Shoulder impingement: why your shoulder hurts overhead

What shoulder impingement is

The term impingement comes from an old idea that the rotator cuff tendons were being pinched between the top of the arm bone and a bony shelf above it (the acromion). That picture is now considered too simple. Many physios and doctors prefer terms like subacromial pain or rotator cuff related shoulder pain, because the problem is usually sensitive, overloaded tendons and the bursa around them rather than a mechanical trap.

That shift matters for treatment. Research has found that surgery to shave bone from the acromion offers little extra benefit over exercise-based rehab for most people, which is why strengthening is now the first-line approach. The name on the letter is less important than understanding that your shoulder is irritated, not broken.

Common causes and who gets it

It is most common from middle age onwards, as tendons become a little less tolerant of sudden changes in load. It also shows up in younger people who train hard, especially swimmers, racket sport players, climbers and lifters. The usual trigger is doing more overhead or pressing work than the shoulder is ready for.

• A sudden increase in pressing volume, such as a bench press or overhead press block
• New high-rep overhead work, including wall balls, push presses or kipping pull-ups
• Returning to training after a long break at the same loads as before
• Painting a ceiling or a weekend of overhead DIY
• Poor sleep and high overall training stress, which reduce tissue tolerance

Typical symptoms

Pain is usually felt at the front, side or top of the shoulder and can spread down the outside of the upper arm, sometimes towards the elbow. A classic sign is a painful arc: raising the arm out to the side hurts most somewhere between shoulder and head height, then eases once the arm is fully up.

Other common complaints include pain reaching behind your back to tuck in a shirt, reaching into the back seat of the car, and lying on the affected side at night. Movement is usually still possible if you push through, which helps a physio tell it apart from frozen shoulder, where the joint genuinely becomes stiff.

What a physio assessment looks at

Your physio will ask how the pain started, what your training looks like and what aggravates it, and will screen for problems that can refer pain to the shoulder, including the neck. The examination usually includes:

• Range of movement, both when you move the arm yourself and when the physio moves it
• Strength testing of the rotator cuff and the muscles around the shoulder blade
• Which positions provoke your pain and whether small changes ease it
• How your shoulder copes with the movements you care about, such as pressing, pulling or hanging

Scans are not usually needed at first. An ultrasound or MRI may be arranged if strength is markedly reduced after an injury, if there is a suspected tear, or if symptoms are not improving despite good rehab.

What usually helps

Treatment rests on two things: easing off the specific loads that irritate the shoulder, and building the capacity of the rotator cuff and shoulder blade muscles through progressive strengthening. Stopping all upper-body training is rarely necessary. Most people can keep training with a few swaps, such as a neutral grip, a slightly shorter range, or a landmine press instead of a strict overhead press for a few weeks.

Manual therapy can ease pain and make exercise more comfortable in the short term. A GP may discuss a steroid injection if pain is stopping you from sleeping or doing rehab, although it is generally used to create a window for exercise rather than as a cure. Pulling work, such as rows and the face pull, is usually well tolerated and helps balance a pressing-heavy programme.

What you can start with at home

1. Isometric external rotation: elbow at your side, bent to 90 degrees, push the back of your hand into a door frame at moderate effort for 30 to 45 seconds, 4 to 5 times.
2. Band external rotation: same position with a light band, 3 sets of 10 to 15 slow reps.
3. Rows with a band or dumbbell, 3 sets of 10 to 12.
4. Wall slides, sliding the forearms up a wall only as high as feels comfortable, 2 sets of 10.
5. Side-lying external rotation with a light dumbbell, progressing the weight over the weeks.

When these feel easy, a physio will usually add pressing variations back in, starting below shoulder height. Our guide to increasing your bench press covers sensible progression once you are back to full training.

Recovery time and when to get urgent help

Many people notice meaningful improvement within 6 to 12 weeks of consistent rehab, although tendons adapt slowly and some cases take 3 to 6 months. If your shoulder is not getting better, the on-site physio at Lycan Strength can assess it and build a plan around your training, with 20% off for members. You can book a physio appointment online.

• Call 999 if shoulder or arm pain comes with chest pain or tightness, breathlessness, sweating or feeling sick, as this can be a heart attack.
• Go to A&E after a fall or injury if the shoulder looks deformed, you cannot move the arm, or you have numbness in the arm.
• Call NHS 111 or see a GP urgently if the shoulder is hot, red and swollen or you have a fever.
• See your GP within a few days if you suddenly cannot lift your arm after a fall or heavy lift, as this may be a rotator cuff tear.
• See your GP if you have unexplained weight loss, a history of cancer or constant pain at night.

Questions