Physiotherapy treatment for shoulder impingement in the acute phase includes local electrotherapy to decrease tissue inflammation, and commencement of postural correction to take pressure off the impinged structures. Postural correction will involve thoracic spine mobilisations to improve thoracic ranges, lower trapezius exercises to encourage scapular retraction, stretching and releasing tight anterior structures such as the pectoral muscle groups, stretches for the posterior capsule of the glenohumeral joint (if this is tight the humeral head is forced forwards), stretches for scalenes and levata scapulae muscle groups, and cervical spine treatment (C5/6/7 segments) if indicated (cervical spine pathology can maintain impingement signs due to referral patterns). Strengthening of general shoulder muscle groups, such as the rotator cuff, will also be implemented.
A local injection of steroid can significantly improve pain if the condition is not settling with conservative management. However, even if a local steroid injection can temporarily settle the pain of an inflamed subacromial bursa, if the biomechanics that have caused the impingement are not corrected, the pain and disability will return before too long.
A study by Ludwig and Borstad revealed that after 10 weeks of conservative management patients reported a meaningful improvement in work related disability, pain and shoulder ratings. Another study by Ali Yeganeh et al, found that a cortisone injection in the subacromial space resulted in symptom improvement but also found that physiotherapy conservative management was more favourable in the long term.