What is Shoulder Impingement Syndrome and how can i treat it?

About the Shoulder

The shoulder is one of biggest and most complex joints in the entire body. It's the most mobile joint in the body which allows the upper body tremendous range of motion. This evidently causes the joint to be extremely unstable which makes it easy to injure. The shoulder joint consists of the scapula (shoulder blade) and humerus (upper arm bone) which connect like a ball and socket. Some other bones and structures that make up the shoulder are the acromion, clavicle, coracoid process, rotator cuff and bursa. 

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What Causes Shoulder Impingement?

Shoulder Impingement Syndrome is a condition where the rotator cuff tendons become trapped and compressed when moving the shoulder. The bone impacts the rotator cuff tendons or bursa to cause this shoulder pain. As result, the tendons become swollen and inflamed which then leads to rotator cuff tendinitis. If its the bursa thats impacted, its called shoulder bursitis. Both of these could occur at the same time. These injuries aren't caused by one wrong fall or movement but continuous movements that build up over time to cause impingement.

How can I treat this?

Before taking steps to treat you pain, it is recommended to get an official diagnosis from your doctor. Medical history, physical exams and X-rays should be incorporated to rule out other injuries or conditions such as arthritis and bone spurs. If the doctor diagnoses you with Shoulder Impingement Syndrome, it is recommended to take anti-inflammatory medications such as aspirin or ibuprofen to help treat your pain. Along with the medication, stretching is key to healing your shoulder. Here are some great stretches to incorporate into your everyday life.

5 stretches to help relieve your shoulder pain

Cross Body Arm Stretch


Take your right arm and cross it against your body. Using your left hand, gently pull the arm closer to your body until you feel a stretch. Hold for 5-10 seconds and repeat with the other arm.

Anterior Shoulder Stretch 

Grasp a doorframe or something above your head. Then move forwards while continuing to hold so that your arm is left behind to stretch the front shoulder and chest muscles. Hold the stretch for 20-30 seconds and repeat. 

Supraspinatus Stretch

Stand with a straight spine while putting your hands on your hips with your palms facing outwards and fingers pointing backwards. While pressing your hands onto your hips, slowly begin to move your elbows forward until you feel a light tension behind the shoulders. Hold this position for 20-30 seconds and repeat.

Shoulder Flexion Stretch

First begin by grasping a light bar or household item like a broom stick. Make sure that you stand straight with shoulder blades back and palms at shoulder width. With your arms being stretched perfectly straight, raise the bar over your head for 5 seconds then slowly return to the starting position. Repeat this stretch 10-20 times for multiple sets. 

Shoulder Internal Rotation

You will need a resistance band for this stretch. 

Tie the band to something sturdy such as a door or piece of furniture. Then grasp the band close to your side with your elbows bent 90 degrees. Put a towel or piece of clothing between you and your arm to make sure your arm stays steady as you perform the stretch. Hold the band and slowly move your forearms towards your stomach, across your body. Then slowly return back to the starting position and repeat. 

Working on your posture may also benefit your shoulder pain and you could read all about that here.

For more information or any questions, give us a call at 718-258-3300 or contact us today!

Why do you have bad posture and how can you treat it?

Why do I have bad posture?

There are many reasons as to why you may have bad posture.  They include: Injury and muscle guarding, disease, bad habits, weak muscle areas and genetics. When we injure a muscle, our brain automatically tries to prevent from adding insult to that injury by locking the muscles in the area that may cause spasms. Those spasms will reduce painful joint movements. This whole process causes other muscles to come together to support that weak area which results in bad posture. Habits such as slouching in a seat or hunching over while texting are examples of everyday habits that take a toll on our posture. All of these causes are preventable and curable with the correct treatment. 

What should I do to improve my posture?

Improving bad posture involves not only working on breaking bad life habits but incorporating the correct exercises to strengthen your core, back and shoulder muscles. Core and back muscle exercises move your torso by flexing and extending your spine while also stabilizing the spine so it aligns in its natural position. Shoulder exercises will strengthen the shoulder blades while also pulling back the shoulder blades to reduce slouching. Strengthening these areas will improve overall bodily fitness levels and posture.

What are some exercises to improve my posture?



Go into modified push-up position with your elbows bent 90 degrees and both forearms resting on the floor. Position your elbows directly underneath your shoulders and look straight toward the floor. Your body should form a perfectly straight line from the head to your heels. Your feet are together with only the toes touching the floor. Hold for as long as possible while keeping the abdomen and lower back muscles tight

 Leg Lifts


 Lay down flat on the ground with your legs fully extended and raised upwards. Point your toes and set your neutral spine. Then brace your core so your back doesn’t move while having your legs raised. As one leg lifts, lower the other. Do 10-12 reps on each side maintaining a strong, braced core while relaxing your shoulders and maintaining your breath.

Bird Dog

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Begin on all fours with your knees directly under your hips and hands under your shoulders. Pull in your abs and keep them tight while reaching out with your right arm and extending your left leg. Make sure to not let your ribs sag toward the floor while keeping your pelvis secure. Then return to the starting position and alternate your arm and leg. 

Wall Angels

Stand with your back against the wall with your arms out to your sides while bending your elbows. Rotate your arms so that the back of your hands are touching the wall directly above your elbows. Slowly move your arms up and over your head while focusing on maintaining contact between your elbows, hands, and the wall, and then lower your arms. Only go as high or as low as you can to ensure your hands and elbows are always making contact with the wall. 

Back Extensions

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Lie face down, extending arms straight above your head and extending your legs behind you. Keeping your head in line with your spine, gently lift your shoulders as far off the floor as possible, while also lifting your legs for a few seconds to cause a stretch in the back. Once completed, return to the starting position.

For more information or any questions, give us a call at 718-258-3300 or contact us today!

Anterior Hip Pain and How to Manage It

How does the hip work?

The hip is a ball-and-socket joint that comprises the top of the thigh. The femur, which is your thigh bone, sits into the acetabulum, which is the socket that allows it to remain both stable and mobile, and to allow for movement without dislocation.

What is Anterior Hip Pain and what are it's causes?

Anterior hip pain is most often caused by a strain in the hip flexor muscles which are located at the front of the hip. A strain, which is a injury to a muscle or tendon, causes a painful sensation to the hip which heavily contributes while walking, running or squatting. These strains are common with overtraining, strength imbalances, poor technique, inflexibility and forceful contractions such as kicking and sprinting. The most common and impactful of these is overtraining which includes insufficient rest and difficult training sessions. Consistent overtraining sessions will result in micro trauma which accumulate and result in a possible hip flexor strain or tendonitis. 

Myofascial Release of the Anterior Hip

In this video, Chris Desiderio, DPT will explain how to release some tension that may be in the front of the hip in order to help the hip flexors function optimally.

Posterior Mobilization

In this video, Chris will demonstrate a mobilization of the hip in a posterior direction to help release the front of the joint capsule.

Standing External Rotations

In this video, Chris will demonstrate a standing external rotation, which can help strengthen the gluteus medius to prevent anterior hip pain.

Physical Therapy and Your Insurance


Though your insurance company may allow many physical therapy visit per year, they usually also reserve the right to do a pre-check to ensure that the treatment you’ll be receiving will be medically necessary or able to make a positive change.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or pre-certification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

In and Out of Network

Some insurance companies have in-network providers, which means that they have pre-negotiated rates with those doctors or physical therapists, but insurance companies may also restrict the patient to the in-network providers. Some insurance providers that have in-network providers will also have out-of-network providers, although they may cover less of the expense of the treatment and have the patient pay the remainder of the bill.

Knowing your rights when it comes to your insurance

  • First, you should know that your insurance company is there to help you, you are not subject to their demands

  • You have a right to go out of network if your provider doesn’t have any in-network providers

  • If you are denied for authorization, you have your right to have your voice heard and to request more visits. If you are entitled to more visits than you were authorized for, you can speak to your insurance along with you physical therapists and doctor to be granted more visits

  • You are never locked into a healthcare provider, whether it is a doctor or a physical therapist. If you are unhappy with the care you are receiving, you are entitled to finding a care provider that you feel is good for you

  • For some more detailed info concerning healthcare laws in New York, please visit: http://www.dfs.ny.gov/consumer/hrights.htm

If you have any questions, give us a call at 718-258-3300 or contact us today!

What Is Direct Access and How Can It Help You?

What is direct access?

Direct access is the legal term that states that patients can go straight to a physical therapist to receive treatment, and do not have to get referrals from physicians, which can cause delays and be costly. The term has different conditions in every state, but direct access is available in all 50 states in the US, which means that patients are put at the focus of the treatment plan, and are allowed to receive faster and cheaper services than when required to go through a physician.

Are physical therapists qualified to deliver services independent of referral?

Absolutely. Physical therapists are educated at the post-baccalaureate level and receive extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities. All accredited entry-level physical therapist education programs currently culminate in a Doctor of Physical Therapy (DPT) degree. Physical therapists are qualified to recognize when a patient presents with signs and symptoms inconsistent or outside the scope and expertise of the physical therapist and when the patient should be referred to a physician. APTA's Guide of Professional Conduct advocates that physical therapists should assist patients in receiving appropriate medical care when the physical therapist's examination and evaluation reveals signs and symptoms inconsistent with a condition that can be appropriately treated with physical therapy or needs a physician's care and expertise.

Direct Access Laws in New York

The direct access laws in New York have three conditions:

  • Treatment can be rendered by a Licensed PT without a referral for 10 visits or 30 days, whichever comes first.  

  • Licensed PT must have practiced PT on a full-time basis for no less than three years; be of at least twenty-one years of age.

  • PT must provide written notification that services without a referral might not be covered by the patient’s health plan or insurer; notification must state that said services might be covered by health plan or insurer with a referral. Must keep a copy of the written notification in the patient’s file.

The Bottom Line

Allowing individuals to make decisions regarding their health care is inherently good. Eliminating the referral requirement is one step to making health care more accessible to more people across the United States.

Physical therapist education supports practice without referral. Physical therapist practice in the states that allow treatment without referral has proven that it is safe. Yet consumers in many states continue to face arbitrary barriers to physical therapist services.

Direct access is about individual choice in health care decisions through the elimination of unnecessary and burdensome regulation. Direct access also puts control in the patients’ hands, and allows them to be a part of their own plan of care.

What this means for you

This means that you can come to Evolve Physical Therapy without a referral and get treated by one of our amazing physical therapists right away! Should you need more than ten visits, we’d need to get in contact with your doctor, which we’ll try to make as smooth a process as possible.

If you have any questions, give us a call at 718-258-3300 or contact us today!