Why physiotherapy for shoulder impingement syndrome is the best first option


Why physiotherapy for shoulder impingement syndrome is the best first option

Your shoulder is a complex joint made up of the humerus, the collarbone (the clavicle), and the scapula and is the most mobile joint in the human body. Unfortunately this complex ball and socket structure that enables so many of our functional movements is also susceptible to a range of injuries and ailments, one of the most common being; shoulder (sometimes called subacromial impingement) impingement syndrome (SIS).

Shoulder impingement can make reaching overhead difficult, cause pain or discomfort when sleeping, and affect your range of motion. Some studies actually suggest that subacromial pain is the most common cause of shoulder pain, accounting for approximately 30 to 35 percent of shoulder disorders.[1]

What is shoulder impingement syndrome?

Shoulder impingement syndrome (SIS) refers to the combination of shoulder symptoms, examination findings, and radiologic signs that point to the compression of structures around the glenohumeral joint. Impingement pain occurs because the rotator cuff tendon and bursa are compressed against bone (the acromion) as the arm is elevated.[2]

Who is at risk of developing subacromial impingement syndrome?

Repetitive activity at or above shoulder height during work or sports represents the main risk factor for SIS, along with simply getting older.[3] SIS is common among athletes who participate in overhead sports including: swimming, throwing, tennis, weightlifting, golf, volleyball, and gymnastics.[4] Overhead work activities such as: painting, stocking shelves, and mechanical repairs can also increase the risk for developing SIS.[5]

Is frozen shoulder the same as shoulder impingement syndrome?

Shoulder impingement syndrome shouldn’t be mistaken for its equally complicated cousin, frozen shoulder despite early phase frozen shoulder having similar symptoms. These two conditions are very different and the correct diagnosis should be made by an experienced sports physio or musculoskeletal specialist.

Shoulder Impingement requires prompt and accurate diagnosis and treatment. With this, you are much more likely to have a full and uncomplicated recovery.

How is shoulder impingement syndrome diagnosed by a sports physio?

In the years since the original classification of SIS, much has changed in the way it is diagnosed, viewed and treated by musculoskeletal physiotherapists and sports physios.

Your Lane Cove physio will likely perform the following tests to make an accurate diagnosis[6]:

  • Complete neck examination
  • Inspection for atrophy or disfigurement
  • Evaluation of glenohumeral range of motion (including painful arc testing and a comparison of passive versus active motion)
  • Rotator Cuff strength testing (including drop arm test and external rotation strength testing)
  • Specialty testing (including the Neer and Hawkins-Kennedy tests)

Why physiotherapy is the best first option for shoulder impingement syndrome

The results of a number of recent controlled trials raise doubts about the effectiveness of surgery for shoulder impingement on its own.[7]

According to a meta-analysis of 13 randomized trials involving 1062 patients, surgical intervention (most often arthroscopic decompression) failed to produce clinically significant reductions in pain or improvements in shoulder function at 1 and 2 year follow-ups compared with conservative treatment (primarily physiotherapy).[8]

All of Lane Cove physio’s personalised programs follow the basic steps of rehabilitation:

  • Decrease pain and inflammation
  • Restore normal range of motion (ROM)
  • Improve individual muscle function
  • Restore overall functional capacity
  • Educate and direct injury prevention exercises to avoid re-injury

Our sports and musculoskeletal physios will usually take you through[9]:

  • Range of motion exercises to improve motion in all planes (flexion, extension, abduction, adduction, internal and external rotation).
  • Glenohumeral joint mobilisation, including specific manoeuvres for capsular structures.
  • Strengthening exercises, focusing on the Rotator Cuff, scapular stabilisers, and core musculature.
  • Biomechanical training to improve the repetitive activity that led to injury.
  • Exercises to improve the strength and stability of the core muscles and to integrate shoulder rehabilitation into patient-specific functional activities.

Surgery is uncommonly required and only recommended if 3-6 months of non operative treatment fails.

This surgery is usually performed arthroscopically (keyhole or minimally invasive surgery) depending on the extent of the damage and is called an Arthroscopic Acromioplasty where the acromion bone is trimmed to allow more space for the Rotator Cuff to move.

If you’ve got questions, Sports physios are experts in the retraining of movements and activities related to sport, work and day to day activities that aggravate the shoulder. At Lane Cove Physio, we also understand the value of patient education in getting you back to what you were doing before the pain. Whether you have shoulder surgery coming up, just had it, or contemplating surgery for a shoulder injury get in touch with us on (02) 9428 5772 or send us an email at info@lanecovephysio.com.au – don’t wait until the pain becomes severe or chronic.


[1] Juel NG, Natvig B. Shoulder diagnoses in secondary care, a one year cohort. BMC Musculoskelet Disord. 2014;15:89. Published 2014 Mar 18. doi:10.1186/1471-2474-15-89

[2] Caliş M, Akgün K, Birtane M, Karacan I, Caliş H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59(1):44-47. doi:10.1136/ard.59.1.44

[3] Ardic F, Kahraman Y, Kacar M, Kahraman MC, Findikoglu G, Yorgancioglu ZR. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006;85(1):53-60. doi:10.1097/01.phm.0000179518.85484.53

[4] Hutton Ks, Julin MJ. Shoulder injuries. In: Team Physician’s Handbook, 3rd, Mellion MB, Walsh WM, Madden C, et al (Eds), Hanley & Belfus, Philadelphia 2002. p.397.

[5] Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil. 2006;16(1):7-25. doi:10.1007/s10926-005-9003-2

[6] Lange T, Matthijs O, Jain NB, Schmitt J, Lützner J, Kopkow C. Reliability of specific physical examination tests for the diagnosis of shoulder pathologies: a systematic review and meta-analysis. Br J Sports Med. 2017;51(6):511-518. doi:10.1136/bjsports-2016-096558

[7] Karjalainen  TV, Jain  NB, Page  CM, Lähdeoja  TA, Johnston  RV, Salamh  P, Kavaja  L, Ardern  CL, Agarwal  A, Vandvik  PO, Buchbinder  R. Subacromial decompression surgery for rotator cuff disease. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD005619. DOI: 10.1002/14651858.CD005619.pub3.

[8]Khan M, Alolabi B, Horner N, Bedi A, Ayeni OR, Bhandari M. Surgery for shoulder impingement: a systematic review and meta-analysis of controlled clinical trials. CMAJ Open. 2019;7(1):E149-E158. Published 2019 Mar 7. doi:10.9778/cmajo.20180179

[9] Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther. 2004;17(2):152-164. doi:10.1197/j.jht.2004.02.004