11/04/2025
Subacromial bursitis, an inflammation of the bursa beneath the acromion, often causes shoulder pain and limited mobility, especially with overhead movements. Physiotherapy is a cornerstone of treatment, focusing on reducing pain, restoring function, and preventing recurrence. Here’s a breakdown of physiotherapy approaches tailored to subacromial bursitis:
1. Pain and Inflammation Management
• Rest and Activity Modification: Avoid aggravating movements like reaching overhead or lifting heavy weights. Relative rest helps calm inflammation, but complete immobilization is discouraged to prevent stiffness.
• Ice Therapy: Apply ice packs for 15-20 minutes, 2-3 times daily, especially after activity, to reduce swelling and pain.
• Electrotherapy: Modalities like ultrasound or transcutaneous electrical nerve stimulation (TENS) may be used to alleviate pain. Evidence for ultrasound is mixed, but TENS can provide short-term relief.
• Class 3B Laser Therapy: As discussed previously, low-level laser therapy can reduce inflammation and promote tissue healing. Sessions typically last 5-10 minutes over the bursa, using wavelengths around 820-904 nm. Studies suggest modest benefits for shoulder pain, though results vary.
2. Range of Motion (ROM) Restoration
• Pendulum Exercises: Gentle, pain-free swings of the arm (forward-back, side-to-side, or circular) while leaning forward help maintain mobility. Perform 10-15 reps, 2-3 times daily.
• Passive and Active-Assisted ROM: A physiotherapist may guide the arm through its range using tools like a pulley or cane, progressing to active movements as pain decreases. For example, wall walks (fingers creeping up a wall) improve elevation.
• Stretching: Gentle stretches for the pectoralis, trapezius, and posterior capsule (e.g., cross-body stretch) prevent tightness. Hold stretches for 15-30 seconds, 3-5 reps, avoiding pain.
3. Strengthening
• Scapular Stabilization: Weak scapular muscles contribute to impingement. Exercises like scapular retractions (pulling shoulder blades together) or wall push-ups strengthen the trapezius and serratus anterior. Start with 10-15 reps, 2 sets.
• Rotator Cuff Strengthening: Once pain subsides, isometric exercises (e.g., pushing against a wall in external rotation) progress to dynamic ones using resistance bands. External and internal rotation with a band (elbow at side) targets the infraspinatus and subscapularis. Perform 10-15 reps, 2-3 sets, ensuring no pain.
• Deltoid and Upper Back: Light dumbbell exercises (e.g., lateral raises) strengthen the deltoid while rows target the rhomboids, improving shoulder mechanics.
4. Posture and Movement Retraining
• Postural Correction: Forward head or rounded shoulders worsen impingement. Cueing to sit/stand tall and retract the scapula during daily tasks helps.
• Neuromuscular Training: Relearn proper shoulder mechanics, like avoiding excessive upward shrugging during arm elevation. Therapists may use biofeedback or mirrors to reinforce correct patterns.
5. Manual Therapy
• Soft Tissue Mobilization: Massage or myofascial release around the shoulder (e.g., targeting the deltoid or trapezius) reduces muscle tension.
• Joint Mobilization: Gentle glides or oscillations of the glenohumeral joint improve mobility and reduce stiffness. Techniques are tailored to avoid aggravating the bursa.
6. Education and Prevention
• Ergonomics: Adjust workstations or sports techniques to minimize shoulder stress (e.g., lowering computer monitors to reduce arm elevation).
• Home Exercise Program: A tailored plan ensures long-term maintenance of strength and mobility. Consistency is key—daily exercises for 6-12 weeks often yield lasting results.
• Gradual Return to Activity: Resume sports or heavy lifting only when pain-free ROM and strength are restored, typically after 4-8 weeks, depending on severity.
Evidence and Outcomes
• Studies support physiotherapy for subacromial bursitis, with exercise therapy improving pain and function more than no treatment. A 2017 meta-analysis found supervised exercise plus manual therapy outperforms home exercises alone for shoulder impingement syndromes, including bursitis.
• Recovery varies: mild cases may improve in 4-6 weeks, while chronic or severe cases take 3-6 months. Combining physiotherapy with a corticosteroid injection can accelerate relief, though injections aren’t always necessary.
• If symptoms persist beyond 3 months, imaging (ultrasound or MRI) may rule out rotator cuff tears or other issues, potentially warranting surgical consultation.
Considerations
• Individualization: Treatment depends on factors like age, activity level, and coexisting conditions (e.g., rotator cuff tendinopathy). For example, a young athlete may progress faster to strengthening, while an older patient focuses longer on mobility.
• Pain-Guided Approach: Exercises should stay below a 3/10 pain level. Pushing through pain risks worsening inflammation.
• Adjuncts: Taping (kinesiology or rigid) can support the shoulder, though evidence is limited. Orthopedic referral is considered if no progress occurs after 6-12 weeks.
If you have specific symptoms (e.g., night pain, weakness) or activities causing issues, sharing those details could help refine the plan. Would you like guidance on any particular exercise or aspect of treatment?
