Subacromial impingement syndrome

like scapula dyskinesis (our previous post), is not a musculoskeletal diagnosis, but an umbrella term that describes a set of symptoms. It is, in itself, a cause for debate over its definition, causative factors, structures involved, and best treatments. Kibler et al describes an alteration in activation sequencing and decreased performance of the scapula muscles in patients with impingement (it is often associated with scapula dyskinesis). Amber pesented with what would be considered fairly common impingement type symptoms - pain at the top/front of the shoulder provoked by elevating the arm, with some referral down the outer shoulder & upper arm. We found that manually assisting the scapula into upward rotation during arm elevation almost completely reduced pain to zero. Adding light resistance to the arm from the side also reduced symptoms on arm elevation (by assisting cuff activation?) Using this information, our plan of attack is to bias initial exercise prescription towards movements and muscles that contribute to scapula upward rotation - primarily lower trap and serratus anterior as described by Kibler et al (2013). We’ll also aim to activate the external rotators of the cuff in some full body movements. Research has demonstrated maximal scapula muscle activation when muscles are activated as part of the kinetic chain (vs isolated). We recognise there are many ways to approach this. This is where we will start, with changes made as and when appropriate. #shoulder #shoulderpain#shoulderrehab #rotatorcuff#strongshoulders #scapula#impingement #exercisephysiology#exerciserehab #movementismedicine#londonexercisephysiology #physio#londonphysio #yoga #londonyoga#kensington #kensingtongym #lifting

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