What is shoulder impingement?
Shoulder impingement (also called subacromial impingement syndrome) occurs when a bottleneck develops between the roof of your shoulder (acromion) and the head of your upper arm bone (caput humeri). During certain arm movements, sensitive structures under the shoulder roof get pinched or rub against it. This mechanical problem causes pain and considerably restricts the mobility of your shoulder.
Which structures are affected?
In shoulder impingement, various tissues under the shoulder roof can be affected:
- Supraspinatus muscle: This muscle lies directly under the shoulder roof and is responsible for lifting your arm out to the side. It is part of the rotator cuff, which wraps around the head of your upper arm bone like a cuff and centres it in the socket.
- Subacromial bursa: This bursa normally acts as a cushion between the tendons and the shoulder roof and reduces friction. In impingement, this bursa can become irritated and inflamed.
- Tendon attachments of the rotator cuff: Repeated pinching can irritate and inflame the tendons and, over the long term, even cause them to tear.
What causes shoulder impingement?
Shoulder impingement can be triggered or promoted by various factors:
- Muscular imbalances: Imbalances in the strength and coordination of the shoulder muscles
- Changes in bone structure: Bone spurs or deformities of the shoulder roof
- Calcifications: Calcium deposits in the tendons of the rotator cuff
- Tendon changes: Thickening of the tendons due to overuse or ageing
- Shoulder instability: Excessive mobility of the shoulder joint
- Chronic inflammation: Persistent irritation of the bursa or tendons
- Posture problems: Malalignment of the shoulder blade and spine
If impingement persists over a long time, the increased friction and pressure can lead to inflammatory processes. Left untreated, this can lead to persistent pain, progressive tissue damage and even tears of the rotator cuff tendons.
What symptoms occur with shoulder impingement?
The typical signs of shoulder impingement are:
- Pain at the side of the shoulder: The pain can radiate into the upper arm
- Painful arc: Lifting the arm out to the side is particularly painful between 60° and 120°
- Restricted everyday movements: Difficulty getting dressed, combing your hair or brushing your teeth
- Night pain: Worse symptoms when lying on the affected shoulder
- Loss of strength: Weakness when lifting the arm or during overhead activities
- Restricted movement: Reduced range of motion of the shoulder
The characteristic "painful arc" is an important diagnostic sign: you can first lift your arm without pain, then severe pain occurs in the middle of the movement (between 60° and 120°), which may ease off again as you lift further beyond 120°.
What can you do yourself?
At the first signs of shoulder impingement, you can take the following measures:
Acute pain relief
- Avoid guarding: Despite the pain, you should move your shoulder within the pain-free range
- Cooling: For acute pain, cooling can bring relief
- Heat: For chronic symptoms, heat can promote circulation
- Sleeping position that takes the strain off: Avoid lying on the affected shoulder
Correcting posture in daily life
- Keep an upright posture: Shoulders back and down, chest open
- Optimise your workspace: Screen and keyboard at the correct height
- Notice your shoulder position: Avoid hunching your shoulders when stressed
Adjusting your load
- Reduce overhead activities: Do as few tasks above head height as possible
- Avoid heavy lifting: Especially with your arm outstretched
- Take activity breaks: During longer tasks in the same position
Simple exercises for home
- Pendulum movements: Lean forward slightly and let your arm swing gently in circles
- Shoulder blade mobilisation: Consciously draw your shoulders back and down
- Light stretching exercises: Carefully guide your arm across your chest for a gentle stretch
Important: Do all exercises only within the pain-free range. If symptoms persist or get worse, you should definitely seek professional help.
How can Kineo help you with shoulder impingement?
Physiotherapy plays a central role in the treatment of shoulder impingement. Our comprehensive therapy approach aims to:
- Achieve freedom from pain
- Restore normal shoulder function
- Regain full strength and mobility in all directions
- Let you go about your daily life without pain again
Our treatment methods include:
1. Pain relief and reducing inflammation
- Manual therapy: Targeted mobilisation of the shoulder joints and the shoulder blade
- Trigger point therapy: Treatment of painful muscle knots
- Shockwave therapy: Effective for chronic tendon inflammation and calcifications
- Cold or heat applications: Depending on your symptoms
2. Improving mobility
- Gentle mobilisation techniques: For the shoulder joint and shoulder blade
- Targeted stretching exercises: For shortened muscle groups
- Soft tissue techniques: To improve tissue elasticity
3. Correcting poor posture and movement
- Posture training: Optimising your posture and shoulder position
- Shoulder blade positioning: Learning the correct position of the shoulder blade on the rib cage
- Movement pattern training: Relearning functional movement sequences
4. Muscle strengthening and coordination
- Targeted strength training: For the rotator cuff and shoulder blade muscles
- Correcting imbalances: Strengthening weak muscles, stretching tight muscles
- Coordination training: Improving the interplay of the shoulder muscles
Effective exercises for the rotator cuff
With your physiotherapist's guidance, you learn specific exercises to strengthen your rotator cuff:
1. Abduction (strengthens the supraspinatus)
- How to do it: Lift your arm out to the side, with your thumb pointing up
- Dosage: 3 sets of 15–20 repetitions each, 5 times a week
- Important: Make sure you don't hunch your shoulder at the end of the movement
2. Internal rotation (strengthens the subscapularis)
- How to do it: Attach a resistance band at elbow height and pull it towards your body with your forearm
- Dosage: 3 sets of 15–20 repetitions each, 5 times a week
- Important: Your elbow stays against your body throughout the exercise
3. External rotation (strengthens the infraspinatus)
- How to do it: Using a loop band or resistance band, rotate your arms outwards
- Dosage: 3 sets of 15–20 repetitions each, 5 times a week
- Important: Your elbows stay against your body, only the forearms move outwards
Why regular therapy and exercises are so important
Treating shoulder impingement takes time and consistency. Poor posture or unhelpful movement patterns have often developed over years and can't be corrected overnight. For the best treatment result, it is therefore crucial to:
- Attend physiotherapy regularly
- Do the exercises you have learned at home several times a week
- Be patient: improvement comes step by step
- Work on correct shoulder mechanics in the long term
By training the rotator cuff in a targeted way, you create more space in the bottleneck between the shoulder roof and the head of the upper arm bone, and can lastingly reduce the symptoms of impingement.
Conclusion
Shoulder impingement can considerably affect your quality of life, but it can be treated very well with the right treatment and consistent exercises. Physiotherapy gives you effective strategies for pain relief, improved movement and restoring full shoulder function.
Our aim is for you to enjoy your daily life and your hobbies without pain again. With the right support and your active commitment to therapy, you can successfully master this path!
