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  • Writer's pictureBilly Gilhooley

Shoulder Pain No More: The Ultimate Guide to Subacromial Pain Syndrome Rehabilitation

Shoulder pain is a common complaint among adults, and one of the most prevalent shoulder conditions is subacromial pain syndrome. Subacromial pain syndrome is a condition that affects the structures that pass through the subacromial space, including the rotator cuff tendons, subacromial bursa, and long head of the biceps tendon. The condition can cause pain, weakness, and restricted movement of the shoulder joint, which can have a significant impact on daily activities and quality of life.

An image of a physiotherapist conducting an assessment on a patient's shoulder. The physio is gently manipulating the patient's arm while the patient sits upright and looks forward. The patient's face appears calm and relaxed.

Effective rehabilitation is essential in the treatment of subacromial pain syndrome. The goals of rehabilitation are to reduce pain, restore range of motion, and improve strength and function of the shoulder joint. As a physiotherapist who specialises in the diagnosis and treatment of subacromial pain syndrome, my role is to provide effective rehabilitation to promote recovery and improve the quality of life for my patients.


In this blog post, I will discuss the definition of subacromial pain syndrome, the importance of shoulder rehabilitation, and the role of a physiotherapist in the diagnosis and treatment of the condition. I will also address some of the most commonly asked questions about subacromial pain syndrome, including its causes, treatment options, and recovery time.


Understanding Subacromial Pain Syndrome

Subacromial pain syndrome is a condition that affects the structures that pass through the subacromial space, including the rotator cuff tendons, subacromial bursa, and long head of the biceps tendon. To understand the condition better, it is essential to have a basic understanding of the anatomy of the shoulder joint.


Anatomy of the Shoulder Joint

The shoulder joint is a ball-and-socket joint that allows for a wide range of motion in the arm. It is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The head of the humerus fits into a shallow socket in the scapula called the glenoid. The rotator cuff muscles and tendons, which attach to the humerus and scapula, help to stabilise the shoulder joint.


Causes and Risk Factors of Subacromial Pain Syndrome

Subacromial pain syndrome is commonly caused by overuse or repetitive strain, such as in sports or jobs that require overhead activities. Other risk factors for the condition include age, poor posture, and shoulder instability. Trauma, such as a fall or direct impact to the shoulder, can also cause subacromial pain syndrome.


Symptoms of the Condition

Symptoms of subacromial pain syndrome include pain in the shoulder, weakness, and limited range of motion. Patients may also experience pain and discomfort when lying on the affected shoulder, lifting objects, or performing overhead activities. These symptoms can be severe enough to affect daily activities and may lead to secondary problems, such as neck and upper back pain. It is essential to seek medical attention if you experience any of these symptoms.


Diagnosis of Subacromial Pain Syndrome

Diagnosing subacromial pain syndrome requires a comprehensive assessment of the patient's symptoms, medical history, and physical examination. As a physiotherapist, I perform a thorough evaluation to determine the cause of the patient's symptoms and develop an individualised treatment plan.


Physical Examination of Shoulder Joint

During a physical examination, I assess the patient's range of motion, strength, and stability of the shoulder joint. I also check for any tenderness or swelling around the joint and evaluate the patient's posture and movement patterns. Specific tests, such as the Neer and Hawkins-Kennedy tests, may be performed to help diagnose subacromial pain syndrome.


Imaging Tests

Imaging tests, such as X-rays, ultrasound, and MRI, may be ordered to confirm the diagnosis of subacromial pain syndrome and to rule out other conditions that may present with similar symptoms. Imaging tests can provide detailed images of the bones, joints, and soft tissues of the shoulder, which can aid in the diagnosis and treatment of subacromial pain syndrome.


Differential Diagnosis

It is essential to differentiate subacromial pain syndrome from other conditions that can cause shoulder pain, such as rotator cuff tears, biceps tendinopathy, and adhesive capsulitis. A thorough assessment and evaluation are necessary to identify the underlying cause of the patient's symptoms and develop an appropriate treatment plan.


Shoulder Rehabilitation: Physiotherapy Approach

As a physiotherapist, my primary goal in the rehabilitation of subacromial pain syndrome is to reduce pain, restore range of motion, and improve strength and function of the shoulder joint. Rehabilitation is essential for promoting recovery and improving the patient's quality of life.


Goals of Rehabilitation

The goals of rehabilitation for subacromial pain syndrome include reducing pain and inflammation, improving range of motion, and restoring strength and function of the shoulder joint. Rehabilitation may also include education on proper posture, movement patterns, and ergonomic modifications to prevent future injury.


Stages of Shoulder Rehabilitation

Rehabilitation for subacromial pain syndrome typically progresses through several stages, starting with pain management and progressing to strengthening exercises. The specific treatment plan depends on the severity of the patient's symptoms and their individual needs.


Typically, the stages of rehabilitation include:


Pain Management: The first stage of rehabilitation focuses on reducing pain and inflammation through modalities such as ice, heat, and manual therapy.


Range of Motion: The next stage of rehabilitation focuses on restoring range of motion to the shoulder joint through stretching exercises and mobility drills.


Strengthening: The final stage of rehabilitation focuses on restoring strength and function to the shoulder joint through resistance exercises and functional movements.


Exercises and Stretches for Subacromial Pain Syndrome

Specific exercises and stretches can help improve the symptoms of subacromial pain syndrome. Examples of exercises and stretches that may be prescribed include:


1. Rotator cuff strengthening exercises, such as external rotation and scapular retraction exercises.

2. Shoulder blade stabilisation exercises, such as wall slides and rows.

3. Range of motion exercises, such as pendulum swings and shoulder circles.

4. Stretching exercises for the chest and posterior shoulder, such as the doorway stretch and the sleeper stretch.


Importance of a Home Exercise Program

A home exercise program is an essential component of rehabilitation for subacromial pain syndrome. The patient's commitment to their home exercise program can have a significant impact on the success of their rehabilitation. By performing exercises and stretches at home, the patient can reinforce the progress made during their physiotherapy sessions and continue to make improvements in their shoulder function.


Top 10 Most Commonly Asked Questions About Subacromial Pain Syndrome

As a physiotherapist, I understand that patients may have many questions about their condition. Here are the top five most commonly asked questions about subacromial pain syndrome, along with their answers:


What Causes Subacromial Pain Syndrome?

Subacromial pain syndrome is caused by the compression of the soft tissues in the subacromial space, which can result in inflammation and pain. This compression can be caused by a variety of factors, such as overuse, poor posture, and shoulder impingement.


How Is Subacromial Pain Syndrome Diagnosed?

Subacromial pain syndrome is typically diagnosed through a physical examination, imaging tests, and a review of the patient's medical history. The physical examination may include specific tests to evaluate the shoulder joint, such as the Neer and Hawkins-Kennedy tests. Imaging tests, such as X-rays, ultrasound, and MRI, may also be used to confirm the diagnosis and rule out other conditions.


Can Subacromial Pain Syndrome Be Treated Without Surgery?

Yes, subacromial pain syndrome can often be treated without surgery. A comprehensive rehabilitation program that includes exercises, stretches, and manual therapy can help reduce pain, improve range of motion, and restore strength and function to the shoulder joint.


How Long Does It Take To Recover From Subacromial Pain Syndrome?

The recovery time for subacromial pain syndrome varies depending on the severity of the condition and the individual's response to treatment. However, with appropriate treatment and rehabilitation, many patients experience significant improvements within a few weeks to several months.


Can Subacromial Pain Syndrome Recur After Treatment?

Yes, subacromial pain syndrome can recur after treatment if the underlying cause of the condition is not addressed. To reduce the risk of recurrence, it is essential to address any contributing factors, such as poor posture, overuse, or improper movement patterns, and to maintain an appropriate exercise program to support shoulder joint health.


What are the risk factors for developing subacromial pain syndrome, and how can they be managed or mitigated?

As a physiotherapist, I know that several risk factors may increase the likelihood of developing subacromial pain syndrome. These include age, occupation (especially those involving repetitive overhead motions), poor posture, shoulder instability, poor shoulder blade control, and muscle imbalances. Sports that require frequent use of the shoulder joint, such as swimming and throwing sports, may also increase the risk of developing subacromial pain syndrome.


To manage or mitigate these risk factors, it is important to take appropriate preventive measures. These may include maintaining good posture and body mechanics, avoiding repetitive overhead motions or excessive force on the shoulder joint, and ensuring that the muscles around the shoulder blade and rotator cuff are strong and balanced. In addition, proper warm-up and stretching before physical activity can help prevent injury and reduce the risk of developing subacromial pain syndrome. Finally, staying active and engaging in regular exercise can help maintain overall shoulder strength and function, which can reduce the likelihood of developing shoulder pain and injuries in the future.


How can subacromial pain syndrome be prevented, and what steps can individuals take to reduce their risk of developing the condition?

As a physiotherapist, I know that there are several ways to prevent subacromial pain syndrome and reduce the risk of developing this condition. One of the most important steps is to maintain good posture and body mechanics, especially during activities that involve the use of the shoulder joint. This can help prevent excessive stress and strain on the rotator cuff tendons and other structures in the shoulder, reducing the risk of injury and pain.


Another key factor in preventing subacromial pain syndrome is ensuring that the muscles around the shoulder blade and rotator cuff are strong and balanced. Exercises that target these muscles can help improve stability and reduce the risk of developing imbalances or weaknesses that may contribute to shoulder pain and injuries.


Individuals can also take steps to reduce their risk of developing subacromial pain syndrome by avoiding repetitive overhead motions or excessive force on the shoulder joint. Proper warm-up and stretching before physical activity can also help prevent injury and reduce the risk of developing subacromial pain syndrome.


Finally, maintaining overall shoulder strength and function through regular exercise and activity can help reduce the likelihood of developing shoulder pain and injuries in the future. A physiotherapist can work with individuals to develop a personalised exercise program that targets their specific needs and helps prevent subacromial pain syndrome.


What are some common myths and misconceptions about subacromial pain syndrome and shoulder pain, and what is the truth behind them?

As a physiotherapist, I often come across common myths and misconceptions about subacromial pain syndrome and shoulder pain. One of the most common myths is that shoulder pain is always caused by a rotator cuff tear or injury. However, in reality, there are many different causes of shoulder pain, and not all cases are related to the rotator cuff.


Another common myth is that rest is the best treatment for shoulder pain, and that any movement or exercise will make the condition worse. In fact, rest alone is rarely effective in treating subacromial pain syndrome and other types of shoulder pain, and a program of appropriate exercises and stretches is often necessary to restore strength and mobility to the shoulder.


Some people also believe that surgery is always necessary to treat subacromial pain syndrome and other types of shoulder pain. However, in many cases, non-surgical treatment approaches such as physiotherapy, manual therapy, and exercise are highly effective in reducing pain and improving shoulder function.


Finally, some people believe that shoulder pain is an inevitable consequence of aging or wear and tear on the joints. While it is true that the risk of developing shoulder pain and injury increases with age, there are many steps that can be taken to prevent and treat shoulder pain, including maintaining good posture and body mechanics, staying active and physically fit, and seeking prompt treatment for any symptoms of pain or discomfort in the shoulder.


Overall, it is important to seek professional advice from a physiotherapist or other healthcare provider to dispel any myths or misconceptions about subacromial pain syndrome and shoulder pain and to develop an effective treatment plan that is tailored to the individual's specific needs and goals.


What factors should be considered to determine the optimal time to return to sports after experiencing subacromial pain syndrome?

As a physiotherapist, there are several factors that I would consider when determining the optimal time for a patient to return to sports after experiencing subacromial pain syndrome. These factors include:


The severity of the injury: The severity of the injury is a key factor in determining when a patient can return to sports. If the injury is severe and requires surgery or a lengthy recovery period, the patient may need to wait several months before returning to sports.


The patient's level of pain: Pain is a sign that the injured tissues are not fully healed. Before returning to sports, the patient should be pain-free during their activities of daily living and during rehabilitation exercises.


The patient's range of motion: The patient's range of motion should be equal to their unaffected shoulder before returning to sports. This ensures that the shoulder is strong and stable enough to withstand the demands of sports.


The patient's strength and endurance: The patient's strength and endurance should be sufficient to meet the demands of their specific sport. A physiotherapist can help the patient develop a tailored exercise program to restore strength and endurance.


The patient's functional ability: The patient should be able to perform sport-specific movements without pain or discomfort before returning to sports.


It is important to note that returning to sports too soon can increase the risk of re-injury, which can prolong the recovery process. Therefore, it is important to work closely with a physiotherapist to develop a safe and effective rehabilitation program and to follow their guidance on when to return to sports.


What is the recommended frequency for performing exercises as part of a shoulder rehabilitation program for subacromial pain syndrome?

As a physiotherapist, I recommend performing exercises for subacromial pain syndrome at a frequency of 3-5 times per week. It is important to start with low intensity exercises and gradually progress to higher intensity exercises as tolerated by the patient. Overdoing it can lead to increased pain and further damage to the shoulder joint, so it's crucial to listen to your body and adjust the frequency and intensity of exercises accordingly. A physiotherapist can provide a tailored exercise program that suits your specific condition and needs.


Physiotherapy for shoulder pain

As a physiotherapist who specialises in the diagnosis and treatment of subacromial pain syndrome, I cannot stress enough the importance of seeking professional help if you experience any shoulder pain. Delaying treatment or self-managing the condition can result in worsening pain and a longer recovery time.


Physiotherapy plays a critical role in the rehabilitation of subacromial pain syndrome, and a comprehensive rehabilitation program can significantly improve your shoulder function, reduce pain, and prevent recurrence. Exercises, stretches, and manual therapy are some of the key interventions used by physiotherapists to help patients recover from this condition.

In the future, research in the management of subacromial pain syndrome will continue to explore new treatment modalities and rehabilitation techniques to improve outcomes for patients. As physiotherapists, we will continue to adapt our approach to the latest research and advancements to provide the best possible care for our patients.


In summary, if you experience shoulder pain, seek professional help as soon as possible. A physiotherapist can diagnose and treat subacromial pain syndrome effectively and help you get back to your normal activities. Remember, early intervention and a comprehensive rehabilitation program can significantly improve outcomes and prevent recurrence.


Billy Gilhooley at Specific Physiotherapy is here to help

Billy Gilhooley is a highly experienced and qualified physiotherapist located in Preston, Victoria. With years of experience in the field of physiotherapy, he specialises in providing top quality services for shoulder pain, including subacromial pain syndrome. Billy understands the importance of accurately diagnosing the underlying cause of shoulder pain, and provides physio treatment plans tailored to his patient's specific needs. He utilises evidence-based techniques and exercises to help patients recover from their injuries and improve their quality of life. His passion for helping patients recover from shoulder pain and regain their mobility is evident in the positive results he consistently achieves. If you're suffering from shoulder pain, Billy Gilhooley is a physiotherapist you can trust to provide the highest level of care and expertise. Give him a call today on 0490 021 474 to discuss your shoulder pain. Alternatively please visit https://www.specificphysiotherapy.com/ to book online or for more information.

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