Exercise Training Sequence for Subacromial Impingement Syndrome

While physical therapy is an effective element in the rehabilitation of rotator cuff (RC) disease, the most effective sequence of training interventions has not been defined. The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises.

The study was a prospective randomized crossover design. 26 men and 14 women, mean age 51, diagnosed with subacromial impingement syndrome (SAIS) were randomly assigned to one of two groups for a comprehensive and standardized rehabilitation program over six visits at an orthopedic outpatient clinic. One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation.

Inclusion criteria

• 18-80 years of age
• diagnosis of Neer Stage I/II subacromial impingement with a primary pain complaint in the shoulder and/or upper arm
• presence of at least two of the following findings: painful arc, weakness in external rotation, positive impingement sign (Hawkins-Kennedy or Neer/Walsh tests), pain and/or weakness with resistance to internal rotation, external rotation, or scapular plane elevation.

Exclusion criteria

• concurrent medical co-morbidities including pregnancy, diabetes, and rheumatoid arthritis -
• osteoarthritis greater than grade 2 on the Kellgren-Lawrence scale
• current diagnosis and/or previous history of glenohumeral instability or dislocation
• full-thickness rotator cuff tear
• adhesive capsulitis
• fractures of the scapula, clavicle or humerus
• scapulothoracic or rotator cuff paresis
• shoulder surgery in past year
• inability to speak the English language at a level sufficient to obtain informed consent.