This blog post is a comprehensive guide which offers effective exercises and strategies to help fix Shoulder Impingement.

What is Shoulder Impingement?

Shoulder Impingement refers to the condition where there is compression of the following shoulder structures: Subacromial Bursa and/or Supraspinatus tendon.

1. Subacromial Bursa

The Subacromial Bursa is a fluid-filled sac structure in the shoulder that is located underneath a part of the shoulder blade called the Acromion.

2. Supraspinatus Tendon

The Supraspinatus is part of a group of shoulder muscles called the “Rotator Cuff”.

It has the important role of stabilizing and moving the shoulder joint.

Table Of Contents

• Implications
• Causes
• Tests
• Exercises To Fix Shoulder Impingement
• Common Questions

Implications

With Shoulder Impingement – these relatively soft structures tend to get squashed between the Acromion (part of the shoulder blade) and the Humerus (upper arm bone).

(The region where this impingement occurs is referred to as the “Subacromial space”)

Compression of the Subacromial bursa and Supraspinatus tendon may eventually result in the irritation of said structures.

This can lead to the following painful conditions:

Subacromial Bursitis

This refers to inflammation of the Subacromial bursa.

This can cause pain, increased sensitivity and swelling in the bursa.

Supraspinatus Tendinopathy

This refers to an injury to the Supraspinatus Tendon.

This may eventually lead to issues such as:

(Keep in mind – it is normal for these structures to be compressed (to an extent) when the arm is lifted above shoulder height. Just because there is impingement does not necessarily mean that the shoulder structures will be painful.)

causes

There are several factors that may predispose one to experiencing impingement in the shoulder.

(These will be addressed in the exercise section of this blog post.)

Tests for Shoulder Impingement

Collectively – The following tests act as a general guide line to help determine if you have impingement in the shoulder.

(Note: Many other structures in your shoulder can also make these tests reproduce pain which may give a misleading diagnosis.)

Presentation Of Symptoms

The area of pain is usually felt deep at the point of the shoulder.

In many cases, pain can also refer down the side of your upper arm. (see above)

Pain is often aggravated in certain positions of shoulder (such as with over reaching and over head movements).

Painful Arc

Instructions:

• Abduct (raise) your arm out to the side and over your head.
• Pay attention to when you feel an increase in shoulder pain.

Results:

If you experiencing the following, this suggests that you may have shoulder impingement.

Hawkins-Kennedy Test

Instructions:

• Bring your bent arm to 90 degrees of shoulder flexion in front of you. (see above)
• Crank your hand down with the help of your other hand. (Shoulder Internal rotation)
  • Do not let your shoulder hitch upwards.

Empty Can Test

Instructions:

• Raise your arm towards the front/side to shoulder height with the thumb pointing downwards.
• Use the hand on the other side to push down on your arms as you resist the downward force.

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Exercises For Shoulder Impingement

• STEP 1: Stop Aggravating Activities
• STEP 2: Reduce Inflammation
• STEP 3: Decompress Shoulder Joint 
• STEP 4: Release Tight Muscles
• STEP 5: Gentle Exercises
• STEP 6: Encourage joint centration
• STEP 7: Ideal Scapula Position
• STEP 8: Activate Serratus anterior
• STEP 9: Strengthening Exercises
• STEP 10: Address Posture

Note: These Shoulder Impingement exercises must be comfortable and performed gently. Listen to your body!

Step 1: Stop aLL activities that cause pain

How can you expect your shoulder to get better if you keep exposing it the activities that make it worse?

It may sound really straightforward, but I’ve seen so many people get this first simple step wrong.

… STOP aggravating your pain!

For now – try to avoid aggravating positions such as over head movements, lifting and sleeping on the painful shoulder.

(This will help limit the amount of pressure on the painful shoulder structures.)

Step 2: Reduce inflammation

If there is an excessive amount of inflammation in the area, you may find that everything in the shoulder region will be painful.

Once the inflammation levels have subsided, you should be able to tolerate the exercises on this blog post without aggravating your symptoms.

Here are a few ways to reduce inflammation:

Anti-Inflammatory Gel

Apply the anti-inflammatory gel to the whole shoulder.

Do this 2-3/day.

I prefer products with natural active ingredients like arnica, calendula or hypericum.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take a strong anti-inflammatory medication for at least 7-10 days.

(Please consult your Primary Care Provider before taking any new medication.)

Ice/Cold Therapy

Apply an ice pack to your shoulder for at least 10-15 minutes.

Do this 3-5 times per day for the first 48-72 hours.

Shoulder Sling

If the pain is severe, you can temporarily immobilize your shoulder for a short period of time.

(… DO NOT wear it for longer than 1-2 days!)

Try Natural Products

Taking turmeric and/or fish oil capsules are natural ways to help reduce the inflammation.

Step 3: Decompress The Shoulder

The next step in addressing the impingement is to reduce the amount of compression on the Subacromial Bursa and Supraspinatus tendon.

Deltoid Release

The aim of this exercise to loosen up the Deltoid muscle.

(The Deltoid tends to pull the Humerus bone upwards (Superior Translation) which can be associated with shoulder impingement.)

Instructions:

• Lie down on the floor.
• Place your Deltoid muscles directly on top of a massage ball.
• Continue for 2-3 minutes to cover the entire area.
• Keep in mind – Since the Deltoid is at the front, side and back of the shoulder, you’ll need to move your body into the appropriate position.

(Note: If you are unable to lie on top of your shoulder, you can perform this exercise against the wall instead.)

Shoulder Impingement Stretch

Instructions:

• Anchor a strong resistance band underneath your foot.
• Hold onto the end of the resistance band with your hand.
• Keep your shoulder and arm as relaxed as possible to allow the resistance band to pull your arm downwards.
• Lean away from the band.
• Aim to feel a pulling sensation in your shoulder.
• Apply more tension to the band if you would like to increase the stretch.
• Hold for 30 seconds.
• Repeat 3-5 times.

Note: Do NOT pull into sharp pain. (… especially if you have a tear!)

Step 4: Release tight muscles

The following tight muscles can limit how much you can raise your arm.

This may place more pressure on the shoulder muscles which are responsible for lifting the arm up (including the Supraspinatus).

(I strongly recommend looking up the exact location of these muscles on Google.)

Pectoralis Minor

Latissimus Dorsi

Teres Major

Triceps

Step 5: gentle Exercises

The aim of the exercises in this section is to keep the shoulder as mobile as possible.

Do as much as you can without over doing it!

Overprotecting your shoulder may result in more stiffness and predispose you to developing Frozen Shoulder (… which can take 18 months to recover!).

Pendulum

Instructions:

• Lean over a chair and allow your injured arm to hang underneath you.
• Using the momentum of your arm, gently sway your arm side ways/forwards/backwards/circles.
• Allow the shoulder to move as much as you can without reproducing any pain.
• Repeat each movement for 10 repetitions each.
• Alternative: Roll a ball on a table top in a circular motion.
• Progression:
  • Generate more tension throughout the whole arm as you move the arm.

Assisted Elevation

Instructions:

• Lie down on your back.
• Hold onto your wrist with your other hand.
• Keep your arm completely relaxed.
• Use your other arm to lift your shoulder as far as possible without causing any pain.
• Perform 20 repetitions.

Forward Leans

Instructions:

• Place your hand on the back of a chair.
• Take a few steps backwards away from the chair.
• Lean the torso forward as to bring your arm in an upwards direction.
  • Do this as much as you can without reproducing any pain.
• Perform 20 repetitions.
• Alternative:
  • Roll a ball forwards/backwards on a table top.
  • Roll a ball up/down the wall.

Shoulder External Rotations

Instructions:

• Bend your elbows to 90 degrees.
• Keep your elbows in contact with the side of your body.
• Proceed to rotated your arm outwards/inwards.
• Allow the shoulder to move as much as you can without reproducing any pain.
• Perform 20 repetitions.

(If you do not have full external rotation in the shoulder, make sure to check out this blog post.

Step 6: Encourage joint centration

If the top of the shoulder bone (… also known as the Humeral head) is not centered within the shoulder socket, it can often move into a forwards and upwards direction.

This may increase the chance of impingement occurring within the shoulder.

Here are a few exercises that can help improve the position of the Humeral head within the shoulder joint.

Posterior Shoulder Release

A tight posterior capsule may be associated with the forward position of the humeral head within the shoulder socket.

Instructions:

• Lie down on the floor.
• Place the back portion of your shoulder on top of a massage ball.
• Apply an appropriate amount of your body weight into the area.
• Continue for 1 minute.

(If you are unable to lie down on your shoulder, perform this exercise against a wall.)

Posterior Shoulder Stretch

Instructions:

• Gently pull your shoulder blades backwards.
• Without moving your shoulder blades, bring your arm across the body.
• Pull the arm further across the body using your other hand.
• Aim to feel a stretch at the back of your shoulder.
• Hold for 30 seconds.

(For more exercises that stretch the back of the shoulder, see post: Posterior Deltoid Stretches.)

Anti-Impingement Exercises

The following exercises will help reduce the amount of impingement occurring in the shoulder by pulling the Humeral head downwards relative to the shoulder socket.

(This may take some time to understand and perform correctly… and that’s fine. Keep at it!)

Internal Rotation

Instructions:

• Tie a resistance band to a stationary object at elbow height.
• Hold onto the band.
• Move away from the anchor point to increase tension on the band.
• Keep shoulders back throughout the exercise.
• Bend your elbows to 90 degrees.
• Keep your elbow fixated to the side of your body.
• Pull the resistance band across the body.
• Hold for 3-5 seconds.
• Perform 20 repetitions.
• Perform 3 sets.

Extension

Instructions:

• Anchor resistance band on top of the door.
• Face the door.
• Starting at shoulder height, pull the resistance band down towards your body.
• Keep constant tension through resistance band throughout movement.
• Hold for 3-5 seconds.
• Slowly return the hand back to shoulder height
  • If this hurts, you may want to start at a lower height
• Repeat 20 times. 
• Perform 3 sets.
• Progression:
  • Start from a higher position.
  • Apply more tension to the band

Adduction

Instructions:

• Anchor resistance band on top of the door.
• Stand side on to the door.
  • The affected shoulder should be closer to the door.
• Starting at shoulder height, pull the resistance band down towards your body.
• Make sure your palms are facing forward.
• Keep constant tension through resistance band throughout movement.
• Hold for 3-5 seconds.
• Slowly return the hand back to shoulder height
  • If this hurts, you may want to start at a lower height
• Repeat 20 times.
• Perform 3 sets.
• Progression:
  • Start from a higher position.
  • Apply more tension to the band

Step 7: Ideal Scapula Position

By optimizing the position of the scapula (shoulder blade), this can help reduce impingement in the sub-acromial space.

Try this quick and easy way to reset your shoulders into a more neutral position.

How To Re-Position Shoulder Blade

Instructions:

• Keep your shoulders “long and wide”: Reach and stretch out your hands as far to opposite sides as possible. (see above)
• Retraction: Slightly bring your arms backwards.
  • Make sure you can feel a gentle contraction between your shoulder blades.
  • Do not over squeeze your shoulder blades together!
• Posterior Tilt: Turn your palms upwards so that your thumbs are angled towards the back.
  • Imagine the inferior angle (“the pointy part of lower scapula”) is lightly digging into the back of your rib cage.

Take note of your new shoulder blade position. 

Keep this position and slowly lower your arms down by your side.

Scapula movement during arm movement

Now that you know how your scapula should ideally sit when your arms are by your sides, it is just as important to understand how it should MOVE when you use your arm.

Check out this video: [See video]

This is achieved by learning how to…

Step 8: Activate your Serratus anterior

The Serratus Anterior muscle is responsible for upward rotation of the shoulder blade which is an important movement as you lift your arm up.

Upward rotation of the Scapula involves the shoulder blade rotating outwards along the rib cage. (see above)

This places the shoulder in a more optimal position and reduces the likelihood of impingement in the shoulder.

How To Activate Serratus Anterior

It is important that you can feel the Serratus Anterior muscle contracting as you perform the following strengthening exercises.

For more exercises: Serratus Anterior Exercises

Step 9: Strengthening Exercises

Maintain the ideal scapula positioning throughout all of these exercises.

Remember:

Isometric Exercises

Isometric exercises involve strengthening your shoulder muscles without moving.

This is a good place to start strengthening exercises as the chance of aggravation is minimized.

You can perform an isometric contraction in ANY shoulder position and in ANY direction.

You will need to decide what exact shoulder position you will be performing the isometric contraction.

(Choose a position that you are having some difficulties with.)

For example: If raising your arm forwards is challenging, this would be a good isometric exercise:

Isometric Elevation

Instructions:

• Raise your arm in front of you.
• Place your other hand on top of this arm.
• Push down with your hand.
• Keep your injured arm completely still.
• Hold this position for 30-45 seconds.
• Repeat 3 times.

Note: Only push yourself as far as you are comfortable!

Dynamic Exercises

Make sure that you do not move into any pain.

External Rotation

Instructions:

• Anchor the resistance band at elbow height.
• Stand sideways with the affected arm further from the door
• Pull the band away from your body.
• Aim to keep your elbow in contact with the side of your body at all times.
  • Think about squeezing a piece of paper between your elbow and the side of your body
• Repeat 20 times
• Perform 3 sets
• Progression: Increase the tension on the resistance band.

Flexion

Instructions:

• Stand on the end of a resistance band.
• Pull the resistance band as high as you can comfortable go without pain.
• Keep constant tension on the resistance band throughout movement.
• Hold for 3-5 seconds.
• Slowly return the hand back to the body.
• Repeat 10-30 times.
• Perform 3 sets.
• Progression: Increase the tension on the resistance band.

Abduction

Instructions:

• Stand on the end of a resistance band.
• Pull the resistance band towards the side as high as you can comfortably go without pain.
• Keep constant tension on the resistance band throughout movement.
• Hold for 3-5 seconds at end range.
• Slowly return the hand back to the body.
• Repeat 20 times.
• Perform 3 sets.
• Progression: Increase the tension on the resistance band.

Weight Bear Exercises

Rock Back

Instructions:

• Assume the plank position with your knees on the floor.
• Assume the Ideal Scapula Position.
• Push your forearms into the floor throughout this exercise.
• Rock your body backwards as far back as possible.
• Return to starting position.
• Repeat 30 times.
• Progression: Increased the amount of weight going through your shoulder by performing the exercise whilst on your hands and feet.

Strengthen In Functional Positions

What exact activity can’t you do because of your painful shoulder?

You need to find an exercise that will mimic the motion of doing this SPECIFIC movement/activity.

For example:

If you have difficulty hanging out your clothes on the clothes line… you can do the following exercise:

Instructions:

• Stand on the end of a resistance band.
• Assume the Ideal Scapula Position.
  • This is to prevent you starting from a slouched shoulder position.
• Aim to pull the resistance band as high as you can go without causing any pain.
  • (Experiencing a small amount of discomfort is fine!)
• Keep constant tension on the resistance band throughout movement.
• Hold for 3-5 seconds.
• Slowly return the hand back to the body.
• Repeat 10-30 times.
• Perform 3 sets.

Step 10: Address Posture

If you have been persistent with these shoulder impingement exercises and are still experiencing symptoms, you may need to consider addressing the following postural issues which may be limiting your progress with the exercises:

Rounded Shoulders

Having Rounded Shoulders is when the resting shoulder position is in front of the mid line of the torso.

For a full guide on how to address this posture:

See Post: Rounded Shoulders

Thoracic Hyperkyphosis

Thoracic Hyperkyphosis is where the upper back is significantly curved forwards.

This can place the shoulders in an ineffective position to function.

For a full guide on how to address this posture:

See Post: Fix Hunchback Posture

Winged Scapula

A Winged Scapula is when the inner border of the shoulder blade protrudes off the rib cage.

The scapula is in a position of anterior tilt and downward rotation which can increase the chance of compression occurring in the subacromial space.

For a full guide on how to address this posture:

See Post: Winged Scapula Exercises

Common questions

If you have any question, please feel to ask me in the comment section.

How often should I do Shoulder impingement exercises?

• Start with 1/week.
• Aim for 3/week.
• Monitor and assess how the shoulder responds.
• Adjust frequency accordingly.

How long does it take to recover?

It really depends!

There are many factors that will influence the time it will take for a full recovery.

Try to focus on consistent improvements.

Does the Cortisone injection help?

If you have already been to your doctor, then the chances are that they have already suggested that you get the cortisone injection.

This injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to:

Sounds great in theory… right?

Yes, it does…

BUT – The problem is that it does absolutely nothing to address the underlying cause of the shoulder impingement.

More often than not – the injection may provide some short term relief, but only to have the pain come back at a later date (… and usually with a vengeance!).

Do I need Surgery?

My immediate answer: NO.

The reason behind this is that I have a strong belief in healing the body via conservative means.

Please give these exercises a chance before even considering surgery for Shoulder Impingement.

(Keep in mind – not all surgeries are successful!)

However, that being said, every situation is different. You may need to talk to the Shoulder Surgeon for more information.

Are there any exercises to avoid?

The main thing is to be very careful with over head movements.

These might include:

Keeping your exercises below shoulder height should be fine.

How do you sleep with a Shoulder Impingement?

Avoid sleeping on top of your affected shoulder as this will compress the painful areas.

Instead – I recommend sleeping on your back using pillows to support the weight of the arms.

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Conclusion

Shoulder Impingement is a shoulder condition which involves compression of the structures in the sub-acromial space: Sub-acromial Bursa and Supraspinatus Tendon.

Compression of these structures may lead to the irritation and result in a painful shoulder.

Follow this comprehensive guide to fix your Shoulder Impingement.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.