Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Shoulder Impingement Physical Therapy Guide

What is Shoulder Impingement Syndrome?

A shoulder impingement can be defined as a compression and mechanical abrasion of the rotator cuff muscle structures as they pass beneath the coracoacromial arch during elevation of the injured arm. The most commonly compressed rotator cuff tendon is that of the Supraspinatus muscle which is highly susceptible to impingement. The exact cause of shoulder impingement syndrome is not clear however current thinking is that the syndrome begins as an repetitive overuse injury and causes a tendinopathy of the Supraspinatus muscle, especially on its undersurface near the head of biceps. In layman’s terms, this means that the small muscles within the shoulder are being repetitively overworked for many weeks and months, so much so that they begin to get pinched by the structures within the shoulder which then causes pain. This shoulder pain then leads to various other shoulder abnormalities such as:

  • Secondary rotator cuff muscle dysfunction: this in turn causes the head of the humerus (upper arm bone) to move inappropriately and places more load on the injured structures.
  • A subacromial bursitis.
  • The development of bone spurs on the nearby ligaments.

What Causes Shoulder Impingement Syndrome?

This is covered fully in our rotator cuff guide here!

A rotator cuff injury that causes an impingement of the shoulder is often due to progressive degeneration and wear and tear of the tendons. There are many risk factors that can predispose you to developing any rotator cuff injury. These include:

  • Repetitive overhead activity
  • Heavy lifting for a prolonged period of time
  • Bone spurs may irritate or damage the tendon.
  • Reduced blood supply

What Are The Risk Factors For Developing A Shoulder Impingement?

Like all injuries there are many risk factors that increase your chance of developing a condition such as a shoulder impingement, some of which are unavoidable. These include:

  • Age: The older you get, the higher your risk of developing a shoulder injury. Shoulder impingement syndrome is most common in people over the age of 40.
  • Occupation: Certain jobs that involve repetitive over head work such as stocking shelves and farming are at a much higher risk of developing a shoulder tendon injury.
  • Genetics: There may be a family link involved in the development of shoulder impingement.

What Are The Symptoms Of Shoulder Impingement Syndrome?

The most common symptoms are:

  • Pain when performing overhead movements and movements reaching away from your body.
  • Arm weakness and stiffness.
  • Difficulty reaching up behind the back,
  • Disturbed sleep, especially when lying on your affected shoulder.
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Reusable Ice Packs

The application of ice is extremely common for the treatment of most sports and occupational conditions that affect the musculoskeletal system. When applied correctly, ice can be of enormous benefit to reduce pain, inflammation, and swelling. Physical Therapists agree that following an acute injury, ice should be the cornerstone of initial treatment, as well as rest, compression, and elevation of the affected body part. Make sure to apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Don’t place ice directly on to the skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!

What Are My Treatment Options?

There is a whole host of treatment options available to those who suffer with a shoulder impingement syndrome! Your rehabiliation programme and recovery time depend entirely on how severe the rotator cuff tendinopathy is. Make sure you get a full assessment from your health care professional before commencing your exercise programme.

Rest & Time

Initially, it is advised that you try your best to cease all activity that caused the shoulder to impinge in the first place and prevent agitating it further.  Immediately following the injury you can commence the RIC(E) protocols:

  • Rest. It is vital that you take a break from any activity that may be increasing your shoulder pain.
  • Ice. Cold packs will assist in reducing any pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Don’t place ice directly on to the skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the shoulder with a compression sleeve or brace will help limit painful movements and improve recovery time. You can find our favourite shoulder brace here!
  • Elevation

Shoulder Impingement Exercises

1) Pendulum Swings

This is the number one exercise that Physical Therapists prescribe to increase range of movement in the shoulder joint and open up an impinged shoulder. It slightly pulls the ball & socket joint apart and facilitates an increase in mobility between the joint structures.

How to do it:

  • Hold a small weight in your injured arm.
  • Whilst standing, lean forward on a immovable object and let your injured arm hang down towards the floor.
  • Slowly swing your arm forwards and backwards in a gentle circular (pendulum) motion.

Repeat 20 times each direction, multiple times per day.

2) Wall Walks

An exercise to increase the forward flexion of your shoulder, you should not be trying to push through pain, but gradually increasing range of motion as you feel comfortable.

How to do it:

  • Standing in front of a wall
  • Place the fingers of your affected arm on the wall staring at the bottom. 
  • Slowly walk your fingers up the wall as far as you can with a straight arm, before walking them back down again

Repeat 10 times, 3 times per day.

3) Shoulder Raises & Retractions

A simple yet fantastic exercise to loosen up the upper trapezius and rhomboid muscles, whilst opening up the upper spinal joints. 

How to do it:

  • Sit with good posture
  • Raise your shoulders up towards your ears; holding for 2 seconds before returning to neutral.
  • Pull your shoulder blades together behind you, squeeze for 2 seconds.

Repeat 20 times, every hour, aiming for 5 or more sets per day.

4) Deltoid Stretch

Deltoid tightness is a common secondary problem for those who suffer from impingement syndrome due to the reduction in shoulder mobility. It is a good idea to get in to the healthy habit of stretching your deltoid muscles to prevent any further issues related to tight shoulder structures.

How to do it:

  • Gently take your injured arm across your body
  • Use your other arm to take it a little further until you feel a stretch.
  • Hold at a mild to moderate stretch pain free for 15 seconds and repeat 4 times on each arm.

Repeat 3 times per day.

5) Active Assisted ROMs

Using a stick is an effective and cheap way to progress your shoulder range of movement without over stretching the tendons and muscles of the painful shoulder. These exercises are considered “Active Assisted” because the majority of the work is completed by your non-injured arm and can be pushed in any direction at whatever force you feel comfortable with. Start by holding a stick with your hands on both ends.

How to do it:

  • Flexion: Push your injured arm up towards the sky in front of you using your non-injured arm.
  • Extension: Push your injured arm backwards using your non-injured arm.
  • Abduction: Push your injured arm out to the side using your non injured arm.

Repeat 20 reps of each movement, twice daily.

6) Isometric Shoulder Squeezes

Isometric exercise aims to increase strength in the affected muscle groups without actually moving the muscle through range, and thus limiting the pain caused by moving an injured structure. The purpose of these exercises is to complete all shoulder movements against a non moving resistance.

How to do it:

  • Flexion: Stand facing a wall. With a straight arm put your hand on the wall. Push upwards towards the ceiling and hold this contraction for 10 seconds.
  • Extension: Standing facing away from the wall. With a straight arm behind you touch the wall. Try and push your arm backwards against the wall, holding the contraction for 10 seconds.
  • Abduction: Standing parallel to the wall. Move your straight arm to the side of your body towards the wall and place the side of your fist against the wall. Try and push your arm up towards the ceiling and hold this contraction for 10 seconds.

Shoulder Impingement Syndrome Prognosis

Most impinged shoulders do resolve by themselves over a short period of time however it difficult to put an exact figure on this, as everyone is different! Anti-inflammatory medications can help to reduce the pain and inflammation, gentle Physical Therapy manipulations can help restore movement faster, however the key component of recovery is low grade exercises to increase your range of movement and maintain strength in the shoulder. Sometimes, conservative care cannot reduce the pain. The key to success is patience and persistence! Unfortunately, there is no such thing as a quick fix unless you want to undergo surgery. Follow these treatment modalities and you will see fantastic results in weeks to months.