Can physiotherapy assist with sub-acromial injections for management of shoulder pain?
Shoulder pain can be debilitating and hamper your ability to continue your regular work, lifestyle and leisure activities, often it is difficult to shake.
Most frontline treatment guidelines discuss options of over the counter pain medications, physiotherapy or steroid injections for management of difficult shoulder pain. Firstly, If you need some more information regarding steroid injections then pop over to our pervious blog regarding Cortisone injections and their indications, uses and possible side effects here https://myphysiosa.com.au/steroid-injections-myphysiosa-explains/.
A common questions asked in clinic is how long should I wait for physiotherapy following Cortisone injections or that we “can’t” do physio if you have an injection. Often patients with persistent or severe shoulder pain trial physiotherapy and feel it may be “unsuccessful” so decide that another option may be more effective in managing their pain and feel they need to cease physiotherapy.
Evidence has shown that steroid injections can be effective to assist in managing the difficult shoulder pain such as the aching pain in your shoulder at night or debilitating pain with activity that hasn’t responded to other management like anti-inflammatories in the short term (Arroll & Goodyear-Smith, 2005).
Pain relief is great and the overall goal of treatment but, we often see patients return with multiple bouts of shoulder pain as the injection relieves their acute inflammatory pain but fails to address the underlying issues that may have contributed to their shoulder pain. this doesn’t need to be the case and physiotherapy and other pain management strategies such as cortisone injection may be more effective if used together in right patient (Hsieh, et al., 2023).
If you’ve had injections for your shoulder pain, physiotherapy can assist in improving range and function with day to day activity in the first couple of weeks following an injection. This may be a combination of manual therapy, gentle exercise and activity modifications to assist in letting the shoulder settle post injection (Kulakli, et al., 2020). Longer term goals of treatment following your pain improvement after injection are to return normal range and function to the affected shoulder as the inflammatory response is settling.
Physiotherapy works with you to map out your progressive and personalised rehabilitation plan as this has been shown to be more effective than regular advice or exercise handouts (Roddy, et al., 2021) . Progressive exercise and guided exposure to activity is important to build back strength, mobility and coordination – aimed at improving your shoulder performance and reducing the likely hood of reoccurring shoulder pain (Hsieh, et al., 2023).
If you have persistent shoulder pain and have had or are considering cortisone injections, you don’t have to choose, why not do both!
Arroll, B. & Goodyear-Smith, F., 2005. Corticosteroid injections for painful shoulder: a meta-analysis.. British Journal of General Practice, 55(512), pp. 224-228.
Hsieh, L. et al., 2023. Comparison of corticosteroid injection, physiotherapy and combined treatment for patients with chronic subacromial bursitis – A randomised controlled trial.. clinical Rehabilitation, 37(9), pp. 1189-1200.
Kulakli, F. et al., 2020. Can the efficacy of subacromial corticosteroid injection be improved using a single- session mobilization treatment in subacromial impingement syndrome? A randomized single-blind controlled trial.. Turkish Journal of Medicine, 50(1), pp. 205-212.
Roddy, E. et al., 2021. Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. British Journal of Sports Medicine, Volume 55, pp. 262-271.
Written by James Craig, Senior myPhysioSA Marden Physiotherapist.