Shoulder Impingement

What is Shoulder impingement

Shoulder impingement is best viewed as an umbrella term as there are many causes of shoulder impingement. Ultimately it is where the space in the Glenohumeral joint (shoulder joint) becomes narrowed and consequently causes damage and inflammation of the soft tissues that run through the space. Tendonitis (inflammation of tendons) of the Supraspinatus rotator cuff muscle as it passes through the subacromial space (part of the shoulder joint, the passage beneath the acromion) is the main causes of pain in shoulder impingement.

Other causes of Shoulder Impingement Syndrome

  • ACJ OA
  • Subacromial Bursitis
  • Calcific Tendonitis
  • Low lying acromion / hooked acromion

Symptoms of shoulder impingement

Shoulder impingement can start suddenly or come on gradually.

Symptoms include:

  • pain in the top and outer side of your shoulder 
  • pain that’s worse when you lift your arm, especially when you lift it above your head 
  • pain or aching at night, which can affect your sleep 
  • weakness in your arm


  • Avoid movements and activities that make your shoulder pain worse
  • Ice 
  • Sleeping position 
  • Posture! 
  • Complete the exercises as shown as directed – better chance of quicker recovery

Avoid movements and activities that make your shoulder pain worse – this tends to be reaching above shoulder height, reaching for the car seat, feeding a belt through, tucking your shirt in, fastening a bra, taking your tops off etc. You have an INJURY so you need to treat it with care! Meaning you will need to use your good arm to reach for things, work within a pain free zone, so spinning your bra round to fasten it and the front and then spin it back etc.

ICE If its feeling painful and swollen use ice = using a flannel soak in cold water, wring it out and then place in the fridge for about 5mins, then place the flannel on the area. This won’t be as cold as ice which could cause the area to go into spasm but should be cold enough to ease the pain

Sleeping Position You may have noticed your pain is worse on an evening or first thing in a morning after sleeping. My advice is to always sleep either on your back or good side not on your bad shoulder, Think about your posture even in bed so ensure your neck is in a neutral position and your bad arm is supported by your side – using pillows is a great way to support your arm and posture.

Posture – is key! Often a rounded posture (rounded shoulders ) closes the subacromial space within the shoulder joint and this can be a contributing factor to developing shoulder impingement. In confirmed cases of shoulder impingement its vital we try and increase the space in shoulder joint so the better your posture the more it will help.

Exercises / mobilise – .Keep moving – the body likes movement, it helps to keep our joints lubricated and helps fluid exchange happen within our bodies cells, which is vital in areas of inflammation.  Simply walking swinging your arm gently can help to keep your shoulder mobile and aid recovery. Exercises are also vital in shoulder injury recovery. Following the exercises prescribed by your therapist or following the ones below within a pain free range will help speed up recovery.

Exercises – different stages

As an Osteopath when anyone comes to us with pain and symptoms of shoulder impingement we follow the following stages when prescribing exercises. Progressing too quickly through these stages can be detrimental, so never be in a rush to rehabilitate your shoulder injury, they take time to heal, so you need to be patient. These stages also can often overlap, so when you progress on to the later stages you will still benefit from completing the prior stages also.

  • Pain and inflammation reduction 
  • Improve ROM
  • Stabilise 
  • Strengthen 
  • Function movement 

Stage 1 – Pain and inflammation reduction 

  • Ice applied to the tip of the shoulder
  • Pendulum swings 
  • Sleeping position – Propped up with pillows

Stage 2 – Improve ROM

  • Rock the baby 
  • Passive arm flexion 
  • Passive bra strap exercise – Arm up back 

Stage 2 – Stabilise

  • Prone active wide shoulder retraction
  • Kneeling press up
  • Arm press against stability ball (against wall)

Stage 4 – Strengthen

  • Theraband – Drawing the sword
  • Theraband – Internal Rotation
  • Theraband – Seated Reverse Pec Fly

Stage 5 – Functional Movement

  • Theraband – Ball Throw
  • Theraband – Push / pull
  • Etc – Functional exercises are unique to you and your daily activity