Introduction
There are various options, both conservative and operative, available to treat impingement syndrome. The therapy is always based on the individual state of the disease. However, a conservative therapy is usually started.
This means that physiotherapy, osteopathy, medication etc. are used to reduce the symptoms and promote the healing process. Only when these methods fail, surgical treatment is considered.
The Physiotherapy
Impingement involves both manual therapy and humeral head centering exercises. With the help of manual therapy, the therapist can identify the existing movement disorders of the shoulder and treat them using specific techniques. Since impingement of the shoulder results in movement restrictions, the physiotherapist attempts to expand the range of movement of the shoulder again by means of manual therapy.
The patient does not actively move the shoulder because the shoulder joint is moved by the therapist. In addition, the muscles of the shoulder, which are often tense during impingement, can be loosened by the physiotherapist through massage, heat therapy or electrotherapy. Once the mobility of the joint is restored, the humerus centering process is continued.
The shoulder joint or humeral head (upper end of the humerus) is held in place by the so-called rotator cuff (shoulder musculature). If the muscles are too weak, the head of the humerus may slip or not lie properly in the socket, thereby pinching structures and causing impingement. Furthermore, muscles that pull the humeral head downwards – such as the latissimus dorsi muscle – should be strengthened.
The muscles are strengthened, for example, by means of weights or are trained with the help of equipment. In addition to strengthening the shoulder muscles, stretching exercises should also be performed. During physiotherapy, it can be decided which exercises are suitable.
The exercises against impingement serve to strengthen the rotator cuff and the latissimus dorsi muscle. The rotator cuff is trained by means of internal and external rotation training and the latissimus dorsi by so-called “lat pulling”. For this purpose, various traction exercises are performed with a weight puller or an attached elastic band.
Which exercise is suitable and what the correct execution looks like should be discussed with the physiotherapist. It is important that these exercises are not performed in pain. You should also think about stretching the shoulder joints sufficiently afterwards.
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