Subacromial Shoulder Pain

85% of shoulder pain in primary care is sub acromial, so, if you have ever had unexplained shoulder pain  it is likely to be subacromial shoulder pain. This term is not a specific diagnosis however is commonly used by health professionals. Other names that you may have heard are subacromial impingement syndrome, subacromial shoulder impingement, or just shoulder impingement. If you have ever suffered or been told your pain is subacromial shoulder pain and you're unsure what it is and how to help it, let me help you! We will nut this out together! 

What is Subacromial Shoulder Pain?

The word subacromial refers to the space between the top of the arm (humorous) and the pointy bit of your shoulder (acromion). Refer to the picture below to help you. Within this space, important shoulder muscles run, you may have heard of the rotator cuff, or more specifically supraspinatus (one of the rotator cuff muscles, there are 4). Another structure that is within this space is a bursa, a fluid filled sack for cushioning and comfort of the rotator cuff. 

The pain you experience is due to some form of irritation of these structures within the subacromial space. This irritation can begin from a traumatic event such as grabbing something really fast and wrenching on your shoulder or from overusing the shoulder, when the shoulder is worked more than its capacity can handle. People who commonly get this shoulder pain are people who do some DIY gardening or home renovations and particularly when they are with overhead movements. Often the cause of your shoulder pain is a combination of overusing the shoulder and poor shoulder mechanics. 

The common diagnosis you may hear are; 

• Bursitis 
• Rotator cuff tear
• Rotator cuff tendinopathy 
• Rotator cuff tendinitis. 

Whatever the mechanism, the structures of the subacromial space become inflamed and cause pain.

Management of Your Shoulder Pain

You may find yourself going down many different pathways to manage your shoulder pain with different health professionals however some have been found to be more effective to others. Specific exercise to improve shoulder strength and function have been found to be very effective for subacromial shoulder pain. 

Treatments  that are often seen for this type of pain include:

• Exercise
• Activity modification 
• Medication 

• Injections (cortisone)
• Surgery 

Activity modification and exercise have been the most effective in producing long term success in improving shoulder pain. Below we will go through management for improving shoulder pain

Unloading the shoulder or modifying activity

We have to take steps to modify whatever is irritating the shoulder. What movements are hurting your shoulder at the moment? What movements help your shoulder pain? What things do you do to relieve pain? When is your shoulder pain the worst? These are all the questions we need to answer so that we can modify the activity we are doing and unload that shoulder and settle down your pain and get you back to the activities you want.  

Loading up the shoulder 

I know what you're thinking, I've just told you to unload the shoulder! However we also need to find a load that the shoulder can handle so we can reduce the amount of strength lost meanwhile building up specific shoulder strength. Not to mention there are certain exercises that have shown to have a reducing effect on pain. 

As I said above, often the cause of your pain is from overuse and poor mechanics, therefore it is important that we target improving the mechanics of the shoulder and build up the strength of the shoulder so it can handle a higher capacity. 

Loading up the shoulder is a gradual process, the trick is to find the right starting point and progress as our body adapts so that we avoid the best we can flare ups of pain along the way. Flare ups, however are common and sometimes unavoidable, however doesn't mean we are doing damage to our body. 

There are certain types of muscles that we aim to target in the initial phase of shoulder rehabilitation to improve shoulder mechanics and strength and these include; 

Rotator cuff muscles: The rotator cuff muscles are important for shoulder stability and strength. The job of these muscles is to rotate the Humerus (upper arm) both internally and externally, however their arguably more important role is to hold the head of the upper arm in the socket of the shoulder. By improving the strength and durability of these muscles we can help improve the stability of the shoulder particularly when it is moving. Below is an exercise targeting rotator cuff muscles. 

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Muscles that move the scapula (shoulder blade): As the upper part of the arm (humerus) is joined onto the scapula at the glenoid fossa, the muscles that move the scapula have an important role in keeping the glenoid fossa in the correct place for shoulder movement. Not to mention the movements the scapula can do help to improve the subacromial space. Below is an exercise targeting the muscles that move the scapula (shoulder blade).

​Muscles that adduct the Arm (bring the arm towards the body): These muscles are important as when you lift your arm above your head, naturally the muscles of your shoulder are pulling the upper part of your arm (humerus) upwards towards the acromion (pointy bit in your shoulder) reducing the subacromial space. Essentially the adductors of the arm help to pull the upper part of your arm (humerus) towards the ground. Below is an exercise targeting the muscles that adduct the arm. 

You may be wondering, I've got all this great information and some exercises I can try! How long will it take before my shoulder pain will go away and I can start to do what I want? That questioned cant be answered on here as shoulder recovery is very individualised however research has shown that people with shoulder pain typically don't start to feel improvement until up to 6 weeks and it can take 12 weeks or longer before they can get to a satisfied outcome. 

Key takeaways from this Blog are:

• Activity modification and exercise have been the most effective in producing long term success in getting rid of shoulder pain.
• We need to understand what is causing your pain so that we can modify and decrease load on the shoulder and reduce pain. 
• Loading up the shoulder is a gradual process, the trick is to find the right starting point and progress as our body adapts so that we can avoid the best we can flare ups of pain along the way. 
• People with shoulder pain typically don't start to feel improvement until up to 6 weeks and it can take 12 weeks or longer before they can get to a satisfied outcome. 

Don't be alarmed! It's better to take 12 weeks then to have ongoing pain for years. If you have read this blog and still don't know where to start, come in and see one of our exercise physiologists. 

The videos shown are just some examples of baseline exercises and may not be the right exercise for everyone. 

Izaac Boylan 
Accredited Exercise Physiologist

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