As the shoulder joint is the most mobile joint of the body, it is no surprise that with the demands of sports such as swimming, tennis and javelin throwing, it is implicated in a high proportion of reported shoulder injuries. Of these injuries impingement syndrome is reported to be the most common form of shoulder pathology.

Shoulder impingement syndrome (SIS), also known as subacromial impingement syndrome or painful arc syndrome, occurs when one of three structures becomes compressed in a small tunnel at the top of the shoulder, known as the subacromial space. These structures are:

• The subacromial bursa
• The rotator cuff tendons (most commonly supraspinatus)
• The long head of the biceps muscle

SIS is a complex syndrome with many possible causes, however within sport SIS commonly occurs in overhead activities such as freestyle swimming, tennis serves and javelin throwing. As the arm is raised above the head the subacromial space decreases in size, predisposing any of the structures in the space to become impinged.

Normal Shoulder

Other possible factors include poor posture, tears of the rotator cuff muscles, shoulder instability and bony growth at the shoulder joint. For this reason it is often recommended to seek advice from a professional who will be able to diagnose the cause of the problem and help to speed up recovery time by addressing these causes.

The initial management of SIS should be rest from pain-provoking activities combined with the application of ice for 20-30 minutes several times a day to reduce pain and inflammation. The area should not be immobilised, gentle activity is important to help promote healing.

Studies have shown that SIS can be effectively managed with exercise rehabilitation. Rehabilitation for SIS is based on stretching exercises for muscles found to be short (typically latissimus dorsi, pectoralis major/minor, subscapularis and teres major) as well as strengthening exercises for muscles found to be weak.

Typical stretches prescribed would therefore include:

Posterior compartment stretch

Anterior compartment stretch

Typical strengthening exercises are used to strengthen the rotator cuffs, providing support to the shoulder joint

Resisted shoulder external rotation

Resisted shoulder internal rotation

Exercises such as these should be performed within a pain free range and built so that they are performed daily for 30 repetitions, either in sets of 3 x 10 or 2 x 15.

Focus should also be placed on strengthening the muscles that stabilise the scapula, or shoulder blade. One way to do this is whilst standing assume a press up position against the wall. The shoulder girdle should be in neutral with the scapula flat on the thorax. Alternate lifting one hand off of the wall, holding the position whilst not allowing the position of the scapula or thorax to change.

Sally Wade BSc (Hons) Ost

Registered Osteopath at Complete Care Clinic, Guildford

Contact: 07792 526642 or sallywade@live.com

RELATED: 3 Rules for Rapid Fat Loss

POPULAR: Why You Should be Deadlifting!