Improving the Treatment of “Shoulder Impingement”: Suggestions for Better Care
Subacromial shoulder pain is a common reason why many individuals seek physiotherapy treatment. However, difficulties arise in managing this condition due to conflicting explanations about the causes of shoulder pain and patients’ lack of adherence to exercise programs. An updated approach to discussing shoulder pain suggests moving away from the previous subacromial “impingement” model based on biomechanics. This theory proposed that compression of soft tissues in the subacromial space, such as the rotator cuff and bursa, resulted in shoulder pain. However, recent research challenges this theory as imaging findings do not precisely align with symptoms. Moreover, psychological and social factors play a role in the onset and persistence of shoulder pain, indicating that focusing solely on biomechanics may lead us astray.
Should we completely abandon the term “impingement”? Unfortunately, it’s not that straightforward. Many patients and clinicians still use this terminology. According to Powell and colleague, we may need to use this term when communicating with other clinicians and sometimes even with patients. However, it is crucial to understand how patients’ perception of this diagnostic label affects their willingness to undergo physiotherapy treatment.
Some patients may merely hear the word “rehabilitation” and be prepared to start the process. Others, however, may think that physiotherapy is unable to stop tissue compression in the subacromial area. Many authors advises utilising your evaluation to teach a patient how to adjust their suffering for such patients rather than debating the narrative head-on. This “show-then-tell” strategy enhances exercise adherence while fostering trust and strengthening your therapeutic connection.
⇒How I evaluate a shoulder pain
Traditionally, the examination of the shoulder during physical therapy comprised a number of specialized tests to pinpoint the offending soft tissue. However, when a patient has shoulder discomfort, we already know that they are in pain, so these tests are probably going to be upsetting. Furthermore, the structures implicated in subacromial pain cannot be consistently determined by these tests (1).
- Shoulder Range of motion
- Instability
- Shoulder pain’s relationship to the cervical spine
- Thoracic spine mobility
- Rotator cuff muscles performance
Last but not least, Jeremy lewis et al, suggests techniques for symptom adjustment (such altering scapular posture, muscle activation patterns, etc.). We just do an action, retest it, and then ask, “How does that feel?” Then, the alleviating techniques direct our medical care.
⇒How to increase the effectiveness of shoulder exercise regimens
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