Subacromial impingement (SAI – aka shoulder bursitis) like most other orthopedic problems is influenced a number of factors. Some are structural – like the presence of a “hook” acromion – while others are related to lifestyle and body mechanics. Specifically, sedentary individuals seem to suffer far more from SAI than those who are not sedentary. One of the reasons may be related to posture.
Posture? Aren’t You Just Nagging Me?
I’m paranoid of accepting anything in physical rehabilitation that might be strictly dogma – there’s plenty of that to go around already without contributing to it myself. Although I knew for quite some time that postural problems (and a stiff upper thoracic spine) could dispose some individuals to having SAI, I wasn’t terribly convinced of the mechanism. There have even been some conflicting studies that do not support that view of the pathomechanics of SAI.
What Is the Evidence?
After viewing a video of a cadaveric study (not to be gross) a year or two ago, I have since emphasized posture as a component of rehabilitation of the painful shoulder. The key concept of SAI is that the rotator cuff and bursa (fluid filled sac) are compressed and become inflamed between the humerus, the acromion, and some ligaments that typically can become thickened over time. When surgery is indicated, it is termed a subacromial decompression. The surgeon enters the shoulder through an arthroscope, then removes the bursa (bursectomy) then grinds away bone from the underside of the acromion and trims or cuts selected ligaments to create more room in the subacromial space, where the rotator cuff resides. During the recovery process, the shoulder heals and a bursa is generated.
The whole procedure yields a few millimeters of space. Back to the dead people – A cadaveric study was undertaken. Shoulder motion and measurements were taken from a position that many people assume – with a rounded upper back and “protracted scapulae” meaning that the shoulder blades were forward and to the outside. Then the posture was corrected, with the shoulder blades drawn in and down to a more central position. The result? An average of 14mm additional space for the rotator cuff. So, if your treatment for SAI includes postural correction (and exercises to maintain it) it’s not just because your therapist is a nag.
At Terry Rehabilitation, each patient is expertly evaluated, each treatment plan is customized for that patient, and all treatment occurs with a highly trained professional.
Our shoulder rehabilitation programs include:
- Hands-on manual therapy techniques – to quickly correct loss of motion
- Supervised therapeutic exercises (strength and flexibility) targeted to specific deficiencies
- Modalities such as cold packs, heat, and electrical stimulation to reduce pain, inflammation, and to increase flexibility
- Targeted home exercise programs that do not require special equipment
- Restoration of functional strength and stability for daily activities
- Work-specific or sport-specific rehabilitation
Contact us to schedule an initial evaluation. If physical therapy is recommended, we will contact your physician in writing regarding the recommended plan of care, allowing him or her to make the most informed decision possible for the care of your shoulder.