What physical therapy (PT) exercises and stretches are recommended for acromial bursitis?

Physical Therapy and Stretches for Acromial Bursitis

For acromial bursitis, a structured physical therapy program focusing on gentle stretching and progressive strengthening exercises is recommended as first-line treatment, particularly when combined with other conservative measures like NSAIDs. 1

Initial Approach to Physical Therapy

Gentle Stretching Techniques

• External rotation and abduction stretches are particularly important for shoulder mobility 1
• Start with gentle stretching to the point of tension (not pain), holding each stretch for 20-30 seconds
• Perform stretches after warming up or at the end of exercise sessions
• Focus on:
  • Posterior shoulder capsule stretches
  • Cross-body adduction stretches
  • Doorway pectoral stretches

Progressive Strengthening Program

• Begin with isometric exercises before advancing to resistance training
• Target both rotator cuff and scapular stabilizer muscles:
  • Eccentric exercises for rotator cuff (2 types)
  • Concentric/eccentric exercises for scapular stabilizers (3 types) 2
  • Start with 15 repetitions in 3 sets, twice daily
  • Progress by gradually increasing external load based on pain tolerance 2

Structured Exercise Protocol

Weeks 1-2

• Focus on pain control and gentle range of motion
• Avoid exercises that cause pain above 3/10 on pain scale
• Perform active-assisted range of motion exercises
• Incorporate posture correction exercises

Weeks 3-8

• Progress to strengthening exercises with light resistance
• Rotator cuff exercises: external/internal rotation with resistance band
• Scapular stabilization: rows, scapular retraction, wall push-ups
• Continue stretching program daily
• Maintain proper shoulder alignment during all exercises 2

Weeks 9-12

• Increase resistance progressively
• Reduce frequency to once daily while maintaining intensity
• Add functional movement patterns specific to patient's activities 2

Evidence for Effectiveness

Research shows that specific progressive strengthening exercises targeting the rotator cuff and scapular stabilizers are more effective than general, non-specific exercises for shoulder impingement conditions 2. A structured rehabilitation program combined with other conservative measures has demonstrated significant improvements in:

• Shoulder function (Constant-Murley scores)
• Pain reduction, particularly night pain
• Reduced need for surgical intervention 2

Combination with Other Treatments

Physical therapy is most effective when combined with other treatments:

• NSAIDs (oral or topical) for pain management 1
• Ice application for 10-minute periods through a wet towel to reduce inflammation 1
• Rest from aggravating activities while maintaining general mobility
• Corticosteroid injection may be considered if PT alone is insufficient 3

Important Considerations and Pitfalls

• Avoid complete immobilization as it leads to muscle atrophy and deconditioning 1
• Maintain good posture during all exercises to prevent impingement
• Progress gradually based on pain response, not on a fixed timeline
• Monitor for symptom exacerbation and adjust exercise intensity accordingly
• Consistency is crucial - daily home exercises between supervised sessions improve outcomes

When to Consider Additional Interventions

If minimal improvement is seen after 8 weeks of consistent physical therapy:

• Consider corticosteroid injection as an adjunct to continued PT 3
• Note that combined treatment (PT plus injection) shows better outcomes than either treatment alone, but PT alone has the lowest recurrence rate 3
• Evaluate for other potential causes if symptoms persist despite appropriate therapy

Physical therapy remains a cornerstone of treatment for acromial bursitis, with evidence supporting its role in improving function and reducing pain when properly structured and consistently performed.