Shoulder Impingement: Symptoms, Causes and Physiotherapy Treatment

By Keziah Loewen, Physiotherapist

Shoulder impingement is a common cause of pain when lifting the arm overhead, reaching behind the back or performing repetitive upper-body activities.

Today, clinicians often use the term subacromial pain syndrome to describe this type of problem. This reflects our improved understanding that symptoms are not always caused by one structure simply being “pinched”.

Instead, pain may involve the rotator cuff tendons, surrounding tissues, muscle strength, movement patterns and the amount of load placed through the joint.

At the Institute of Sports and Spines in Tingalpa, these symptoms are a common reason people seek physiotherapy assessment and rehabilitation.

What Does Shoulder Impingement Feel Like?

Symptoms can vary from person to person.

Common signs include:

• Pain when lifting the arm overhead
• Discomfort when reaching behind the back
• Pain when putting on a shirt, jacket or bra
• Difficulty reaching into a cupboard
• Pain when sleeping on the affected side
• Discomfort that travels into the upper arm
• Reduced strength
• Stiffness or restricted movement
• Pain during gym exercises, swimming or throwing activities

For some people, symptoms develop following a particular activity or sudden increase in training.

For others, discomfort develops gradually without a clear moment of injury.

What Causes It?

The joint is highly mobile and relies on muscles, tendons and surrounding structures to provide both movement and stability.

The rotator cuff is a group of four muscles and their tendons that help control the upper arm during movement.

When these tissues are exposed to more load than they can currently tolerate, irritation and pain may develop.

Contributing factors can include:

• Repetitive overhead movements
• Sudden increases in training or activity
• Reduced rotator cuff strength
• Reduced muscular endurance
• Changes in movement patterns
• Poor control of the shoulder blade
• Reduced upper-back mobility
• Previous injuries
• Repetitive lifting at work
• Returning to sport or exercise too quickly

In most cases, there is not one single cause. Symptoms often develop because several factors occur together.

Does Poor Posture Cause Impingement?

Posture can influence how the upper body moves, but there is no single “perfect posture” that prevents pain.

Spending long periods in one position may contribute to stiffness or discomfort for some people. However, having rounded shoulders does not automatically mean you will develop impingement.

More importantly, the muscles and joints need enough strength, mobility and capacity to tolerate the activities you regularly perform.

For example, someone who suddenly increases overhead lifting at the gym may develop symptoms even if their posture is otherwise good.

For this reason, physiotherapy should focus on the individual rather than simply trying to “correct” posture.

The Role of the Rotator Cuff

The rotator cuff tendons play an important role in movement, strength and stability.

When you lift your arm, these muscles work together to control the head of the upper arm bone within the joint.

If the rotator cuff becomes irritated, weak or overloaded, movements such as lifting, reaching or carrying may become uncomfortable.

Fortunately, many cases of rotator cuff-related pain respond well to appropriate rehabilitation and progressive strengthening.

How Is Impingement Diagnosed?

A physiotherapist will usually begin by discussing your symptoms, daily activities, training history and any previous injuries.

A physiotherapy assessment may examine:

• Range of movement
• Rotator cuff strength
• Shoulder blade control
• Upper-back mobility
• Neck movement
• Painful movements
• Functional activities
• Work demands
• Sporting requirements

The aim is not simply to identify which structure hurts. It is also important to determine why symptoms developed and what may be preventing recovery.

Imaging such as an ultrasound or MRI is not always required.

Many cases can initially be assessed clinically. However, imaging or further medical investigation may be recommended if symptoms or examination findings suggest that it is necessary.

Physiotherapy Treatment

Treatment for subacromial pain or impingement will depend on your symptoms, activity levels and individual goals.

A rehabilitation program may include several approaches.

Rotator Cuff Strengthening

Progressive exercises can improve the strength and capacity of the rotator cuff muscles.

The aim is to gradually increase your ability to tolerate lifting, reaching and other everyday movements.

Shoulder Blade Control

The muscles surrounding the shoulder blade are important for smooth and controlled upper-limb movement.

Exercises may focus on improving strength, endurance and coordination through this region and the upper back.

Improving Mobility

If movement through the upper back or affected joint is restricted, specific mobility exercises may be incorporated into rehabilitation.

Improved mobility can make everyday tasks and exercise feel easier and more comfortable.

Managing Training and Activity

Complete rest is not always necessary.

Instead, physiotherapy often involves temporarily modifying aggravating activities while gradually rebuilding tolerance.

For example, someone experiencing pain during overhead pressing may initially reduce the weight, range of movement or training frequency rather than stopping all upper-body exercise.

This allows activity to continue while giving irritated tissues an opportunity to adapt.

Manual Therapy

Manual therapy may sometimes be used to reduce pain, stiffness or improve movement in the short term.

However, exercise and progressive loading are usually important components of long-term rehabilitation.

Exercises for Impingement

There is no single exercise program that works for everyone.

Depending on the assessment, rehabilitation may target:

• Rotator cuff strength
• Scapular control
• Upper-back mobility
• Range of movement
• Overhead strength
• Muscular endurance
• Functional lifting ability

Exercises should be progressed according to your symptoms, current strength and goals.

For example, the rehabilitation needs of a swimmer may be very different from those of an office worker, builder or recreational gym user.

Should You Stop Exercising if It Hurts?

Not necessarily.

In many cases, maintaining an appropriate level of physical activity can be beneficial.

However, exercises that repeatedly cause significant or worsening pain may need to be temporarily modified.

This may involve changing:

• Exercise weight
• Number of repetitions
• Range of movement
• Training frequency
• Exercise selection
• Overall training volume

The aim is to find a level of activity you can comfortably tolerate and then gradually rebuild strength and capacity.

How Long Does Recovery Take?

Recovery varies between individuals.

Mild cases may improve relatively quickly, while more persistent rotator cuff-related pain can require several weeks or months of progressive rehabilitation.

Recovery may be influenced by:

• How long symptoms have been present
• Current strength and mobility
• Work demands
• Sporting activities
• Previous injuries
• General health
• Training load
• Consistency with rehabilitation exercises

Early assessment can be useful because contributing factors can be identified before symptoms become more persistent.

When Should You See a Physiotherapist?

Consider having the problem assessed if:

• Pain persists for more than a few days or weeks
• Symptoms repeatedly return
• You have difficulty lifting your arm
• Pain interferes with sleep
• Strength is decreasing
• You cannot perform normal work or sporting activities
• Movement is becoming increasingly restricted

Sudden severe pain, significant weakness following an injury, visible deformity or symptoms following major trauma should receive prompt medical assessment.

Getting Back to Comfortable Movement

Shoulder impingement and rotator cuff-related pain can be frustrating, particularly when symptoms interfere with sleep, work, exercise or everyday activities.

Fortunately, many cases can be managed with an appropriate combination of:

• Education
• Activity modification
• Progressive strengthening
• Mobility exercises
• Load management
• Individual rehabilitation

At the Institute of Sports and Spines in Tingalpa, our physiotherapists can assess the factors contributing to your symptoms and develop an individual treatment plan based on your needs and goals.

If pain is stopping you from exercising, working or enjoying your usual activities, book a physiotherapy assessment online.