., 2017).

Common symptoms include:

  • Pain when raising the arm, particularly above shoulder height.
  • Weakness or difficulty lifting the arm.
  • Pain during everyday activities, such as reaching for objects or brushing your hair.

Diagnosing Shoulder Impingement

Accurate diagnosis is crucial for effective treatment. Common clinical tests such as Neer’s test and Hawkins-Kennedy test are used to provoke symptoms of impingement (Verry & Fernando, 2016). These tests help assess the likelihood of impingement by identifying pain caused by specific shoulder movements.

Imaging techniques, such as diagnostic ultrasound, are often used alongside clinical tests to confirm the diagnosis. Ultrasound is particularly useful for detecting inflammation, tendon damage, and bursitis, which are frequently present in shoulder impingement syndrome (Eliason et al., 2021). A thorough clinical examination combined with imaging ensures a comprehensive understanding of the problem, guiding treatment decisions effectively.

Effective Treatment Options for Shoulder Impingement

Exercise Therapy

Exercise therapy is one of the most effective treatments for shoulder impingement syndrome. Research shows that a structured exercise program focusing on strengthening the rotator cuff muscles and improving shoulder flexibility can significantly reduce pain and improve function (Silveira et al., 2024). These exercises help restore balance between the muscles around the shoulder, improving the subacromial space and alleviating pressure on the affected tendons (Green, Buchbinder, & Hetrick, 2003).

Manual Therapy

Manual therapy, including techniques like joint mobilizations and soft tissue massage, is often used in conjunction with exercise therapy. Studies show that manual therapy can improve shoulder range of motion, reduce pain, and enhance overall function when added to a stretching and strengthening regimen (Tauqeer et al., 2024). Mobilizing the shoulder joint helps to restore normal mechanics, reducing impingement and facilitating recovery.

Neuromobilization

Neuromobilization techniques focus on mobilizing the nerves that might be entrapped or irritated due to shoulder dysfunction. Research suggests that adding neuromobilization to traditional physiotherapy interventions can provide greater pain relief and improved functional outcomes compared to physiotherapy alone (Chughtai & Rathore, 2021; Akhtar et al., 2020).

Extracorporeal Shock Wave Therapy (ESWT)

Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment that uses sound waves to stimulate healing in the injured tissues. Studies show that ESWT, when combined with conventional therapy, is highly effective in reducing pain and improving function, especially in patients with chronic shoulder pain (ElGendy et al., 2023). It works by promoting blood flow and accelerating the healing process, making it an ideal option for those who have not responded to other treatments.

Dry Needling for Shoulder Impingement

Dry needling is an advanced technique that targets trigger points within the muscles around the shoulder. By inserting thin needles into specific muscle areas, dry needling helps alleviate tightness and pain while promoting muscle relaxation and improved blood flow (Yang et al., 2024).

Research indicates that dry needling can effectively reduce pain and improve range of motion in patients with shoulder impingement syndrome, particularly when it is combined with other forms of physiotherapy (Lo et al., 2022). This approach is especially beneficial for those who have persistent muscle tension contributing to their shoulder dysfunction.

Conclusion

Shoulder impingement syndrome can cause significant discomfort and limit your daily activities, but with the right treatment plan, you can manage and overcome the condition. Effective treatments like exercise therapy, manual therapy, neuromobilization, shock wave therapy, and dry needling have all been shown to reduce pain and improve function in individuals with shoulder impingement.

At Parkway Physiotherapy, we’re here to support patients in Langford, Victoria, and Sooke with specialized, evidence-based treatments for shoulder impingement. If you’re ready to start your recovery journey, book an appointment with one of our expert physiotherapists today!

References

Akhtar, M., Karimi, H., Gilani, S. A., Ahmad, A., & Raza, A. (2020). The effectiveness of routine physiotherapy with and without neuromobilization on pain and functional disability in patients with shoulder impingement syndrome. Journal of Orthopaedic Research, 15(3), 298-306.

Chughtai, R. R., & Rathore, F. A. (2021). Comments on effects of routine physiotherapy with and without neuromobilization in the management of internal shoulder impingement syndrome: A randomized controlled trial. Pak J Med Sci, 37(1), 296-297.

Eliason, A., Harringe, M., Engström, B., Sunding, K., & Werner, S. (2021). Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome. Journal of Musculoskeletal Disorders, 25(1), 232-238.

ElGendy, M. H., Mazen, M. M., Saied, A. M., ElMeligie, M. M., & Aneis, Y. (2023). Extracorporeal shock wave therapy vs. corticosteroid local injection in shoulder impingement syndrome: A three-arm randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 102(6), 533-540.

Green, S., Buchbinder, R., & Hetrick, S. E. (2003). Physiotherapy interventions for shoulder pain. Cochrane Database of Systematic Reviews, 2003(2), CD004258.

Lo, C. N., van Griensven, H., & Lewis, J. (2022). Rotator cuff related shoulder pain: An update of potential pathoaetiological factors. New Zealand Journal of Physiotherapy, 50(2), 82-93.

Silveira, A., Lima, C., Beaupre, L., Chepeha, J., & Jones, A. (2024). Shoulder-specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis. PLOS ONE, 19(4), e0294014.

Tauqeer, S., Arooj, A., & Shakeel, H. (2024). Effects of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome. BMC Musculoskeletal Disorders, 25(192), 35-44.

Verry, C., & Fernando, S. (2016). Rotator cuff disease: Diagnostic tests. American Family Physician, 94(11), 925-931.

Yang, F., Li, X., Wang, J., Gao, Q., & Zhang, Y. (2024). Efficacy of different analgesic strategies combined with conventional physiotherapy program for treating chronic shoulder pain: A systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research, 19(544), 1-20.

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