Shoulder impingement: understanding your pain and getting back to your activity

What is shoulder impingement?

Subacromial space anatomy

The subacromial space is the narrow area between the head of the humerus and the acromion, through which the rotator cuff tendons and subacromial bursa pass. Shoulder impingement (or subacromial impingement) is a pinching of these structures within this space during arm-raising movements, causing pain and local inflammation.

Why does this impingement appear?

Shoulder impingement appears when the subacromial space narrows, either because of weakness in the muscles that actively depress the head of the humerus (rotator cuff), a rounded shoulder posture that alters the shoulder blade’s position, or, more rarely, a particular bone shape of the acromion.

Symptoms and diagnosis of shoulder impingement

Typical pain and its triggers

The pain is triggered by arm-raising movements, particularly between 60° and 120° (the painful arc), lying on the painful side at night, and overhead movements (throwing, swimming, cocking the arm back).

How symptoms progress without treatment

Without treatment, the muscle imbalance behind the impingement tends to persist, with a risk of progressing to a more established rotator cuff tendinopathy if the tendons continue to be repeatedly compressed.

Differential diagnosis

Several shoulder pains can resemble this impingement:

• A rotator cuff tendinopathy, often a progression of untreated impingement
• A frozen shoulder, where the loss of mobility is global rather than painful only in a specific arc
• Shoulder instability, worth considering if there’s a feeling of the shoulder “giving way” alongside the pain

Causes and risk factors

Shoulder impingement most often develops from a functional muscle imbalance that’s reversible with appropriate rehab.

Biomechanical and personal factors

• Weakness in the muscles that actively depress the head of the humerus (rotator cuff)
• A rounded shoulder posture that alters the shoulder blade’s position
• Intensive practice of repeated overhead movements
• More rarely, a particular bone shape of the acromion

Which sports contribute to shoulder impingement?

All sports involving repeated arm-raising carry a risk of this impingement:

• Swimming and water polo
• Tennis and badminton
• Volleyball and handball
• Weight training with overhead presses
• Weightlifting
• Crossfit with repeated overhead movements

Treating shoulder impingement in rehab with a sports physio

The goal of treatment is to enlarge the subacromial space by strengthening the muscles that actively depress the head of the humerus and by correcting shoulder blade posture, to remove the mechanical cause of the impingement.

1. 1Reducing pain and managing load
2. 2Shoulder and shoulder-blade mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Rotator cuff work
7. 7Correcting sporting technique
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“Shoulder impingement is resolved by freeing up space, not by avoiding movement.”

Strengthening, the cornerstone of treatment

Strengthening the rotator cuff, particularly the muscles that depress the head of the humerus, combined with strengthening the shoulder blade stabilisers, durably enlarges the subacromial space and removes the cause of the impingement rather than just treating the symptoms.[2]

In brief

• Strengthening the rotator cuff
• Strengthening the shoulder blade stabilisers
• Associated postural correction
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily adapt your activity by reducing the overhead movements that clearly reproduce the pain, while starting to strengthen the cuff as soon as possible.

When should you see a specialist for shoulder impingement?

If pain persists for more than three to four weeks despite adapting your activities, or if it comes with a clear loss of strength, a medical opinion is recommended to rule out structural rotator cuff damage.

Expected recovery from shoulder impingement

Since shoulder impingement is most often functional in origin, the outlook is generally good with well-conducted rehab. A clear improvement is usually seen within a few weeks, with a full return to sport once the muscle rebalancing is consolidated.[2]

Preventing relapses

Once the impingement has resolved, several measures help limit the risk of recurrence:

• Keep up rotator cuff and shoulder blade stabiliser strengthening over the long term
• Work regularly on posture, particularly if you spend long periods in a rounded-shoulder position (desk, screens)
• Progress cautiously in your volume of overhead movements
• Don’t ignore discomfort that reappears, a sign that the imbalance is creeping back

The HOPP care programmes to treat your shoulder impingement and get back to sport

This impingement requires progressively rebalancing the forces around the shoulder. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your shoulder is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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