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Best Treatment for Subacromial Pain Syndrome

Subacromial pain syndrome (SAPS) (also known as rotator cuff related pain, shoulder impingement, sub-acromial bursitis and rotator cuff tendinopathy) is a very common problem in the general population. To give you some idea, it accounts for around 70% of all reported shoulder pain. Nearly half of those suffering with SAPS report that symptoms can last for over a year. The pain causes reduced day to day function and ability to perform work duties as well as often interrupting sleep.

SAPS is characterised by pain around the shoulder itself and extending into the upper, outer aspect of the arm. The symptoms can vary in intensity and often develops into debilitating pain that has a big impact on day to day life. The good news is that, whilst recovery is usually lengthy, it can get better!

We cover the causes, symptoms and anatomy of subacromial pain syndrome in a previous blog. Check it out here.

Effective physiotherapy offers the best treatment for sub-acromial pain syndrome. Here’s how we can help and provide the best chance of recovery.

What are the best treatments for sub-acromial pain syndrome?

Progressive Exercise
Exercises for SAPS

A physiotherapist will guide you through a tailored, progressive programme of exercises to strengthen the rotator cuff and the muscles that control the shoulder blade.

It may also be appropriate to work on improving posture, muscle timing and activation patterns, or work on the mobility of the neck, shoulder girdle and thorax. You can read more about exercises for SAPS here.

Manual Therapy

Hands on treatment commonly consists of joint mobilisations and soft tissue techniques such as trigger point release and massage. These techniques can help to reduce pain and consequently facilitate normal shoulder movement.

Advice and Education
Shoulder injections

A significant component of SAPS rehabilitation is managing how much load is being placed upon the shoulder. It is one of those conditions where aggravating activities need to be reduced and gradually reintroduced as pain allows. Usually, lying on the affected side is discouraged.

A physiotherapist will guide you through the process of easing back to the activities that you need and love to do. They will also advise of any treatment adjuncts that may be helpful (see other treatment options below).

Complementary treatments for subacromial pain syndrome

Non-steroidal Anti-Inflammatory Drugs (NSAIDS)

Ibuprofen, Naproxen and Voltarol are all examples of NSAIDs. Commonly there is an inflammatory component to SAPS, therefore medication to help reduce inflammation can be helpful. Your physiotherapist will advise you if this is recommended. If required, a prescription can be arranged at the practice.

Corticosteroid Injections

Corticosteroids can be very effective at relieving inflammation and pain. They are indicated in the instance of highly irritable shoulders and are best performed under ultrasound guidance.

Shockwave Therapy

Extracorporeal Shockwave Therapy (ESWT) is a treatment in which high-amplitude sound waves are focused on soft tissues and predominantly tendons. Shockwave Therapy is has a strong scientific base for the effective treatment for various musculoskeletal problems, including subacromial pain.


In most instances, SAPS will respond to conservative (i.e. non-surgical) treatment. In cases where conservative management has been exhausted and is unsuccessful, a referral to an orthopaedic shoulder surgeon may be necessary. A subacromial decompression procedure may be suggested.

Younger patients with a history of trauma and a sizable rotator cuff tear, may be referred earlier with a view to a potential rotator cuff repair.

How long does it take to get better?

Unfortunately, this is a ‘how long is a piece of string’ question as there are many factors that influence the answer. You are certainly looking at months rather than weeks, with three months being the minimum to expect. However, it is more common for it to take 6-12 months and sometimes longer.

What next?

If you think you may have subacromial pain syndrome, book an appointment today with one of our experienced musculoskeletal physiotherapists for a thorough assessment, clear diagnosis and tailored treatment plan.