The movements associated with sports such as a swimming stroke, cricket bowl, golf swing or tennis serve, when completed in numerous repetitions, particularly if there is a dysfunctional movement pattern present, can develop into a shoulder injury such as impingement syndrome. Impingement syndrome also known as Bursitis, Subacromial Impingement, or Rotator Cuff Tendinopathy can lead to long stints on the sideline if not treated correctly.
These injuries occur in all levels of athletes ranging from an acute exacerbation where the athlete may be deconditioned (e.g. start of the season, returning from injury/break) to a tendinopathy to a full thickness tear of the rotator cuff.
Physiotherapy is the front line treatment for this type of injury to address the acute symptoms (pain, loss of movement and strength), predisposing factors (poor biomechanics, muscle imbalances, posture) and prevent future reoccurrences once you have returned to you sport.
The shoulder girdle is a group of joints, muscles and tissues that is designed for mobility rather than stability. The trade-off for all the mobility that the shoulder offers is that it requires a lot of muscle coordination to keep everything running smoothly. The subacromial bursa, rotator cuff tendons and long head of biceps tendons are the primary structures that can be injured in impingement syndrome.
Mechanism of Injury
The rotator cuff muscles are the dynamic stabilisers of the shoulder, meaning that when your shoulder is moving, these muscles are stabilising the humerus (upper arm bone) to the acromion (shoulder blade) and preventing injury. When there is excessive stress placed of the rotator cuff either by overuse or compression in the subacromial space, this can lead to inflammation of the subacromial bursa and rotator cuff tendons. If stressed over a long period can lead to chronic inflammation and degeneration of the rotator cuff tendons.
How Physiotherapy can help
A full assessment of the shoulder injury is imperative to provide the appropriate treatment. This should include assessing the cervical and thoracic spines, kinetic chain, soft tissue mobility, joint mechanics, strength testing and a scan if appropriate.
Early management includes:
- NSAIDS tablets or topical gel
- Taping to offload rotator cuff
- Neuromuscular facilitation exercises
- Begin to address predisposing factors
- Reduce tissue inflammation
- Restore full movement of shoulder girdle (this may mean more shoulder ROM than pre-injury)
- Optimise stability of the shoulder joint through a progressive strengthening program
- Progression to sports specific drills and exercises
- Return to sport once all predisposing factors have been resolved
Your physiotherapist can help to reduce injury time and injury reoccurrence with:
- Thoracic (midback and ribs) mobilisations
- Soft tissue release
- Graded strengthening including stability and strengthening exercises
- Kinesiology taping