Anti-impingement Therapy?

In the study by Johansson et al reported in “Effects of Acupuncture Versus Ultrasound in Patients With Impingement Syndrome” (June 2005), the authors selected 85 patients with an actual shoulder impingement with appropriate inclusion and exclusion criteria. Unfortunately, they applied no physical therapy clinical reasoning to examine the cause of the impingement. There are several forms of impingement (primary and secondary subacromial, subcoracoid, posterosuperior), caused by several tissue lesions (tendons, bursa, capsule, labrum, ligament) at several locations, that can cause the patient’s complaints. Without considering which form of impingement and type of tissue lesion is present, you might treat the rotator cuff when the scapular muscles or a joint are responsible for the problem. The relationship between impingement and the applied exercise therapy is absolutely unclear. Is exercise 1 performed via elevation, scaption, or abduction? With or without pain? Are 30 repetitions of exercise 2 realizing the desired improvement in the trophic condition of the rotator cuff? I do not know any evidence for that. In the second part of the exercise program, strength exercises are prescribed. Was the strength, without physical therapist evaluation, decreased? Are we talking about absolute or duration strength, or does that make no difference? This nonfunctional exercise program lacks necessary components such as training of local stabilizers, improving scapular rhythm, and functional training.1,2 Ultrasound therapy can be a part of a plan of care for impingement, but only if complaints …