Dear Colin: I’m 33 years old and tired of having shoulder pain. After nine months and multiple tests (MRI, X-ray), my doctor diagnosed me with “impingement syndrome” and referred me to physical therapy. It helped a little, but the worst part is the 20 exercises I’m supposed to do at home. The PT says all of these exercises are required for me to get better, but I simply don’t have the time (or desire) to do them all. Is this customary and, if so, how do most people succeed in PT? The time commitment seems ridiculous.
— Larry, McMinnville
Shoulder pain is one of the most common musculoskeletal problems medical providers see and usually doesn’t spontaneously resolve without the right form of physical therapy (Spine 2005; The Rheumatologist 2006).
Not being involved in your care prevents me from providing specific treatment advice, but shoulder impingement syndrome is when the relatively small space between the top of your upper arm bone (humerus) and your shoulder blade (scapula) is too small to allow adequate space for tissue between them when moving your arm out to the side and/or above your head. There are multiple possible causes, which may include muscle weakness (Journal of Orthopaedic & Sports Physical Therapy 2006), abnormal bone anatomy (Clinical Orthopaedics and Related Research 1983), tightness of muscles and/or ligaments (American Journal of Sports Medicine 1998) and/or posture (Manual Therapy 2005).
The key to overcoming shoulder impingement syndrome (as well as many other causes of shoulder pain) is a thorough physical examination to find out the specific cause(s) of impingement. For example, a weakened rotator cuff can allow your upper arm bone to move excessively upward during certain arm motions, thus compressing sensitive tissues and causing pain. There are four rotator cuff muscles, so it’s important to identify which of the four should be targeted so you don’t waste time doing exercises for muscles that aren’t impaired. Tightness of the chest muscles is also a common culprit and must be carefully screened for in the examination (Archives of Physical Medicine and Rehabilitation 2002).
When prescribed appropriately, physical therapy exercises and stretches have been shown to significantly reduce pain associated with shoulder impingement syndrome. However, a common mistake is prescribing too many exercises that can quickly sap anyone’s motivation to follow through with a program.
Prescribing exercises for any condition should always take safety and effectiveness into consideration. A great physical therapist will choose exercises that effectively strengthen multiple muscles simultaneously to reduce the time requirement. The only potential drawback is that these more effective exercises require more time to learn to do correctly. A great example is the prone arm press, an exceptional shoulder exercise that safely strengthens the rotator cuff, upper middle back muscles (rhomboids, middle and upper trapezius), back of the shoulders (posterior deltoid), neck (upper trapezius) and lower back (paraspinals).
Important things to note:
1. Very little weight is needed;
2. Tightness in your shoulders and chest will make the exercise more difficult;
3. Keep your head completely still, and;
4. Keep your head, chest, shoulders and arms close to the ground but don’t touch it.
Sets and repetitions should be established by your physical therapist.
With any rehabilitation, try to keep an open, honest dialogue with your physical therapist to help facilitate success. If you’re told to do a program that takes more time than you’re willing to commit to, it probably will be a waste of time.