Useful Manual Therapy Techniques to Improve Shoulder Impingement Outcomes

The shoulder gives the most degrees of freedom of any joint in the body. The rotator cuff is an extremely important structure in providing a vital balance between mobility and stability. The rotator cuff consists of the tendons (a tendon is an extension of a muscle which attaches that muscle onto a bone) of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These structures are vulnerable to injury. One of the most common of all shoulder injuries is impingement.

Impingement occurs when the rotator cuff tendons get pinched in the space between the arm bone and the arch of the shoulder blade, which is known as the sub acromial space, as they pass from their muscle to their attachment at the front of the shoulder. This causes a mechanical stress to the tendon which results in swelling and/or damage. This pain is usually felt when lifting the arm up straight in front of you or out to the side as this is when the sub acromial space is at its smallest.

Rotator cuff impingement can be difficult to cure. Stretching or strengthening exercises and non steroidal anti inflammatory (NSAID's) are often prescribed as treatments for impingement. Another valuable treatment option is manual therapy. Manual therapy has been shown to improve the outcomes for rotator cuff impingement treatment ⁽¹⁾. Manual therapy helps to relieve the mechanical stress on the tendon which causes the damage and helps the damaged tendon to recover more quickly.

What is Manual Therapy?

Manual Therapy is a term used to describe a ‘hands on' treatment approach where joints, muscles ligaments and other soft tissues are mobilized or manipulated by a therapist to achieve a therapeutic benefit.  The benefits for the shoulder and rotator cuff muscles in using these techniques includes increased flexibility, increased tissue healing, improved muscle function without impingement, and a patient's increased tolerance to performing functional activities without impingement pain following treatment.

There are a range of techniques which fall into the category of manual therapy, those most commonly used for the treatment of rotator cuff impingement are:

• Soft Tissue Massage
• Friction massage
• Manipulation
• Mobilization

Soft Tissue Massage

Soft tissue massage is the systematic application of pressure and movement on the soft tissues of the body with the intention of facilitating normal range of movement.

Friction Massage

Deep  tissue friction massage is the application of a massage technique whereby superficial tissues are rubbed against deeper tissues. It is useful in assisting the body's own healing mechanisms and as such can help to speed up the healing of injured tendons.

Manipulations

Manipulation is a passive joint movement performed with the aim of increasing joint mobility. It incorporates a small amplitude quick thrust movement at the end of the available joint range.

Mobilizations

Joint mobilization involves the application of a passive force to increase joint range of motion. Mobilizations are performed up to the end of available joint range, but always within that range.

Although manual therapy has been proven to improve rotator cuff impingement recovery, it is not clear which of these manual therapy interventions is better ⁽²⁾. It would seem logical to assume that a combination of these treatments would prove to be of benefit in promoting recovery from rotator cuff impingement.

References

1. The effect of manipulation on the structures of the shoulder girdle as additional treatment for symptom rekief and for prevention of chronicity or recurrence of shouder symptoms. Bergman, GJD, Winters, JC and G, Heijden. 2002, Physical Therapy, Vol. 25, pp. 543-549.

2. Comparison of conservative treatment with and without manual physical therapy for patients wth shoulder impingement syndrome: a prospevtive, randomized clinical trial. G, Senbursa., Baltaci, G and Atay, A. 2007, Knee surgery sports traumatology and arthroscopy, pp. 915-921.

How Exercise Helps to Improve Your Performance in the Workplace

According to the National Institute for Occupational Safety and Health, over 30% of employees report high levels of stress and experience associated health problems on an ongoing basis. While there are a number of reasons for the cause of stress at work, its effect frequently results in illness and injury. The common disorders ensuing from a stressful work environment include psychological, emotional, behavioral and cognitive ailments. If left unchecked, simple issues may evolve over time into serious illnesses such as cardiovascular disease.

The lack of exercise on a daily basis can exacerbate many of the ailments associated with workplace pressures. However, many of the symptoms of such distress may be alleviated by making lifestyle choices which benefit employees both mentally and physically.

Your health may be at risk if you are experiencing symptoms relating to workplace stress. If you suffer from depression, anxiety, fatigue, lack of concentration, or experience aches, sleep disorders, or pain, then you would benefit from a change in lifestyle habits which encompass a suitable form of daily exercise.

You will need to cope with these pressures because although the causes may not be in your control, you will suffer the effects of job stress. To mitigate these effects, you may need to make lifestyle choices such as taking care of your diet and achieving work-life equilibrium. The set of stress inducing factors you deal with are unique to your individual situation. Implementing a daily exercise routine is just one step in the multi-faceted approach to helping yourself to improve workplace performance. The benefits of following such a routine have been shown to increase morale, improve mood and energy levels, and to achieve focus and induce relaxation.

How does exercising on a daily basis help you improve your performance on the job?  Exercising daily has been proven to improve your mood and overall health, which has a positive impact on your ability to achieve your work goals.

A research study in the International Journal of Productivity and Performance Management by Sameer Kumar, et al (1) conducted a cost-benefit analysis of a company's employee wellness program and healthcare costs. It determined that improving employee health resulted in enhanced worker performance and thereby increased the organization's productivity. Thus it established a direct link between employee health and work productivity.

A second study in the Journal by J.C. Coulson et al (2) measured the specific effects of exercise in the workplace by a group of employees. The employees recorded data on days they exercised as well as on days they did not exercise. On comparison, a direct link between exercise and employee productivity was established. It was found that on the days that the group of employees chose to exercise, they experienced a positive change in mood, which led to enhanced performance outcomes.

If you are experiencing symptoms or know a person who has difficulties related to the workplace, including muscle aches, changes in appetite, sleep deprivation, and fatigue, we can help by customizing a plan to incorporate exercise in your daily routine. Our programs will help you cope with your career goals and help you improve your workplace performance over time.

References:

(1) Operational Impact of Employee Wellness Programs: A Business Case Study Kumar, Sameer; McCalla, Michael; Lybeck, Eric: International Journal of Productivity and Performance Management. 58(6):581-597, 2009. DOI: 10.1108/17410400910977109

(2) Exercising at Work and Self-Reported Work Performance Coulson, J.C.; McKenna, J.; Field, M. International Journal of Productivity and Performance Management. 1(3):176-197, 2009. DOI: 10.1108/17538350810926534

Improve Your Walking Speed, Balance, and Functional Capability with Resistance Training.

Resistance training exercises have been shown to improve muscle strength, metabolism, and endurance.  But what effect does resistance training have on improving your overall lifestyle.  In other words, how does it help you to do your daily activities such as walking, lifting objects, work, or maintain balance?

Many people rely on other forms of exercise to stay in shape, maintain balance, and normal function.  These include aerobic or cardiovascular exercise, yoga, and pilates.  Although these are all great forms of exercise, one needs to remember that resistance training is a key exercise component that should be included with other forms of exercise to maintain total body fitness and function.

This is why our programs here emphasize a variety strength training exercises even when a member is performing an "Energy Day" or cardiovascular routine.  Resistance exercises increase core strength and stability allowing you to bend down and pick up items with decreased risk for injury and improved balance. 

Resistance training improves balance by increasing lower extremity and core muscles ability to stabilize joints against ground forces and other forces the body comes up against.  Finally, resistance training of the lower extremities improves explosive power and muscle endurance allowing for increased walking speed with less fatigue and risk for balance loss.

A study by Holviala, Jarrko H.S. et al. backs these statements.  Holviala and company looked at how a 21-week resistance-training program improved balance, functional capacity, and strength in middle age to older women.  The program was performed twice a week by a group of 48 women ages 52 and up.  Results showed significant improvements in functional balance, walking speed, and extensor strength of the lower extremities (1). 

So when you are going through a strength training day, remember the benefits of doing so will help you either maintain or improve your capacity to perform all of life's daily functional, work related, and recreational activities including walking faster and maintaining your balance. 

Reference:

1) Effects of Strength Training on Muscle Strength Characteristics,Functional Capabilities, and Balance in Middle-Aged and Older Women. HOLVIALA, JARKKO H.S.; SALLINEN, JANNE M.; KRAEMER, WILLIAM J.; ALEN, MARKKU J.; HÄKKINEN, KEIJO K.T.  The Journal of Strength & Conditioning Research. 20(2):336-344, May 2006.