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GOALS OF TREATING SHOULDER IMPINGEMENT
Short Term:-Rest-Reduce Pain-Reduce Inflammation-Begin ROM exercises-Begin resistance exercises
Long Term-Full ROM-Full Strength-Pain free-Psychologically prepared for safe return
REHABILITATION PROTOCOL
A progressive rehabilitation protocol based on the healing phase should be implemented:
-Inflammatory Phase (0-2 weeks)-Sub-Acute Phase (2-4 weeks)-Tissue Remodeling Phase (4-6
weeks)
INFLAMMATORY PHASE
Goals:-Rest-Reduce pain-Reduce any inflammation-Begin ROM exercises (within pain tolerance)
Modality for pain modulation (Ice and E-Stim) Flexibility Criteria for progression
-Pain starts to decrease-Inflammation becomes reduced-Exercises become too easy for the athlete
FLEXIBILITY
Important factor in the rehabilitation process
Can help decrease the onset of re-injury
Helps to increase performance Should not be performed with acute
pain
FLEXIBILITY
Sleeper Stretch-Can be
performed at 70, 90, and 110 degrees of motion.
Biceps -Make sure
palm is facing up when performing this stretch.
SUB-ACUTE PHASE
Goals:-Continue with stretching protocol-Introduce CV endurance (elliptical for upper
extremity)-Continue to reduce pain/inflammation-Continue to increase strength and ROM
Joint Mobilizations Resistance Training can begin Continue with modalities to modulate pain Criteria for Progression:
-Athlete feels significant reduction in pain-Significant improvements in ROM-Very little to no swelling-Athlete is not challenged by resistance exercises
JOINT MOBILIZATIONS
Swelling reduced Provides a precise stretch Tensile forces applied over time 2-3 oscillations per second Allowing capsular tissue to remodel in
an elongated position. Remember the convex/concave rule!!!
RESISTANCE EXERCISES
Progress from light to heavy resistance Easy to complex exercises Stable to unstable surfaces Do not perform resistance training with
acute pain!!
REMODELING PHASE
Goals:-Begin more sport specific exercises-Throwing program-Overhead activities-Acquire full ROM-Pain free-Full strength
Athlete should be preparing for functional testing and RTP
FUNCTIONAL TESTING AND RTP
Functional test should include sport specific maneuvers (throwing, blocking, tackling, etc.)
Athlete should meet the following criteria before RTP:-Ability to have full ROM -Perform all overhead tasks the sport demands -NO PAIN!!-Full strength (specifically rotator cuff musculature)-Should be able to perform all tasks at full speed
CONCLUSION
Don’t do too much too soon!! Stretching, Stretching, and more
Stretching!! Be creative with rehab!!
REFERENCES
Michener L, McClure P, Karduna A. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics. 2003;18:369-379.
Conroy D, Hayes K. The effect of Joint Mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther. 1998;28:3-14.
Bang M, Deyle G. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;30:126-137.