Shoulder Pain & Subacromial Pain Syndrome
The shoulder joint is the most mobile joint in the human body and is formed by the humerus (upper arm bone) that fits into the groove of the shoulder blade like a ball and socket. Sometimes after repetitive overhead activity or activity loads that the shoulder is unaccustomed to, we may experience a sharp, pinch-like pain when elevating our arm to reach into our cupboard or even night pain when sleeping on the same shoulder.
You may be experiencing “subacromial pain syndrome”, or also known as “shoulder impingement syndrome”. This is where structures in the space between the humerus and acromion (tip of the shoulder), become compressed when we lift our arm. Some of these structures that get impinged may include the bursa (fluid-filled sac), rotator cuff muscle and the long head of the biceps tendon.
Subacromial pain syndrome is one of the most common disorders found in the shoulder and the causes are generally multifactorial, as the diagnosis ‘subacromial pain syndrome’ encompasses several pathologies and abnormalities such as:
- Subacromial bursitis
- Rotator cuff tears
- Rotator cuff or biceps tendinopathy and/or tendonitis
- Imbalances in our muscles or postures that lead to poor shoulder biomechanics
Do I Need Surgery?
Subacromial pain is preferably treated nonoperatively unless there is no improvement in symptoms with exhaustive non-operative treatment. Surgical repair of a torn rotator cuff may be indicated, depending on the condition of the muscle as well as your age and activity level, which all play a role in deciding whether or not you actually need surgery.
What Can I Do to Treat it?
Despite the different causes of subacromial pain syndrome, the overall recommended treatment is relatively similar:
- Relative rest and avoid repetitive overhead movement in acute phases
- Exercise: there is increasing evidence for exercise as the most important management strategy for subacromial pain syndrome
- Massage and stretching can support the effect of exercises
- Consider using anti-inflammatory medications
- Strict immobilization is not recommended
The best course of action is to see a physiotherapist for an assessment and some advice, as having an understanding of the contributing factors of impingement and a specialized exercise program will lead to accelerated recovery.
A physiotherapist will run you through a series of tests to rule in or out any other shoulder pathologies (it might not be subacromial pain syndrome in the first place!) and also find out the root cause(s) of your shoulder impingement. They will be able to prescribe you specific exercises for strengthening shoulder muscles and shoulder blade stability, which have shown to reduce pain and improve function of the shoulder in recent literature.
5 Exercises & Stretches You Can Do at Home
Thoracic extension over a foam roller
- We require a certain amount of spinal mobility in order to achieve full shoulder range of motion. This exercise targets any stiffness or mobility issues within the spine.
- Place a foam roller or multiple rolled up towels on the floor and lie on it with the roller going horizontally across your shoulder blades. Clasp your hands around your neck and extend your back over the foam roller while you exhale through your lungs. Repeat 10 times.
Doorway pec stretch
- This will stretch the pectoralis muscle which may be affecting the shoulder joint mechanics.
- Stand with your affected shoulder closest to the wall and place your forearm up the door frame at around shoulder height. Rotate your body away from the door frame until you feel a stretch in your chest. Hold for 30-60 seconds.
Shoulder pendulum exercise
- This exercise will use gravity to gap the space between the humerus and acromion, which may help to relieve symptoms.
- Bend at the hips and knees and place one hand on a table or another sturdy surface to maintain balance. Let the affected arm hang downwards. You can also rock your body front-to-back or side-to-side to swing the arm and allow it to swing through a small range of motion, gently.
Side-lying shoulder external rotation
- Once pain settles, you can use this exercise to begin strengthening your rotator cuff muscles, which can lead to better alignment of the humerus and shoulder stability.
- Lie on your non-affected shoulder so that the affected shoulder is on top with the elbow by your side and bent at 90 degrees. Starting with the forearm rested across the body and holding a small weight, lift the weight up by externally rotating your upper arm and ensure your elbow does not lift off your body. Once the arm reaches its end of external rotation range, slowly lower the weight into the starting position. Repeat this movement 10-12 times and make sure you pick a weight that allows you to complete this safely.
Wall Slides
- This exercise promotes upward rotation and protraction of the shoulder blade, a necessary movement to be able to reach overhead without impingement.
- Start by placing your forearms on the wall, perpendicular to the floor and parallel to each other, with wrists at head height. While applying slight pressure into the wall through your forearms and without overly shrugging your shoulders, slide your arms up the wall and bring your chest closer to the wall at the top of the motion. Repeat 15 times.
- Progress the exercise by placing a foam roller between your forearms and the wall or placing a resistance band around your wrist so there is constant tension trying to pull your hands in towards each other.
Note: You will likely require a progression of exercises for optimal recovery and prevention of re-injury. If you are still experiencing pain, seek your physiotherapist for an assessment and further advice.
Jun Sugio
Physiotherapist (BPthy, APA, AHPRA)
References:
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Diercks, R., Bron, C., Dorrestijn, O., Meskers, C., Naber, R., & de Ruiter, T. et al. (2014). Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthopaedica, 85(3), 314-322. doi: 10.3109/17453674.2014.920991
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Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. Journal Of Orthopaedic & Sports Physical Therapy, 50(3), 131-141. doi: 10.2519/jospt.2020.8498
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Umer, M., Qadir, I., & Azam, M. (2012). Subacromial impingement syndrome. Orthopedic Reviews, 4(2), 18. doi: 10.4081/or.2012.e18
Images:
https://msk.org.au/shoulder-pain/
https://pereaclinic.com/front-shoulder-pain/
https://cambridgeshoulder.co.uk/patient-information/physiotherapy-2/
Exercises: Physitrack
