Shoulder Impingement Syndrome
Shoulder impingement (subacromial impingement) is one of the most common causes of shoulder pain. It occurs when the tendons of the rotator cuff get compressed against the bony structures above them when you lift your arm. The result is a characteristic “painful arc” — pain when raising the arm between roughly 60 and 120 degrees.
What’s Actually Happening
The rotator cuff tendons and subacromial bursa sit in a narrow space beneath the acromion (the bony roof of the shoulder). When this space is reduced — whether from muscle imbalance, posture, bony anatomy, or swelling from overuse — the tendons get pinched with arm elevation, causing pain and inflammation.
Common Causes
- Overuse or repetitive overhead activities (painting, swimming, throwing)
- Poor shoulder blade control and posture
- Rotator cuff weakness relative to the larger shoulder muscles
- Tight posterior shoulder capsule
- Bony variations in the shape of the acromion
Symptoms
- Pain at the front or top of the shoulder
- Painful arc when lifting the arm to the side (60–120°)
- Difficulty reaching overhead, behind the back, or across the body
- Aching at rest or at night, especially lying on the affected side
- Weakness with lifting
Treatment
Physiotherapy is the first-line treatment and produces excellent outcomes.
Rotator Cuff and Scapular Strengthening
The cornerstone of treatment — building the strength to keep the humeral head centred in the socket and the shoulder blade well-positioned. We prescribe a progressive, evidence-based exercise program targeting the rotator cuff and periscapular muscles.
Manual Therapy
- Shoulder joint mobilisation to improve range of motion
- Thoracic spine mobilisation — thoracic stiffness is a frequent contributor
- Posterior capsule stretching
Postural Correction
Forward head posture and rounded shoulders narrow the subacromial space. Postural retraining and thoracic mobility work are an essential part of lasting recovery.
Other Techniques
- Dry needling for muscle pain and trigger points
- Taping to improve shoulder blade position short-term
Injections and Surgery
A corticosteroid injection can help settle acute pain and allow better engagement with exercise — but exercise remains essential. Surgery (subacromial decompression) is rarely needed and not significantly more effective than quality physiotherapy in most cases.
