shoulder_impingementSubacromial shoulder impingement often responds well to therapeutic exercise, particularly when coupled with manual therapy (Bang 2000). Injections and surgery are sometimes as good but are associated with higher risks. British researchers were interested in the added benefit of an injection with individualized physiotherapy exercises and manual therapy. 232 patients with subacromial impingement syndrome were randomly assigned to an exercise group or exercise combined with injection. All subjects received individualized exercise interventions as the physiotherapist chose from 6 mobilization techniques and 23 exercises including Thera-Band exercise bands. The exercise combined with injection group received a corticosteroid injection and avoided resistive exercises for the first 2 weeks of therapy. Download the physiotherapy protocol here.

The group receiving exercise with an injection significantly improved in their pain and disability in the short term (first 6 weeks); however, there were no significant differences between groups at 3 and 6 month follow-ups. The authors concluded that a corticosteroid injection is beneficial only if rapid pain relief is a priority, and up to 1/3 of patients will not respond to 12 weeks of exercise and manual therapy, possibly benefiting from a corticosteroid injection. This study supports the use of Thera-Band exercise bands combined with manual therapy in shoulder impingement patients.

REFERENCE: Crawshaw DP, Helliwell PS, Hensor EM, Hay EM, Aldous SJ, Conaghan PG. Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial. BMJ. 2010 Jun 28;340:c3037.

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