Efficacy Of Adding Cervical Stabilization Exercises To Conventional Physical Therapy In Subacromial Impingement Syndrome

Shoulder impingement syndrome is a mechanical compression of the subacromial structures; specifically the subacromial bursa, rotator cuff, and long head of biceps tendons in the subacromial space. There are painful arm motions and functional restrictions.

The treatment of SIS focuses on improving pain and upper limb (UL) functions. Conservative treatments are effective in stages I or II of SIS.

Conservative treatments include non-steroidal anti-inflammatory drugs, corticosteroid injections, and exercise therapy such as strengthening for RC, and scapular muscles, stretching , proprioceptive neuromuscular facilitation (PNF), range of motion (ROM), and scapular stabilization exercises.

Cervical stabilization exercises (CSEs) can improve cervical spine stability, flexibility, muscular strength and endurance, and joint position sense. Shoulder stability extends beyond the shoulder joint as the head, neck, and shoulder are interconnected through muscles, tendons, and fascia.

Alteration of spine alignment leads to change mechanics of the shoulder. Forward head posture (FHP) can cause abnormal scapular orientation (internal rotation, elevation, and anterior tilting), decrease shoulder muscle strength, ROM, and increase humeral head translations that may predispose an individual to SIS. Also, increase thoracic kyphosis may cause increase scapular anterior tipping and retraction.