Maximising Shoulder Health: The Combined Benefits of Exercise and Chiropractic Care
How Can Exercise and Chiropractic Care Alleviate Subacromial Impingement Syndrome (Shoulder Pain)?
What is Subacromial Impingement Syndrome?
Subacromial impingement syndrome (SIS), often referred to as external impingement, represents the most prevalent diagnostic label applied to cases of shoulder pain. This condition arises when the rotator cuff tendons become irritated and inflamed as they pass through the subacromial space, which is the area beneath the acromion, a bony structure that forms the highest point of the shoulder. The impingement can lead to pain, weakness, and restricted range of motion, significantly impacting daily activities and overall quality of life.
What are the muscles that are affected by shoulder pain?
The supraspinatus tendon, which is crucial for shoulder abduction and stability, often becomes compromised in SIS.
The subacromial bursa, a fluid-filled sac that reduces friction between the acromion and the rotator cuff, can also become inflamed, contributing to pain and discomfort.
The long head of the biceps tendon, located beneath the anterior undersurface of the acromion, may be affected as well, leading to additional pain during shoulder movements.
Furthermore, the coracoacromial ligament and the acromioclavicular joint can play a role in the development of symptoms, especially during the elevation of the arm, where mechanical impingement is likely to occur.
Areas that are also affected in the body are:
Upper Trapezius, which contributes to shoulder elevation and can become tense in response to pain.
The serratus anterior, essential for scapular movement and stability, may weaken, leading to further complications.
Inferior trapezius, which aids in scapular depression and retraction, can also be impacted, leading to imbalances in shoulder mechanics.
How do we treat the shoulder pain?
Weakness of the scapular and glenohumeral muscles is recognized as one of the primary impairments in patients diagnosed with Subacromial impingement syndrome. Addressing this weakness through targeted rehabilitation is essential for recovery and the restoration of normal function.
Research has indicated that participants undergoing a structured exercise regimen over a span of five weeks, with two sessions per week, experienced significant improvements in their symptoms. The exercises included:
Bilateral shoulder flexion up to 60°, which helps in strengthening the anterior deltoid and improving shoulder mobility.
A unilateral bench press, is a movement that not only targets the pectorals but also engages the stabilizing muscles of the shoulder.
Bilateral shoulder retraction and extension in the prone position, focusing on the posterior shoulder muscles and enhancing scapular stability.
Additionally, four core exercises were integrated into the treatment plan:
‘Knee push-up’, which strengthens the chest, shoulders, and triceps while promoting core stability.
‘Isometric forearm plank’, a pivotal exercise for core engagement and shoulder stabilization.
‘Gluteal bridge’, which not only strengthens the glutes but also helps in maintaining proper pelvic alignment during shoulder movements.
‘Dead bugs’, is a dynamic exercise that enhances core strength and coordination, contributing to overall shoulder stability.
Each of these exercises was performed for ten repetitions, with a duration of 10–15 seconds for isometric holds, followed by a 1-minute rest between each repetition to allow for adequate recovery and optimal performance.
As part of a comprehensive treatment approach, we would also incorporate chiropractic care, which may include:
Adjustments to the cervical and thoracic spine can help alleviate tension throughout the upper body and improve overall posture, thus reducing strain on the shoulder.
Adjustments to any subluxated ribs can enhance rib mobility and function, contributing to improved shoulder mechanics.
Adjustments to the shoulder joint itself, are aimed at restoring proper alignment and function, ultimately facilitating better movement patterns and reducing pain.
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Gutiérrez-Espinoza H, Méndez-Rebolledo G, Zavala-González J, Torreblanca-Vargas S, Araya-Quintanilla F. The Effect of the Addition of Core Exercises to Supervised Physiotherapy in Patients With Subacromial Impingement Syndrome. Int J Sports Phys Ther. 2025 Feb 2;20(2):210-220. doi: 10.26603/001c.128630. PMID: 39906051; PMCID: PMC11788093.
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