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Sub-acromial Impingement Syndrome

The majority of conditions seen in our office are accompanied by some sort of muscular imbalance. Whether that be the primary cause or a secondary effect varies case to case. One condition in particular that is primarily a muscular imbalance is subacromial impingement syndrome (1). The subacromial space is located in your shoulder region, and impingement syndromes are the most common cause of shoulder pain and dysfunction. Shoulder pain itself is the third most common musculoskeletal complaint, with one in three people experiencing it at some point throughout their life (1,2). Impingement can be described as shoulder pain that is present with internal rotation and elevation of the arm that typically goes away when lowering the arm (3).

Typically, the management of this ailment is a stretching program that is to be performed once a day, every day for several weeks. In a study looking at two different stretching protocols vs heating the shoulder complex and using a TENS unit found that pain at rest decreased in all three groups, but pain with activity was only significantly decreased in the stretching groups (1). In another study that incorporated adjusting the upper thoracic spine in combination with shoulder physiotherapy (PT), the group that received the adjustments in combination with the PT had clinically significantly improved function and passive internal rotation range of motion (3). Finally, a systematic review looking at the differences in outcomes between surgical intervention versus a conservative approach at treating subacromial impingement found no differences between the two groups (2). For many patients, surgery is scary and the current evidence shows and guidelines point towards an exercise-based/conservative treatment as the first steps (2). If you are one of those people or would rather try a more conservative approach, reach out to Dr. Kennedy and he can get you set up with the proper stretching program! Once you have a good understanding of the exercise/stretching protocol you will be able to do the majority of the therapy in the comfort of your own home!


  1. Tahran Ö, Yeşilyaprak SS. Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome. Sports Health. 2020 Mar/Apr;12(2):139-148. doi: 10.1177/1941738119900532. Epub 2020 Feb 4. PMID: 32017660; PMCID: PMC7040949.

  2. Nazari G, MacDermid JC, Bobos P. Conservative versus Surgical Interventions for Shoulder Impingement: An Overview of Systematic Reviews of Randomized Controlled Trials. Physiother Can. 2020 Summer;72(3):282-297. doi: 10.3138/ptc-2018-0111. PMID: 35110797; PMCID: PMC8781486.

  3. Land, H., Gordon, S., & Watt, K. (2019). Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: a randomized controlled trial. Physiotherapy Research International, 24(2).

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