Shoulder Impingement (INDUCTION)

SHOULDER IMPINGEMENT S
YNDROME
PHASE I /ACUTE PHASE[1-7 days]:
Goals:
1.Relieve pain and swelling.
2.Decrease inflammation.
3.Prevent / Reduce muscle atrophy.
4.Maintain/increase flexibility.
Modalities [1-3 days]
• Cryotherapy x 10 min. 5 Times per week
• Trans-cutaneous electrical stimulation (TENS) x 15 min. 5 Times per week.
• Ultrasound x 8 Min [1 MHz/1 W/cm2]. 5 times per week
• LASER - 3-5 joule/cm2 at each point over maximum 5-6 painful points/MIN
• Kinesio Taping [ As per need].
[To start after evaluation on from 4-7 days]
Joint Mobilizations - [20 mobs each, 2 sets per session, 5 times per week]
• Grades 1 and 2.
• Inferior and posterior glides in scapular plane.
Range of Motion
• Active-assisted ROM -Within available ROM- Flexion, Neutral external rota
tion. [10 Reps 4 Times daily.]
Strengthening Exercises
• Isometrics- sub maximal Intensity - External rotation. Internal rotation. Bic
eps. Deltoid (anterior, middle, posterior). [10 Reps: 4 Times daily.]
PHASE II MOTION/ SUBACUTE PHASE[8-14 days]
Goals:
1.Re-establish non painful ROM.
2.Normalize athrokinematics of shoulder complex.
3.Reduce muscular atrophy without exacerbation of pain.
ASSESS/ CHECK Criteria for Progression to Phase 2 :
• Decreased pain and/or symptoms.
• Increased ROM.
• Painful arc in abduction only.
• Improved muscular function.
Modalities
• Cryotherapy x 15 min. 5 Times per week
• Ultrasound x 8 Min [1 MHz/1 W/cm2]. 5 times per week.
• LASER - 3-5 joule/cm2 at each point over maximum 5-6 painful points for 1
minute.
• Kinesio Taping As per Required.
Range of Motion [10 Reps 4 Times daily.]
• Initiate anterior and posterior capsular stretching.
• AROM Exercises in Shoulder Flexion, Abduction (Pain-free motion only).
• External rotation in 45 degrees of abduction, progress to 90 degrees of ab
duction.
• Internal rotation in 45 degrees of abduction, progress to 90 degrees of abd
uction.
• Joint Mobilizations [20 mobs each, 2 sets per session, 5 times per week]
• Grades 2, 3, and 4 Inferior, anterior, and posterior glides. Combined glides
as required.
• MWM.
Strengthening Exercises [10 Reps: 4 Times daily.]
• Continue Isometrics exercises as in Phase I.
• Initiate scapular strengthening exercises
PHASE III/ INTERMEDIATE PHASE [15-21 days]:
Goals:
1.To gain normal full ROM.
2.To gain symptom-free normal activities.
3.To Improve muscular performance.
ASSESS/ Check Criteria for Progression to Phase III
• Decrease in pain and symptoms.
• Normal active-assisted ROM.
• Improved muscular strength.
Modalities: [3 Times/ Week].
• IFT x 20 Min.
Manual therapy:
Soft tissue mobilization: Deep transverse friction. Trigger point therapy, Myofa
scial release, Muscle energy techniques of different muscles as required.
Stretching of glenohumeral joint in anterior, posterior and inferior directions.
Joint Mobilizations: Maitland grade 2, 3, 4 joint mobilizations
Range of Motion: [10 Reps x 4 Times daily]
• Active-assisted Full ROM in all planes without pain.
• Continue self-capsular stretching (anterior-posterior).[Hold 30 secs, Repea
t 3-5 times.]
Strengthening Exercises:
• Initiate elastic band or dumbbell exercises of external and internal rotators
in scapular plane with abduction progression. [1 RM, 2 sets per session, 3
times per week.]
• Initiate extension and horizontal abduction exercise in prone lying positio
n. [10 reps 4 times per day regularly.]
• Initiate scapular stabilization exercises [10 reps, 3 sets, 2 times per day.]
• Initiate overhead activities as tolerated and endurance exercises of upper l
imb.
PHASE IV/ ADVANCED PHASE [22-28 days]:
Goals:
1.Increase Muscular strength and endurance and power.
2.Increase neuromuscular control.
ASSESS/ Check Criteria for Progression to Phase IV
1.Full, non-painful ROM.
2.No pain or tenderness.
3.70% of contralateral strength
Modalities: [As per need].
• IFT x 20 Min.
Manual therapy:
• Soft tissue mobilization: Deep transverse friction. Trigger point therapy, M
yofascial release, Muscle energy techniques .
• Stretching of glenohumeral joint in anterior, posterior and inferior.
• Joint Mobilizations: Maitland grade 2, 3, 4 joint mobilizations in inferior, p
osterior and anterior directions.
Range of Motion: [10 Reps x 4 Times daily]
• Full ROM in all planes without pain.
• Continue self-capsular stretching (anterior-posterior).[Hold 30 secs, Repea
t 3-5 times.]
Strengthening Exercises:
• Continue elastic band or dumbbell exercises of external and internal rotat
ors in scapular plane with abduction progression. [1 RM, 2 sets per sessio
n, 3 times per week.]
• Continue extension and horizontal abduction exercise in prone lying positi
on. [10 reps 4 times per day regularly.]
• Continue scapular stabilization exercises [10 reps, 3 sets, 2 times per day.].
• Continue overhead activities as tolerated and endurance exercises of uppe
r limb
PRECAUTIONS/CONTRA-INDICATIONS:
• To avoid shoulder Flexion and abduction to 90 or greater in activities of dai
ly living and sleep.
• To avoid repetitive motion of the shoulder at home and during activities of
daily living.
• To avoid sleeping on the involved shoulder as this will place compressive f
orces through their shoulder and will exacerbate their pain.
• To avoid overdoing of the exercises and to take adequate rest in between s
ets of exercises.
• A contraindication for joint mobilization is: joint hypermobility.
• Shoulder girdle fracture, Gleno humeral subluxation / dislocation, AC joint
sprain, concomitant cervical spine symptoms.
• Precautions: malignancy, bone disease detectable on x-ray, unhealed fract
ure, excessive pain, hypermobility in associated joints, total joint replacem
ents, systemic connective tissue disease, joint effusion and inflammation,
and elderly individuals with weakened connective tissue

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SHOULDER IMPINGEMENT S

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