SUBACROMIAL OR ROTATOR CUFF IMPINGEMENT: EXERCISES

What is subacromial impingement syndrome?

 There is a little space between acromion and humerus where ligaments, tendons and bursas are working together. When we raise our arms more than 90 degrees that space does smaller and we could feel pain in that zone if we have any shoulder pathology. In my professional experience, this pathology is one of the most frequency in the shoulder.
 Subacromial impingement syndrome could be for different causes. Several structures, such as the subacromial bursa, the tendons of the rotator cuff, the acromion, the coraco-acromial ligament, and the tendon of the long head biceps muscle, are involved in the pathogenesis of subacromial impingement syndrome.
  

Treatment with exercises

 I want to resume a review about the treatment of this pathology through home exercises with clinically significant effects on pain reduction and improving function in patients with persistent subacromial impingement syndrome. ¹. It consist in a specific exercise strategy, focusing on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers.
 

Acromioplasty with exercise vs exercise alone

 “But my doctor said I could need an acromioplasty”. Ok, you can try to do the next exercises while you are waiting for a surgery. Because: 

-      This exercise strategy reduces the need for arthroscopic subacromial decompression within the three months timeframe used in the study ¹,

-      in the first six months, a 47% of patients without operative treatment improve their pain and mobility ² and

-      in the 2.5 years, a 78% of patients without operative treatment improve their pain and mobility ³.
  

Range of Motion and Stretching Exercises 

This type of exercises should be performed daily. Each stretch should be held for 30 seconds and repeated 5 times, with a 10-second rest between each stretch. 


1.       Pendulum: stand up, support an arm in a table and the other one in the air. Do 20 small clockwise circles and 20 anticlockwise, make forward and backwards motions and side to side movements.

Pendulum Exercises

  2.       Posture exercises: Put hands on the hips, lean back and hold.

Posture Exercises

  3.       Shoulder shrugs: Pull the shoulders up and back, and hold. Pinch the back of the shoulder blades together using good posture.

Shoulder Shrugs

  4.       Active assisted range of motion: with a cane or stick raise your arms forwards, external rotation and abduction.

Active assisted range of motion

  5.       Active range of motion: in front of a mirror, raise you arms at the same time and try not elevate your shoulders.

Active range of motion

  6.       Anterior shoulder stretch: Place hands at shoulder level on each side of a door or in a corner of a room. Lean forward into the door or corner and hold.

Anterior Shoulder Stretch

  7.       Posterior shoulder stretch: put your arm over the opposite shoulder and feel the stretch in the back of your shoulder.
  

Posterior Shoulder Stretch

  

Strengthening Exercises

Strengthening should be performed 3 times weekly. 

Each exercise was performed at 3 sets of 10 repetitions with a 60-second rest between each set the first week, followed by 3 sets of 15 the second week, followed by 3 sets of 20 the third week; then increasing TheraBand resistance.



8.       External Rotation: lying on one side with your elbow at 90 degrees, raise your hand with or without weight.

External Rotation

  9.       Scaption: Hold the arm forward, thumb up or down, raise the arm. May add resistance. This exercise should be done only if there is no pain.

Scaption

  10.   Chair press: While seated, press up on the chair, lifting the body off the chair. Try to keep the spine straight.

Chair Press

  11.   Cat-Camel: put your hand just down your shoulders and your knees down hip. Keep a neutral hip position, then arch your spine from neck to bottom.

Cat - Camel

  12.   Press-up: Lie on back, elbow locked straight, weights in hands. Move your arm up toward the ceiling as far as possible.

Press Up

  13.   Rows: Seated or standing, bend your elbows and pull the elastic cord back. Try to pinch your shoulder blades behind you.

Rows

  14.   Upright row: Do one arm at a time. While standing, lean over a table and bend at the waist. Pull the hand weight back, pulling shoulder blade back.

Upright Row

  15.   Low Trapezius: stand up, open your chest and with the elbow extended reach the elastic band behind you.

Low Trapezius

        

Bibliography

  1. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg 2009;18:138-60. 

2. Rahme H, Solem-Bertoft E, Westerberg CE, Lundberg E, Sorensen S, Hilding S. The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and paingenerating mechanisms. Scand J Rehab Med 1998;30:253-62. 

3. Brox JI, Gjengedal E, Uppheim G, et al. Arthroscopic surgery versus supervised exercises in patient with rotator cuff disease (stage II impingement syndrome): A prospective, randomised, controlled studyin 125 patients with a 2 ½ year follow-up. J Shoulder Elbow Surg 1997;8:102-11.

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