Shoulder Impingement

Shoulder Impingement is a condition associated with the sub-acromial region of your shoulder, a gap between the ball-shaped, top end of your humerus (upper arm bone) and the acromion, a shelf-like projection of bone that forms part of your scapula or shoulder blade.

Although this gap is not very big, there are a number of structures that sit within it or pass through it such as your supraspinatus tendon and your sub-acromial bursa (a small sac of fluid that can reduce friction between bone and tendon) Impingement is when these structures become trapped within this space leading to pain, usually felt at the front and/or tip of the shoulder and worse with the arm in overhead positions.


Problems can occur when we carry out repeated activities involving overhead or sideways movements of the arm, such as DIY, cleaning windows, swimming etc. True impingement is when the structures within the sub-acromial space become irritated either due to poor control of the position of the humeral head, allowing it to migrate upwards and lead to a reduction in size of the space; or due to bony spurs or changes to the structure of the underside of the acromion.  These days, our thinking is that the former, poor muscular control of the humeral head is a more likely explanation.

As we age, our tendons become more brittle and less able to tolerate load. This can make partial or full thickness tears a possibility as a result of either the repeated stress of impingement, or as a reaction to carrying unaccustomed loads. It is a good idea therefore to keep exercising our shoulders, and indeed all parts of our body regularly, so that our tendons are strong, flexible and able to tolerate the increased demands that we may occasionally want to place on them

When to seek help

It is not uncommon to feel mild symptoms of impingement, for example after the first game of the cricket/tennis season, after a spring clean or even after sleeping with your arm trapped under your pillow. If the symptoms are due to a particular activity, then resting from that activity for a week to ten days should allow the symptoms to settle.  Sometimes however, we can stir things up with other activities which would normally not cause a problem but now aggravate the already irritated tendon or bursa.  If your symptoms do not subside or become aggravated by day-day activities, it is time to seek help.

Treatments Available

A Physiotherapist or Chiropractor would fully assess your condition and, if a diagnosis of impingement was confirmed, provide treatment to reduce the pain as well as exercises to address any biomechanical and/or muscular dysfunction which may have led to the development of the condition.  These exercises can help with resolution of the problem and prevent further recurrence in the future. If there is a strong muscular component to the problem, a Massage Therapist can help to reduce areas of tension and overuse. If longer term muscle strengthening is required then some 1:1 work with a Sports Therapist may be helpful. There are also specific Pilates exercises for the shoulder/neck and upper back.  All of these services are available at Courtyard.