You are in the sub-theme Physiotherapy of Impingement Syndrome. You will find the start page of this topic under Physiotherapy of impingement syndrome. You will find the medical-orthopedic part under our sub-topic Impingement Syndrome.
In primary impingement syndrome, the head of the shoulder joint is often shifted forward or upward, which means that the tendons are trapped under the acromion when the arm is raised or lowered. With the techniques of manual therapy, the therapist mobilizes the shoulder joint capsule in the restricted directions and thus gives the head of the shoulder joint the opportunity to center itself better in the joint. The mobilization is performed as a sustained stretching of about 30 seconds and several repetitions.
These manual techniques, which are performed passively on the patient, can also actively support the patient in a self exercise. These exercises must be explained and shown in detail during the therapeutic session, as they are not easy to perform correctly. This exercise program must be carried out intensively depending on the individual findings in consultation with the physiotherapist at home every day, since the passive therapy is limited to the 1-3 times weekly sessions in the physiotherapeutic practice.
In a direct comparison of the treatment methods active exercise program and manual therapy, the patients who were additionally treated with manual therapy (MT) had a faster improvement of symptoms. This shows that in any case the combination of both techniques is indispensable. The head of the shoulder joint is located too high in the joint (lack of centering of the head of the shoulder joint in the joint) Technique: Mobilization of the head of the shoulder joint downwards
1. self-exercise for shoulder head centering
Starting position Stand with slightly straddled legs, one weight (1-2kg) is in the hand of the affected arm Exercise performance the arm is gently moved back and forth or sideways in front of the body – the upper body is slightly tilted forward – pendulum Starting position Stand with slightly bent knee joints, the affected arm is supported in a spreading movement before the pain occurs, a belt (suitcase belt closed to form a ring) is located from above very close to the shoulder joint and under one foot. When the knee joint is stretched, pressure is applied to the head of the shoulder joint from above, and the patient simultaneously pulls the shoulder girdle upwards. Effect of the shoulder joint head slides down, creating space under the shoulder joint roof.
Starting position Seated on a stool or stand, upright posture Exercising with the opposite hand gives the patient pressure on the shoulder joint head downwards towards the floor, at the same time the affected arm is raised and spread out until the pain threshold is reached. The simultaneous downward thrust on the shoulder joint head extends the pain threshold and the arm can be further spread before the known pain occurs. The head of the shoulder joint sits too far forward in the joint (lack of centering of the head of the shoulder joint in the joint) Technique Mobilization of the posterior capsule parts (posterior capsule parts) Starting position supine position, the shoulder blade is supported by a wedge, the opposite hand lies on the head of the shoulder joint from the front Exercise execution the hand presses the head of the shoulder joint downwards At the same time, the arm moves in a lifting and spreading movement, when the arm is returned to the starting position, the pressure is released Effect of the backward movement of the shoulder joint head creates more space under the acromion, the movement is extended until the pain threshold is reached
