Typical symptoms
- Pain that increases as you lift your arm to shoulder height and spreads to the outside of the upper arm
- Difficulty with things like brushing your hair, putting on a jacket or reaching a high shelf
- Night pain that gets worse when you lie on the painful shoulder
- Pain in a certain part of the lifting range that eases towards the top
- A feeling of weakness or tiring quickly in the shoulder
Causes and risk factors
The word "impingement" suggests that a tendon is physically pinched against bone, but current evidence shows the pain is largely linked to the tendon being loaded more than it can currently handle. That's why reloading the tendon at the right dose matters as much as rest.
- Jobs and sports that involve lifting your arm above head height often
- Sudden increases in load in throwing and overhead sports such as swimming, tennis and volleyball
- Weakness in the shoulder and shoulder blade muscles
- Age-related changes in the tendons after forty
- Sitting hunched forward for long periods
How I work with shoulder pain
Shoulder pain has many possible causes; frozen shoulder, pain referred from the neck and tendon tears all need a different approach. The first job is to tell them apart.
Assessment
I assess your shoulder's active and passive movement, muscle strength, how your shoulder blade moves, and your neck. Finding the movements that trigger the pain sets the starting point for your exercise programme.
Manual therapy
Mobilisation and soft tissue techniques for the shoulder joint, shoulder blade and upper back can help ease movement, especially during the painful phase. I use them to support exercise, not to replace it.
Exercise therapy
We start with isometric and controlled movements that keep pain at an acceptable level, then progressively strengthen the rotator cuff and shoulder blade muscles using resistance bands and weights. Doing the programme consistently and for long enough is the biggest factor in the result.
Education
We talk about how to load your shoulder in daily life and sport, which activities to reduce for a while, and sleeping positions that ease night pain. If I think it's useful, I may add kinesio taping for short-term support.
How many sessions will I need?
Strengthening tendons takes time, so your home programme matters as much as the sessions. For many people 8–12 sessions and a few months of regular exercise overall is a realistic framework. The exact plan depends on your assessment findings.
What you can do at home
- Don't rest your shoulder completely; keep using it for everyday tasks within a pain-free range.
- Cut back on repeated overhead movements for a while, and carry heavy loads close to your body.
- At night, avoid lying on the painful side; when on your back, put a small pillow under your arm.
- Sit upright at your desk and now and then draw your shoulders back and down.
When to see a doctor first
In the following situations, see a doctor before starting physiotherapy:
- Being unable to lift your arm at all after a fall or blow
- A visible change in the shape of the shoulder, or a suspected dislocation
- Left shoulder and arm pain together with chest pain, shortness of breath or sweating (go to the emergency department)
- A red, hot, swollen shoulder with fever
- Unexplained weight loss or a lump you can feel around the shoulder
- Numbness and weakness spreading down the arm
Frequently asked questions
Can shoulder impingement get better without surgery?
What's the difference between frozen shoulder and impingement?
Is it normal to feel pain while exercising?
Do I need an MRI for shoulder pain?
This page is for general information only and does not replace a medical diagnosis or examination. If your symptoms are severe or getting worse quickly, see a doctor first.