If you're experiencing pain when reaching overhead, lifting weights or putting on a shirt, shoulder impingement may be contributing to your symptoms. Fortunately, most people recover well with physiotherapy and progressive rehabilitation without needing injections or surgery.
At The Addison Physiotherapy, we assess shoulder pain by identifying why your symptoms have developed rather than simply focusing on the painful area. This allows us to create an individual rehabilitation program that gets you back to work, the gym or sport safely.
Key Takeaways
- Shoulder impingement commonly causes pain when lifting the arm overhead.
- Rotator cuff weakness and overload are often contributing factors.
- Most people improve without surgery.
- Strengthening and activity modification are the cornerstones of treatment.
- Early physiotherapy helps prevent ongoing shoulder problems.
What causes shoulder impingement?
Shoulder impingement occurs when the tissues within the shoulder become irritated during movement, particularly when lifting the arm overhead.
While it was once thought that structures were simply being "pinched", we now understand that shoulder impingement is usually influenced by several factors.
Common causes include:
- Rotator cuff tendinopathy
- Shoulder bursitis
- Repetitive overhead activities
- Poor shoulder blade control
- Weakness around the shoulder
- Sudden increases in gym or sporting load
Rather than there being one single cause, shoulder impingement often develops because the shoulder is no longer tolerating the demands being placed upon it.
What are the symptoms of shoulder impingement?
People commonly experience:
- Pain when lifting your arm above shoulder height
- Pain reaching into cupboards
- Pain during overhead gym exercises
- Pain putting on a shirt or jacket
- Shoulder pain at night
- Weakness when lifting overhead
Many people notice a "painful arc", where lifting the arm becomes painful between approximately shoulder height and overhead before easing again.
When should I see a physiotherapist?
It's worth booking an assessment if:
- Shoulder pain has lasted longer than one to two weeks.
- Pain is limiting work, gym or sport.
- You're avoiding overhead activities.
- Your shoulder feels weaker than usual.
- Symptoms continue to worsen.
Early assessment can identify whether shoulder impingement is the primary issue or whether another shoulder condition is contributing.
Do I need imaging?
Usually, no.
Most cases of shoulder impingement can be diagnosed through a detailed history and physical examination.
Imaging may be recommended if:
- You experienced a significant traumatic injury.
- There is substantial weakness.
- Symptoms aren't improving despite rehabilitation.
- A larger rotator cuff tear is suspected.
MRI findings don't always match symptoms, so scans should always be interpreted alongside a thorough clinical assessment.
How is shoulder impingement treated?
Treatment focuses on improving how your shoulder functions rather than simply reducing pain.
Treatment usually includes:
Education
Understanding why your symptoms developed and how to modify aggravating activities.
Load Management
Reducing excessive overhead loading while maintaining as much normal movement as possible.
Progressive Strengthening
Strengthening the rotator cuff and shoulder blade muscles to improve shoulder stability and reduce irritation.
Return to Activity
Gradually returning to work, sport and the gym once strength and confidence improve.
Research consistently shows that exercise-based rehabilitation provides excellent outcomes for most people with shoulder impingement.
Can I keep exercising?
Usually, yes.
Rather than stopping exercise completely, most people benefit from temporarily modifying painful movements.
For example:
- Reduce overhead pressing loads.
- Modify the range of motion.
- Substitute painful exercises with shoulder-friendly alternatives.
As your shoulder becomes stronger, these exercises can usually be progressed back to normal.
How long does recovery take?
Recovery varies depending on the severity of the injury and how long symptoms have been present.
