Physical Therapy for Rotator Cuff Impingement: What to Expect

A rotator cuff is a group of four muscles that stabilize the shoulder and help move the arm. Tissue in this part of the body can become impinged or pinched. Unfortunately, this injury can cause significant pain and may severely limit your normal arm movements and activities.

The most common pain-causing disorder affecting the shoulder joint is rotator cuff impingement syndrome, also known as subacromial impingement syndrome (SAIS). Fortunately, there are several effective treatments for this disorder, including physical therapy (PT).

This article will review the causes of rotator cuff impingement and the types of PT you may receive for this injury.

What Is Rotator Cuff Impingement?

Your supraspinatus is one of four rotator cuff muscles responsible for elevating your arm away from your body and overhead. This important structure originates on your shoulder blade and travels through a small anatomical tunnel before attaching to your arm bone (humerus). The tunnel it traverses through is formed by the outer tip of your shoulder blade (called the acromion) and the top, or head, of the humerus.

Occasionally, the space between these two structures can narrow, and the supraspinatus can be pinched, irritated, or even torn. Other structures, including a fluid-filled sac known as the subacromial bursa, the long head of the biceps muscle, or other rotator cuff muscles, may also be
affected.

Collectively, this issue is known as rotator cuff impingement syndrome and can occur for various reasons. These include:

• Anatomical abnormalities in the shape or orientation of your acromion
• Boney changes in the area where the acromion joins the collar bone (called the acromioclavicular joint).
• Tightness in the strong connective tissue that surrounds the shoulder (known as the capsule)
• Weakness in the rotator cuff or shoulder blade muscles
• Increased flexion or kyphosis in your mid-back (thoracic spine)

Regardless of the cause, this syndrome can lead to a number of symptoms in your arm. Among the most common are:

• Slowly developing shoulder pain that comes on for weeks or months
• Pain along the front or side of the shoulder that may travel down the side of the upper arm
• Pain when moving your arm to the side or overhead
• Pain that interrupts your sleep or prevents you from lying on the affected side
• Difficulty reaching behind your back
• Shoulder stiffness or weakness

Physical Therapy for Rotator Cuff Impingement

If you have significant and persistent shoulder pain, it's important to see your healthcare provider to get an accurate diagnosis. Some injuries, like a rotator cuff tear, may require more significant interventions such as surgery.

If you are diagnosed with a rotator cuff impingement, your healthcare provider will typically advise you to modify your activities to avoid irritating movements. Nonsteroidal anti-inflammatory (NSAID) medications may also be prescribed to help manage your pain. Occasionally, an anti-inflammatory cortisone injection is also administered to help with pain. However, caution must be taken as this can lead to tendon breakdown and is not typically an effective treatment on its own.

In addition, outpatient physical therapy plays an important role in addressing several root causes that can lead to this condition. While each situation is unique, PT typically focuses on the following interventions when treating your rotator cuff impingement symptoms:

Stretching

Sitting or standing with your shoulders in a slumped position can narrow the tunnel that the supraspinatus travels through and make it more susceptible to impingement as you move your arm. Because of this, much of the treatment surrounding a rotator cuff impingement centers on stretching the muscles that get tight when you have poor posture.

Typically, your physical therapist will focus on improving the flexibility in the chest muscles that help move the shoulder (the pectoralis major and pectoralis minor). They may also concentrate on other neck and shoulder structures, including the scalenes, the trapezius, or the sternocleidomastoid.

Soft tissue massage (hands-on massage of the muscles and ligaments) and passive stretching (stretching induced by an outside agent, such as by your PT or a resistance band) may be performed while you are in the clinic.

Your physical therapist will also give you a home stretching program to continue the progress between therapy sessions. Ultimately, improving the flexibility in these structures can help open up your posture and decrease any pinching or irritation on your rotator cuff muscle. 

Strengthening

Weakness in your shoulder blade (scapular) muscles can cause rounding of the shoulders, reduced space beneath the acromion, and ultimately contribute to rotator cuff impingement.

Because of this, maintaining sufficient strength in these structures plays a key role in treating a rotator cuff impingement. Your physical therapist will teach you resistance exercises that reduce impingement by targeting the muscles (like the rhomboids, lower trapezius, middle trapezius,
and the serratus anterior) that bring your shoulder blades into a better position.  

In addition, restoring your normal shoulder range of motion is also an important goal of rehab. Because of this, PT will focus first on gentle active shoulder movements in a pain-free range. As these get easier and full motion is restored, progressive strengthening of the rotator cuff muscles is also commonly performed to increase the stability of the joint.

Joint Mobilizations

Restrictions in the movement of your shoulder, shoulder blade, neck (cervical spine), or mid-back (thoracic spine) can alter the mechanics of your shoulder joint and lead to rotator cuff impingement.

As part of therapy, your PT may attempt to improve the mobility in these areas by
performing joint mobilizations. During this treatment, manual pressure is applied to the targeted area in the direction of stiffness. Depending on the goal of the mobilization, the force that is applied can be gentle and oscillating (moving back and forth) or more firm and forceful.

Evidence has shown that including manual therapy like joint mobilizations into your physical therapy sessions can lead to significant improvements in the pain associated with rotator cuff disorders like impingement.

Surgical Treatment

In many instances, physical therapy and other conservative treatment is effective in addressing the symptoms caused by rotator cuff impingement. However, this is not always the case. In situations where PT is ineffective, surgery may be needed to address the underlying origins of your shoulder issue.

When surgery is required, a procedure called a subacromial decompression is typically performed. During this operation, a portion of the acromion is removed to create more room in the anatomical tunnel that your supraspinatus moves through.

Other surgical interventions, such as a rotator cuff repair or debridement, may also be necessary depending on the state of the shoulder structures. An orthopedic surgeon can perform a thorough examination of your arm and shoulder and discuss the appropriate treatments for you.

Summary

Rotator cuff impingement is a common cause of shoulder pain and impaired mobility of the arm and shoulder. Physical therapy can play an important role in easing your pain and restoring your ability to move freely. A physical therapist will work with you to stretch the muscles in the shoulder joint that tend to get tight and pinched from poor posture, strengthen muscles that support the rotator cuff, and help to mobilize the joint with manual pressure. If PT isn't effective, surgical intervention may be needed.

A Word From Verywell

The pain and disability associated with rotator cuff impingement may be mild at first, but as symptoms progress, they can significantly impact your ability to go about your day. Because of this, it is important to seek treatment early on.

Be sure to speak to your healthcare provider about whether PT is appropriate for your shoulder symptoms. Working hand in hand with a physical therapist can help you overcome this annoying and frequently debilitating condition and make returning to your daily activities possible again.