Strategies for Shoulder Impingement and Tendon Pathology
An accurate description of early tendon pain is important. Acute injuries can be framed in one of three phases. #2 Estimate phase of the tendinitis/ tendinosis
Early phase involves pain only after activity without significant loss of range. Pain usually resolves when activity stops. If mechanics and or tendon loading activities are not corrected, tendon irritation can progress.
Moderate pathology presents with extreme exertion and lasts 1-2 hours after activity. As it progresses, pain may be present with moderate activity and last four-six hours after exercise.
Severe pathology will present with pain during any activity that rapidly increases with continued activity. Pain can last 8-24 hours after exercise. Eventually all daily activities become painful.
Chronic tendon pain lasting > six months falls into the tendinosis category. This is a state where a tendon physically starts to change. These changes may include hypoechoic areas as well as general thickening of the tendon evident on ultrasound. 40 • This pathology requires a careful loading program that focuses on high load, long duration resistive activities. • The Physical Therapy Program at The University of Delaware has done extensive research on tendinosis. Click here to see an example of this type of rehabilitation program for achilles tendinopathy. 41
#3 Determine appropriate focus of treatment This will be based on how the patient is presenting. Acute pain will require rest, education, and treatments to address inflammation. More chronic conditions will require progressive loading programs.
#4 Institute appropriate tensile loading program based on the stage of tendon pathology.
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