Q: What should PT consist of?

For patients and providers that are not familiar with the physical therapy experience, you should know:  Orthopedic physical therapists deal with disorders and injuries of the musculoskeletal system.  In the event of subacromial impingement syndrome (please see anatomy and cause in another post), the treatment should be multimodal in its approach, meaning the session should be balanced with the many interventions of physical therapy.  Physical therapists are known for their pursuit of being a profession based on evidence.  If a particular experience does not seem to represent that notion, a patient may want to explore other options (clinics/therapists).

Some of the evidence has shown that:
1. Scapular stabilization exercises can be an important component to the recovery as it more effectively increases strength, improves joint position sense, and reduces scapular dyskynesia.  Of course, there are a lot of exercises that can be effective and important in therapy, but this just shows that sometimes therapists need to think outside the localized area of pain to strengthen something further up the chain, like the base of the shoulder... the shoulderblade (which has 17 muscles attached to it!).  Example stabilization exercises include seated push-ups, high row, low rows, and scapular retraction with a theraband.

Another crucial part of your treatment can be assessed by how much time your therapist is spending with you.  If you are one of many patients during the therapist's hour of working, then you could probably be receiving better care somewhere else.  Furthermore, if the therapist does not have his/her hands on you, then the plan of care could be more productive somewhere else for the patient.  2.  Manual therapy can produce quicker results, such as increased strength, decreased pain, and improved function.  Manual therapy includes soft tissue mobilization, stretching the joint capsule, mobilizing the shoulderblade/thoracic joint, clavicle, etc. since all of these components help the shoulder to move.


Proceed with caution if you ask a therapist about what areas of his practice are evidence-based and he does not have a good answer.  Although modalities are not as well represented as manual therapy and exercise in physical therapy, there are still good studies that are performed on this subject.  Outside of the very popular electrical stimulation and ultrasound, taping techniques should also be considered 3. since they have been discovered to be a promising modality for decreasing pain and improving function.

The beauty of physical therapy is that there are many tools in the toolbelt.  So, if your therapist is not educating the patients or performing dynamic and diverse treatments with the patient, he/she may want to ask the therapist some questions about the plan of care and if there are any upcoming changes soon.  We don't always have to use all of the tools we have; but unlike many in the healthcare profession, physical therapists have more time with the patient, so they can use quite a few of them.


1.  The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome.

Başkurt Z, Başkurt F, Gelecek N, H Özkan M.

2.Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial.

Senbursa G, Baltaci G, Atay A.

3. Taping patients with clinical signs of subacromial impingement syndrome: the design of a randomized controlled trial.

Kalter J, Apeldoorn AT, Ostelo RW, Henschke N, Knol DL, van Tulder MW.