Shoulder Impingement | Physio4Life

Shoulder Impingement

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Shoulder Impingement



Shoulder impingement is a very common problem that affects people from all walks of life.  Often, it may not be clear why it started, but it can also be a result of injury/ trauma to the shoulder following a fall, for example. Termed loosely, shoulder impingement is the process of catching or trapping one or more of the structures with in the joint.  This can be very painful, and left untreated, can go on for a long time and give rise to other shoulder injuries.



Shoulder impingement can be caused a number of ways.  There are varying types of the condition; research classifies it in many different ways too.  Depending on your individual circumstances some diagnoses will be more appropriate than others.  Impingement can arise from any of the following:


1)    Prolonged poor posture – can lead overuse of some muscles and under use of others in static positions.  This can increase the likelihood of impingement.

2)    Direct injury/trauma – can cause swelling and irritation of the joint, leading to impingement.

3)    Muscle imbalance – can alter how your joint moves on a daily basis and also in repeated activities.

4)    Poor training habits – can lead to repeated overuse and trauma in the shoulder.  This can be painful.

5)    Shoulder Instability – Prior injury or any of the above factors can lead to poor movement control which can cause impingement.

6)    Developmental Causes – On occasion, the structural development of a patient’s shoulder blade can make them prone to shoulder impingement.




The entire shoulder is made up of three bones:

1)    Collar Bone (Clavicle)

2)    The Shoulder Blade (Scapula)

3)    The Upper arm (Humerus)


Due to the unique way that these bones relate to each other, and, the amount of movement needed around the shoulder, the shoulder muscles (and their behaviour) are of huge importance in remaining pain free.  There are a lot of muscles that make the shoulder move and identifying which ones are not working as well as they should is key in treating this problem.



Pain, made worse with over head activity, and reaching behind your back.  This can be a result of irritation of the tendons (or other structures) being pinched.


Instability, as a result of damage to the structures that house the Humerus bone in the joint.


Weakness, as a result of any damage done to the rotator cuff, or as a direct result of the pain felt on movement.



Shoulder impingement is normally diagnosed through a clinical examination with a physiotherapist.  Sometimes people are sent for an Xray first by their doctor also, but this is not a very accurate diagnostic test due to the required stillness required for a clear image.  Most impingements present on movement and it is the unique way that the patient moves and responds to specific clinical testing that will highlight a more specific and tailored diagnosis.


You can expect to have a clinician assess repeated movements of your arm, along with more focused muscle strength tests (within the remit of your pain), and some more passive tests where the clinician will take the lead.  Your resting posture (or posture during specific aggravating activities) will also be assessed to look for the relevant contributing factors.







It is massively important to address the symptom of pain, and to let any inflammation settle prior to starting a rehabilitation program.  Non steroidal anti-inflammatory tablets can be effective in this stage.  If the pain is very aggressive, further medical intervention may be required to settle the symptoms sufficiently.




Despite the common nature of this problem, each case has its own individual features.  These will be highlighted in the clinical assessment, and the rehabilitation program will address each of them.  Massage and joint mobilisation techniques will attend to any stiffness that is adding to the problem.  The bulk of rehabilitation of shoulder impingement is exercise lead.  Any muscular weaknesses are addressed through strengthening exercises (commonly focusing on controlled movement of the shoulder blade and the arm) that should be completed pain free.  The exercises will aim to fatigue weakened muscles, and as they recover they will come back stronger (in time).


The goal of any rehabilitation program would be to reduce the symptoms, increase your strength, and prevent the return of the impingement.  Successful treatment of this will see a significant improvement in your performance and function.


Manual Therapy


Some muscles may be tight and painful, some of the inert structures around your shoulder joint could be tight.  Both of these things will alter the way your shoulder moves and could be a major reason for the start of your pain.  Relevant manual therapy will help to address these but should only ever be done in conjunction with a specific and tailored rehab program.


Exercise Videos: i.e.

  • RC control in Neutral into Abduction
  • Pec stretch
  • Inferior Cuff HEP
  • Scapular Control
  • Core Intergration







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