First, the scapular stabilizers must be strengthened to provide a stable skeletal scaffold for the rotator cuff muscles.
Therapeutic exercises for SIS focus on 3 goals. Therapy for SIS involves restoring the balance between these muscle groups to optimize the kinematics of shoulder movement, minimize wear and tear, and decrease pain. These imbalances are often exacerbated by overhead activity, as subjectively reported however, objective evidence suggests that acromiohumeral distance may be shortest during activities closer to 90°.
The relative difference in activation of specific muscles affects the biomechanics of the shoulder and may lead to changes in articulation between the glenoid fossa of the scapula and the humeral head. Shoulder pain and dysfunction secondary to SIS is often precipitated or exacerbated by an imbalance between the various muscle groups of the shoulder: the deltoids, the rotator cuff (including the supraspinatus, infraspinatus, teres minor, and subscapularis), and the scapular stabilizers (including the trapezius, serratus anterior, rhomboids, levator scapula, and pectoralis major). Abnormal scapular kinematics is common in SIS and may include reduced upward rotation and external rotation of the scapula, along with increased elevation and retraction of the clavicle, although increased upward rotation of the scapula has also been noted. During arm elevation, the scapula must externally rotate, upwardly torque and tilt posteriorly. Repetitive activity, particularly during overhead work, heavy lifting and forceful work, as well as working in an awkward posture increases the risk of shoulder disorders. The underlying mechanisms are thought to include inflammation and/or degeneration of the tendon(s) or bursa(e), dysfunctional scapulothoracic and glenohumeral mechanics, debilitated scapular and/or rotator cuff musculature, joint capsule irregularities, postural abnormalities of the neck and/or shoulder, and morphological abnormalities of the relevant skeletal elements. Age is an additional influencing factor because the incidence of SIS is increased among people older than 40 years. The primary risk factor for SIS is repetitive activity at or above the shoulder level, which may include work or recreational activities. The most common shoulder disorder in general practice is shoulder impingement syndrome (SIS), which is caused by compression of the rotator cuff tendons, most prominently the supraspinatus tendon and long head of the biceps along with their bursae in the subacromial space. Shoulder disorders represent approximately one-fifth of all disability payments for musculoskeletal disorders, with significant economic impact. The annual prevalence and incidence of shoulder problems among adults is 2.4% and 1.5%, respectively.
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