REHABILITATION

■ As above, flutter arms alternatively. ■ Four-point kneeling. Alternate arm lifts and holds.

■ Standing facing the wall, shoulders flexed at 120º, elbows flexed at 90º with hands on the wall. Hold scapula in neutral.

TIP

Observe for faulty movement /mus- cle recruitment - examples of this includes: ■ Inability to hold the scapula in neutral, elevation of the scapula, scapula rotates early or exces- sively, or wings

■ Over activity of rhomboids, leva- tor scapulae and upper trapezius

■ Trunk movement (usually exten- sion) due to poor activation of core stability.

SIS MANAGEMENT SUMMARY ■ When designing an exercise programme

based on the assessment findings, the aim should be to restore range, strength, stability and scapulohumeral rhythm and it should be performed in a pain-free manner, using pain as a progression indicator.

■ Scapulohumeral, scapulothoracic rhyth- mic stabilisation and strength exercises should all be introduced at an early stage, along with anterior and posterior capsular stretches. When strength exer- cises are being performed as part of a programme it is vital that scapula stabil- ity exercises are also performed.

■ As muscular stability improves and the shoulder becomes more comfortable, progression should be made to more vig- orous strength exercise and scapular sta- bility exercises.

■ Additional techniques may be useful in the treatment of SIS. Transverse friction massage of affected tendons may be of some benefit. Likewise passive accessory mobilisation of the humeral head within the glenoid into any restriction may be beneficial. Evidence is lacking in how effective these techniques are, however positive patient feedback in our clinic is forthcoming.

■ The evidence seems to point towards lit- tle benefit being gained from the use of electrotherapy in SIS (2). If after 6 months of conservative rehabilitation SIS symptoms persist, onwards referral to an orthopaedic surgeon is recom- mended (16).

www.sportex.net Figure 11: Prone lying hands above head, elbow lift THE AUTHORS

Jo Burgess BSc (Hons), MCSP is a chartered physiotherapist qualifying in 1996 from Keele University. After 6 years working in the NHS, she has spent the last 4 years working for the Royal Air Force at the pri- mary care rehabilitation facility (PCRF) at RAF Wittering treating a variety of patients including fast jet Harrier pilots and elite sports people. She is a Stott trained Pilates instructor and a member of the Society of Orthopaedic Medicine. She is currently work- ing towards a diploma in injection therapy.

Ian Matthews has been a physical training instructor in the RAF for 8 years and now specialises as a remedial instructor. He works in the primary care rehabilitation facility (PCRF) at RAF Wittering, working with fast jet pilots, elite sports people and and multi skilled servicemen/women. He is qualified in Stott Pilates, holds the FA Diploma, is currently studying a BSc (Hons) in Sports Rehabilitation and specialises in exercise rehabilitation. He is also the direc- tor and practitioner of ‘Soteria Injury Rehabilitation Clinic Ltd’ based in Peterborough. www.soteria-irc.co.uk.

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Figure 12: Prone lying hands above head, forearm lift

1998;14:93-105 4. Ginn et al. A randomised, controlled clinical trial of a treatment for shoulder pain. Physical Therapy 1997;77(8):802-811 5. Bang and Doyle. Comparison of supervised exercises with and without manual physical ther- apy for patients with shoulder impingement syn- drome. Journal of Orthopaedic and Sports Physical Therapy 2000;30(3):126-137 6. Moseley et al. EMG analysis of the scapular muscles during a shoulder rehabilitation pro- gram. American Journal of Sports Medicine 1992;20(2):128-134 7. Townsend et al. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. American Journal of Sports Medicine 1991;19(3):264-272 8. Morrison et al. Non-operative treatment of subacromial impingement syndrome. Journal of Bone and Joint Surgery 1997;79A(5):732- 737 9. Dickens VA et al. Role of physiotherapy in the treatment of subacromial impingement syn- drome; a prospective study. Physiotherapy 2005;91(3):159-164 10. Bigliani LU, Levine WN. Current concepts review: subacromial impingement syndrome. Journal of Bone and Joint Surgery 1997;79:1854-1868 11. Greenfield et al.Posture in patients with shoulder overuse injuries and healthy individu- als. Journal of Orthopaedic and Sports Physical Therapy 1995;21(5):287-295 12. Donatelli R A. Physical Therapy of the Shoulder. Churchill Livingstone 2004. ISBN 0443066140 13. Turner H. Diagnosis of the Sporting Shoulder. sportEX Medicine 2001;9:10-12 14. Lewis SJ, Green A, Dekel S. The aetiology of subacromial impingement syndrome. Physiotherapy 2001;87:458-469 15. Neumann D A. Kinesiology of the Musculoskeletal System. Mosby 2002. ISBN 0815163495 16. Cavallo RJ and Speer JP. Shoulder instabili- ty and impingement in throwing athletes. Medicine and Science in Sports and Exercise 1998;30,4,1:18-25

21 Figure 9: Prone lying arms by side Figure 10: Prone lying hands above head, hand lift