Shoulder Impingement: Symptoms, Causes, and How to Fix It
Shoulder impingement is when the rotator cuff tendons get pinched and irritated in the narrow space at the top of your shoulder. This usually results in pain when you reach overhead, lift the arm out to the side, or reach behind your back. The good news is that most shoulder impingement responds well to physical therapy without surgery, by calming the irritated tissue and retraining the shoulder to move properly and with more room. This guide covers what shoulder impingement is, its symptoms and causes, the exercises that help most, and how to fix it for good.
What is shoulder impingement?
Your rotator cuff tendons and a small fluid-filled sac called the bursa pass through a narrow space between the top of your arm bone and the bony roof of your shoulder. When that space gets crowded, or the shoulder is not moving the way it should due to weak or tight muscles, those tendons get pinched during overhead motion. Over time that pinching continually irritates and inflames the tissues in the area, which is what creates that pain.
Having treated plenty of shoulder conditions, including impingement, I have concluded that it is usually caused by weak shoulder stabilizers such as the rotator cuff. These muscles have to be strengthened in a specific sequence in order to avoid continual flare-up of the tendons and structures that pass in that shoulder space. In simple terms, without proper movement of the shoulder, you will continually get pinching of the structures between that narrow joint space when you raise your arm up overhead.
Shoulder impingement symptoms
The most common shoulder impingement symptoms are pain when reaching overhead, pain lifting the arm out to the side (often worst through the middle of the range), pain reaching behind your back, and aching at night, especially lying on that shoulder. These symptoms often show up in overhead sports such as tennis, padel, and pickleball, and basketball. Some people also notice weakness or a catching sensation. The pain usually builds and gradually worsens rather than starting from a single injury. Symptoms often flare with everyday overhead tasks like putting away dishes, reaching up, and washing your hair.
What causes shoulder impingement?
Shoulder impingement is usually a mechanics and overload problem, often with a few contributors stacked together: repetitive overhead activity from sport, work, or lifting; a weak or imbalanced rotator cuff and shoulder-blade (scapular) muscles that let the head of the humerus drift upward into that space creating that pinch. Other factors that can cause shoulder impingement are rounded-shoulder posture that narrows the space further, a sudden spike in overhead training, and age-related tendon changes that make the tissue more easily irritated. However, these are all leading factors that can still be fixed with appropriate physical therapy and a prescribed home exercise program.
The cause I most directly notice is an imbalance between the rotator cuff and the scapular stabilizers, such as the serratus anterior. Weakness in these muscles leads to decreased joint space and pinching of the soft tissue structures, which leads to the pain you are dealing with. This is very common in overhead athletes and in people who lift weights but don't specifically train those muscles.
Shoulder impingement exercises
The right shoulder impingement exercises open up that space and retrain the shoulder to move properly, rather than just stretching the sore spot and icing. In general they fall into three buckets: scapular and postural strengthening (rows, serratus punches, wall slides) to reposition the shoulder blade so the arm bone stops crowding the tendons; rotator cuff strengthening (external rotation progressions using isometrics and light bands) to keep the shoulder centered in the socket; and gentle mobility work including controlled articular rotations (CARs). The key is to work in a pain-free range and build up gradually, not to push through the pinch.
A shoulder external rotation isometric in neutral against a towel is my favorite starter exercise. It helps to build up the foundation of the rotator cuff strength in a neutral position without increasing the risk of injury. Avoid repetitive overhead motions or any positions that can cause irritation, such as bringing the arm up overhead or side sleeping on the affected side.
For a full rotator cuff strengthening routine, see our guide to rotator cuff exercises.
How to fix shoulder impingement
Fixing shoulder impingement means backing off the aggravating motions (relative rest, not total rest), then rebuilding the mechanics with the exercises above while hands-on manual therapy restores normal shoulder and shoulder-blade motion. Cleaning up posture and how you set up for overhead lifts matters too. Most cases settle within a few weeks to a couple of months when the plan targets the cause instead of just the symptom. This is backed by strong evidence: in a randomized trial published in the BMJ, a specific shoulder exercise program worked as well as surgery for impingement and reduced the number of patients who ended up needing an operation.
In my practice, I assess movement patterns, postural positioning, and strength in the evaluation for a shoulder impingement. This lets us come up with a plan that works towards restoring motion, decreasing pain, and improving strength to get you back to your goal of being pain-free. It is the same approach that anchors our sports physical therapy.
Manual therapy for shoulder impingement
Hands-on manual therapy is a big part of settling an impinged shoulder. I use shoulder joint mobilizations to create more space in the joint and take pressure off the pinched tissue. From there, soft tissue mobilization targets the muscles that are often tight and pulling the shoulder into a poor position, like the pectorals, the latissimus dorsi, and the upper trap. Cupping and scraping work well on those same muscles to release tension and bring blood flow to the area. Loosening that tissue gives the joint room to move so the strengthening work can actually take hold.
Dry needling for shoulder impingement
Dry needling to the rotator cuff and the muscles around the subacromial region has solid research behind it for easing shoulder pain. Adding electrical stimulation drives fresh blood flow into the area and helps calm the inflammation that builds up around the irritated tissue. Paired with manual therapy, active mobility and strength work, it helps the shoulder recover faster than exercise alone.
How we treat shoulder impingement at Reclaim
At Reclaim Physical Therapy, we pinpoint exactly why your shoulder is getting pinched, calm the irritated tissue with hands-on work, and rebuild the rotator cuff and scapular control that give the joint room to move. As an in-home, concierge practice serving Key Biscayne and nearby, the whole session comes to you, at home or your gym, one-on-one with a doctor of physical therapy.
Ready to get started or have questions? Call or text us directly at (786) 518-6392 and we will find why your shoulder hurts and build a plan to fix it.
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Shoulder pinching when you reach up?
Book an in-home visit and we'll find why your shoulder is impinging and build a plan to fix it. Serving Key Biscayne and nearby.
Frequently asked questions
What does shoulder impingement feel like?
Usually pain when reaching overhead, out to the side, or behind your back, often with an achy middle part of the range and pain at night lying on that shoulder. It tends to build gradually rather than from one injury.
Will shoulder impingement go away on its own?
Mild cases can settle with rest, but it often comes back if the underlying mechanics are not addressed. Targeted rotator cuff and scapular strengthening is what gives lasting relief.
What exercises should I avoid with shoulder impingement?
Early on, avoid painful overhead pressing and movements that reproduce the pinch. Work in a pain-free range and build up. Avoid overhead shoulder press and incline bench press. Overhead sports will likely also cause irritation, so proceed with caution or modify for the time being.
How long does shoulder impingement take to heal?
Often a few weeks to a couple of months with the right plan, depending on how long it has been going on and how consistent the strengthening is.