What is a Shoulder Impingement?
Shoulder Impingement is the compression of the following structures in the shoulder:
- Subacromial Bursa
- Supraspinatus tendon
As a result – this can lead to the following painful conditions:
a) Subacromial Bursitis
This is the inflammation of the fluid-filled sac structure (Bursa) in the area of your shoulder that is underneath the acromion (Subacromial).
b) Supraspinatus tendinopathy
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.
As the Supraspinatus tendon is located in the area directly underneath the acromion, it is susceptible to getting compressed.
This can lead issues such as:
- Inflammation (“Rotator cuff Tendinitis”)
- Degeneration (“Rotator cuff Tendinosis”)
- Tear (“Rotator cuff tear”)
- Frozen Shoulder
- Neck pain
What causes Shoulder Impingement?
- Poor posture (Eg. Rounded shoulders, Thoracic Kyphosis)
- Repetitive use of shoulder (especially over head)
- Poor scapulohumeral rhythm
- Acromial spurs
- Poor joint centration of the humeral head
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. For more information: Medical disclaimer.
Tests for Shoulder Impingement
Note: These tests give a general guide line in diagnosing your shoulder problem.
Many other structures in your shoulder can also make these tests reproduce pain as well.
The area of pain is usually felt deep within 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 over head movements.
b) Painful arc
- Raise your arm out to the side and over your head.
- (Also known as Shoulder abduction)
- Unable to lift arm into full range.
- Pain between 60-120 degrees of abduction.
- Nil or reduced pain at early (0-60 degrees) and late (120-180 degrees) shoulder abduction.
b) Hawkins Kennedy test
- 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.
Findings: Reproduction of your shoulder symptoms with the movement.
c) Neer’s test
- Raise your arm a) in front of you and b) to the side with your thumb pointing downwards.
Findings: Reproduction of your shoulder symptoms with the movement.
Exercises For Shoulder Impingement
How to fix Shoulder Impingement:
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!
The body can not (…and will not) heal itself if you don’t allow enough time for it to do so.
“… If it hurts, don’t do it!
If feels fine, keep at it!”
Avoid aggravating positions such as over head movements, lifting and sleeping on the painful shoulder!
Quick tip: When you do use your shoulder, try to keep your elbows as close to the side of your body as possible.
Step 2: Reduce inflammation
If there is excessive inflammation in the area, everything will be painful!
Once the inflammation levels have subsided, we can then start the Shoulder Impingement exercises without aggravating the shoulder again.
a) 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.
b) 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 general practitioner before taking any new medication)
c) Ice/Cold therapy
Apply an ice pack to your shoulder for at least 10-15 minutes.
Do this 3-5 times per day.
d) 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!)
e) Try natural products
Taking turmeric and/or fish oil capsules are natural ways to help reduce the inflammation.
Step 3: Reduce pressure on painful structures
a) Shoulder release
This will help decompress the shoulder joint.
- Place your shoulder muscles into a massage ball onto the floor.
- Target muscles: Deltoid
- Continue for 2-3 minutes to cover the entire area.
b) Shoulder Impingement stretches
- Anchor a strong resistance band underneath your foot.
- Whilst holding onto the end of the resistance band, start to lean away from the band.
- Aim to feel a downward pulling sensation in your shoulder.
- Keep your shoulder as relaxed as possible.
- 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.
- Place target area on top of a massage ball or a foam roller.
- Apply an appropriate amount of your body weight on to the ball
- Continue for 1 minute on each area.
- Make sure that you cover the whole muscle.
- (I strongly recommend looking up the exact location of these muscles on Google.)
a) Pec minor
b) Latissimus Dorsi
c) Teres Major
Step 5: Initial Shoulder Impingement exercises
The goal here is to keep the shoulder as mobile as possible.
Do what you can.
Don’t do more than you can’t…
Overprotecting your shoulder may predispose you developing frozen shoulder. (… and that’s way worse!
- Lean over a chair and allow your 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.
- Roll a ball on a table top in a circular motion.
- Progression: Generate more tension throughout the whole arm as you move the arm.
b) Forward leans
- Place your hand on the back of a chair.
- Lean forward as to bring your arm in an upwards direction.
- Do this as much as you can without reproducing any pain.
- Repeat 20 times.
- Roll a ball forwards/backwards on a table top.
- Roll a ball up/down the wall.
- 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.
- Repeat 20 times.
- Progression: Generate more tension throughout the whole arm as you move the arm.
d) Shoulder flexion with band
- Lie on your back.
- Hold a resistance band between your hands.
- Gently pull the band apart.
- Keep your elbows bent at 90 degrees.
- Raise your arms as far as possible without reproducing any pain.
- Repeat 20 times.
Step 6: Encourage joint centration
If 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 in the shoulder.
a) Posterior shoulder release
A tight posterior capsule can push the humeral head forward in the shoulder socket.
- 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.
b) Posterior shoulder stretch
- Gently pull your shoulder blades backwards.
- Without moving your shoulder blades, bring your arm across the body.
- Pull the arm further with your other hand.
- Aim to feel a stretch at the back of your shoulder.
- Hold for 30 seconds.
c) Anti-impingement exercises (Resistance bands)
Humeral head depression:
You need to get familiar with the sensation of depressing your humeral head in your shoulder socket.
Imagine your shoulder bone is constantly being sucked in a downwards AND inwards direction into the socket whilst you move your arm.
(This may take some time to understand and perform correctly… and that’s fine. Keep at it!)
- 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 10-30 times. 3 sets.
- Start from a higher position.
- Apply more tension to the band
- 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 10-30 times.
- Perform 3 sets.
- Start from a higher position.
- Apply more tension to the band
Step 7: Ideal scapula position
By optimizing the scapula position, this will help reduce impingement in the subacromial space.
This is a quick and easy way to reset your shoulders into a more neutral position.
If you ever forget where your shoulder should be, do this:
- 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 floor.
- Imagine the inferior angle (“the pointy part of lower scapula”) is digging into the back of your rib cage.
Take note of your new shoulder position.
Keep this position and slowly lower your arms down by your side.
Now that you know how your scapula should ideally sit, it is just as important to understand how it should MOVE as you use your arm.
- It is VITAL that your scapula moves properly when you lift your arm up. (especially over head)
- As the arm is raised, the scapula should laterally rotate so that the inferior angle reaches the side of your ribs.
- This will promote more space in the subacromial space where compression occurs.
- It can help if you visualize how the scapula should be moving as you use your arm.
- The scapula should sit flat on the rib cage throughout movement.
This is achieved by learning how to…
Step 8: Activate your Serratus anterior
This muscle is responsible for moving your shoulder blade more effectively as you use your arm.
It is important that you can feel the Serratus Anterior muscle contracting as you perform the following strengthening exercises.
Activating the Serratus anterior:
- Assume the wall plank position. (see above)
- Assume the Ideal scapula position.
- (See step 6)
- Activate the Serratus Anterior by pushing your forearms into the wall:
- Pull your shoulder blades DOWN and AROUND the ribs.
- Keep your shoulders long/wide.
- Aim to feel the contraction in the lower and side region of the scapula.
- (… This is where the Serratus Anterior muscle is!)
- There should be a balance between the muscles that are pulling backwards and the muscles that are pulling down/around.
- Hold for 30 seconds.
- Repeat 5 times.
- Progression: Whilst maintaining the activation of the Serratus Anterior, slide your forearms up/down the wall.
For more exercises like this: Serratus Anterior strengthening exercises.
Step 9: Strengthening
Maintain the Ideal scapula positioning throughout all of these Shoulder Impingement exercises.
- Tilt the shoulder blades BACKWARDS.
- Pull your shoulder blades DOWN and AROUND the ribs.
- Keep your shoulders long/wide.
… This is CRUCIAL!
1. Isometric training
This involves strengthening your shoulder muscles without moving.
This is to make sure that you do not aggravate the symptoms in your shoulder.
You can perform an isometric contraction in ANY shoulder position and in ANY direction.
Example: External rotation (with flexion)
- Keep your elbows tucked to the side of your body.
- Gently pull your shoulders back.
- Hold a resistance band between your hands.
- Pull the resistance band away from each other.
- (External rotation)
- Whilst maintaining the tension on the band, lift your arms up as high as you can with nil pain.
- Hold this position for 30-45 seconds.
- Repeat 3 times.
Note: Only push yourself as far as you are comfortable!
2. Dynamic exercises
Progress to these Shoulder Impingement exercises only if you are able to conduct the previous Shoulder Extension, Adduction and Internal rotation exercises easily.
- Depress the humeral head throughout movement.
- Maintain the Ideal scapula position.
- Engage the Serratus Anterior.
a) External rotation
- 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 10-30 times
- Perform 3 sets
b) Internal rotation
- Anchor the resistance band at elbow height.
- Stand sideways with the affected arm closer to the door.
- Pull the band towards your body.
- Aim to keep your elbow in contact with the side of your body.
- Think about squeezing a piece of paper between your elbow and the side of your body
- Repeat 10-30 times
- Perform 3 sets
- 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.
- 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 10-30 times.
- Perform 3 sets.
3. Weight bear exercises
a) Rock back
- Assume the plank position with your knees on the floor.
- Assume the Ideal Scapula Position.
- Push your forearms into the floor.
- 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.
4. Strengthening 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.
If you have difficulty hanging out your clothes on the clothes line… you can do the following exercise:
- Stand on the end of a resistance band.
- Assume the Ideal Scapula Position. (See Step 6)
- 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, consider addressing the following postural issues:
a) Rounded shoulders
Having Rounded Shoulders is when the resting shoulder position is in front of the mid line of the torso.
b) Thoracic Kyphosis
A curved spine will place the shoulders in an ineffective position to function.
c) 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.
1. How often should I do Shoulder impingement exercises?
- Aim for 3/week.
- Start with 1/week.
- Monitor and assess how the shoulder responds.
- Adjust frequency accordingly.
2. How long does it take to recover from Shoulder Impingement??
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.
3. 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:
- a) Reduce inflammation
- b) Reduce pain
- c) Create a “window of opportunity” to progress the exercises.
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!).
- Persist with these shoulder impingement exercises for about 4-6 weeks.
- If there is absolutely no improvement (… or if it’s getting worse), then it might be the next step to take.
- It should NEVER be the first thing that you do.
4. 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!)
5. Are there any exercises to avoid with Shoulder impingement?
The main thing is to be very careful with over head movements.
These might include:
- Shoulder press
- Lat pull down
- Hand stands
- Arm raises above shoulder height
- Downward dog position
Keeping your exercises below shoulder height should be fine.
5. 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.
What to do next:
1. Any questions?… Leave me a comment down below.
2. Come join me on the Facebook page. Let’s keep in touch!
3. Start doing the Shoulder Impingement exercises!
336 thoughts on “Shoulder Impingement Exercises”
Hello there. I get a nerve/weak sensation in my shoulder and down my arm when doing press ups feels like the left shoulder gets a lot weaker than the right. Is this shoulder impingement?. Would these exercises help?.
I get shooting down the arm at times and in the shoulder once again when i do other things to.
Thanks a lot, Great content excellent stuff, please keep it coming.
It is possible that shoulder impingement can give this weakness feeling in the arm. Is there any pain any where?
You will also need to make sure that it’s not a pinched nerve in the neck and/or thoracic outlet syndrome as these are conditions which involve compression of the nerve. This can cause pain/tingling/numbness/weakness down the arm.
I have developed mouse shoulder (shoulder pain from using the computer mouse all day at work 5 days a week).
Are these exercises good for mouse shoulder or do you recommend others?
A lot of the exercises mentioned on this blog post can help.
On top of that – I would suggest that you try to optimize your work station.
Aim to keep your elbow close by your side (avoid flaring elbows to the side), do not over reach for your mouse (keep mouse approximately forearm length away, Keep shoulders in a wide and long position (see post: Rounded Shoulders) and take regular breaks.
after doing your exercises for about 3 weeks, I‘m finally pain free. my question is: Can I get back into the gym now? Can I train chest and shoulders again if I start slowly? How often do I need to do these exercises to stay safe?
I got chronic impingement/bursitis/tendinitis and a slight 3mm tear in my supraspinatus tendon according to my shoulder specialist. Ive been pain free a couple of times at back in the gym (could never do bench press but other exercises like dips, cable crossover and dumbbell benchpress) but whenever I did something slightly wrong the pain got back, I‘m trying to get a rid of the whole situation
Great to hear that you are pain-free now.
If your symptoms have resolved, you can go back to the gym provided that you go very light to the begin with.
I would also recommend that you pick the 2 or 3 exercises that you know you have difficulty with (such as the ones you mentioned) and see if there is an issue with your technique (especially when you are hitting the last few repetitions when fatigue sets in.)
You might also need to consider training your shoulder in different angles with light weight to build up the resilience of your shoulder joint and musculature.
thanks man, you are a good guy god bless you
Hi Mark, thanks for sharing all this information with us. I’m recently diagonesd with subcoracoid impingement, which makes itself known mostly while playing tennis (especially during serve). I do have forward shoulders and a flat thoracic spine. I was wondering if I could follow your impingement regiment as well or if there is anything different I should focus on.
Sounds like you can follow the exercises mentioned on this blog post.
If you would like to address your other postural issues, check out these posts:
– Rounded Shoulders
– Flat thoracic spine
Hello Mark, Ive been dealing with shoulder problems for about 4 years now and I‘ve been to 4 physiotherapists but sadly non could help me long term, maybe you can? I‘m currently visiting a doctor that is a shoulder specialist, he made me do an MRI and xray. The results of the MRI were subacromial bursitis, supraspinatus tendonitis with a 3mm vertical tear and no proof of a subacromial impingement. The xray results were slight AC joint instability, the shoulder specialist said that my impingement cant come from my clavicle tho.
I sadly cant tell if i either got my problems from a fall or from overrusd/bad lifting form. I got rid of the pain a couple of times and was able to do most exercises pain free for months like dumbell benchpress, pull ups, dips, lat pulldowns etc but once I do something slightly wrong, the pain is back for weeks and I need to pause.
On an old MRI result I had impingement diagnosed but that seems to be gone now?
My doctor injected cortisone into my shoulder but that only stopped the pain for about 2 days and I couldnt get another shot because of holidays etc. yet.
My posture is pretty decent nowadays, Im doing your exercises for a while now and I‘m pretty pain free but I still get a cracking when I rotate my arms.
Some questions I also got:
1) If the MRI results are right that I got no Impingement and the cause of the problem is gone, will I be finally free after healing the bursitis/tendonitis properly?
2) I read a lot that I need to put my shoulders back and down when doing most exercises, I also read that this is wrong tho, whats actually good for my shoulder?
3) when Im bringing the Scapular in the proper position (back and around the ripcage), I usually feel like im flexing my lats, is this right?
Thank you so much in advance, I hope you can help me a little.
1) If the pain is directly related to the bursitis +/- tendonitis, then addressing these issues should completely resolve your symptoms. You’ll just need to right exercises to specifically address it.
2) “Shoulder back and down” can be a helpful cue for SOME people, but it certainly does it apply to everyone. It really depends on the normal resting position of the shoulder. However – I find that most people will benefit from learning how to posterior tilt the scapula which I go through in this post.
3) Although the lats can help pull the scapula down a bit, you shouldn’t feel a significant amount of tension in the lats. If you can feel the lats too much, it is likely you are moving your scapula too much +/- there is a lot of tightness (likely from pec minor) limiting full scapula mobility.
Extra: Make sure that you do not have thoracic hyperkyphosis as this can make it difficult to assume the ideal scapula position. For more information: Hunchback Posture.
Hello there Mark,
I need help on this problem i had since January 2021. Im 19 years old and i have always had poor posture. I’m gonna add that in 5th grade, i rode my cousins bike and i didnt know how to stop it (its a mountain bike) i crashed on to my uncles car and i fell on my left shoulder and my glasses broke and i got a scar on my right side of face, its healed though. My left shoulder when i raise it, it cracks so it can be normal. Its like my left shoulder is uneven or its under? i dont know. The reason why i said that is because i dont know if that accident caused my left shoulder to be uneven?? or if its really just my poor posture. I want to know what you think. I dont feel my shoulder is broken, It just keeps cracking every time i move it and raise it up it would hurt so i have to grab onto my wrist and pull my arm up to make it crack so its in normal level again(i hope that made sense.)
The problem is because of my bad posture, i also feel this tingle(like nerve near my shoulder blades and spine in the left side only and its so annoying. If i slouch long enough it keeps going and starts pulsating. Also if i try to use a tennis ball to try and fix it hurts. I dont know the problem. Just my left shoulder and upper back near the shoulder blade. If you know what it is, Please tell me, i really want to know how to fix it. It does go away temporarily when i straighten up my back but i really want it gone for good, i know i need to exercise but i dont know specifically what part. I hope you see this, thank you!
Hello there Angelica,
Following the fall off the bike, did you manage to get an xray to check if there were any fractures or structural damage to the ligaments that support the shoulder?
Cracking in the shoulder could suggest instability in the shoulder joint which can be impacted by structural changes from the fall.
If you experience in a tingling specifically in the area between the shoulder blade and spine (especially after slouching for too long), this could be related to an issue with one of the nerves in this area.
If this is the case , the nerves that could be causing the symptoms may be the Dorsal Scapular Nerve and/or Spinal Accessory nerve. If you shrug your shoulders upwards, this can take tension off the nerve and reduce your said symptoms. You also mentioned that your shoulders are uneven. If your left shoulder is relatively drooping compared to the other side, this could be related!
Addressing the rounded shoulders might help!
Maybe you can help me figure out why my right arm is twisted. When I stick both of my arms straight out to my sides with my palms facing down, my left inner arm / bicep is facing straight ahead. But my right arm (the shoulder with pain) inner arm / bicep will be facing almost straight down towards the ground. something isn’t rotating my right shoulder backwards like my left shoulder. would that be because of weak back / shoulder blade muscles?
If we assume that your shoulder blades are sitting on a neutral rib cage, I would say your right shoulder is internally rotate within the joint and/or the scapula is tilted anteriorly. This would rotate/orientate your arm so that the biceps is pointing more towards the ground.
To address this:
– Learn how to posterior tilt the scapula
– Encourage more external rotation in the shoulder by strengthening the rotator cuff.
– Stretch/release the internal rotators (subscapularis, lats, pecs, teres major)
Thanks for the advice Mark!
In order to do a posterior tilt of my scapula, should my arms be moving a bit forward as my shoulder blades turn posterior? Or should my shoulder blades be moving downward?
Also, for my specific internal shoulder and anterior scapula situation, do I want to be stretching or strengthening my serratus anterior? I know on your should impingement blog it says to strengthen it, but on your rounded shoulder blog it says to stretch it. How do I know which to do?
When you tilt the scapula into a posterior tilt, you will want to keep the arms in a position where the upper arm is vertical. Think of the scapula movement as the beginning of a “back flip” as opposed to a pulling down movement.
Strengthening the serratus anterior will always be good for scapula control and in fact will be used when you posterior tilt (esp the lower fibres). In some cases- you need to stretch and strengthen it!
Great Article. I have had left-side shoulder impingement for a couple months, but I have also had pain in my left-side mid back when I take a deep breathe in that has been there for almost a year. It seems to be right under the shoulder blade, and when I roll my shoulder, my left-side shoulder blade pops and hurts. My shoulder also makes loud popping sounds. I think this is because of weightlifting and swimming, but I’ve quit those and went to different physical therapist, but the pain is still there. Do you think whatever this pain is caused my shoulder impingement? And do you have any ideas what it could be? It’s really been infuriating me for a year and even with heat/ice therapy I’ve achieved no success.
Thank you in advance,
Torso position can definitely affect the shoulder function.
For your left lower/mid back to hurt on inhalation, this might suggest tightness in this area. If it is only occurring on the on side (and in the absence of any traumatic injury), I would suspect that there may be a degree of rotation in the spine. (See post: Twisted Spine)
The popping sensation as you move your scapula could be snapping scapula syndrome.
What’s your opinion of facepulls for fixing shoulder issues?
They are fine to do as long as you have adequate amount of internal rotation from an abducted position.
Otherwise – face pulls could potentially increase impingement in the sub acromial space.
Thanks for great website.
I am Zahra 39 years old, my right shoulder is being painful since nine months. As I checked with your tests I think I have shoulder impingement. During putting my affected hand on opposite shoulder while arm is bent is painful. But I can lift and move my affected hand in all directions while it is stretched.
Also sometimes is making sounds on my shoulder when it moved.
As below some exercises that she has given me to Strengthen the shoulders and spine ( Because she emphasizes the weakness of my spine and shoulders muscles).
I’m not sure these are harmless for my shoulder especially I have to do these exercises With 3 kg dumbbells.
Thank you very much for your help.
Hi Mark! My name is Hanna, I am studying Personal Training with the Australian Institute of Fitness. I found your website while doing some research on exercises for clients rehabilitating a shoulder impingement injury. I love it! Very detailed and informative!
I am hoping you could give me some advice in regards to prescribing warm up exercises for a client rehabilitating a shoulder impingement injury, I have a lot of good exercises already, I’m just unsure about the warm up! Thanks :)
Warm up for shoulder impingement should involve the muscle/tendon that is getting impinged upon.
For example- if the supraspinatus is getting squashed, you would want to incorporate external rotations from various shoulder positions and shoulder elevation in scaption plane.
You will also need to stay away from any painful ranges.
Other general things you could do would be scapular retraction + posterior tilts, pain-free shoulder circles, isometrics
Another Mark here. I got a bad inpingement doing pushups with terrible form. I am very fit/strong. I have seen my physio and my chiro. They both told me to do wall angels for the forseeable but it is not helping. The shoulder hurts but my upper traps and front of my neck are a constant 7.5 out of 10 on the pain scale.
Hello Mark (great name btw),
If the wall angels aren’t helping, you might need to strengthen whatever structure is being compressed. Most commonly (but not limited to) the Supraspinatus tendon.
The exercises mentioned on this blog post might help with that.
Pain in the front of the neck might suggest that you may have another injury other than the shoulder impingement.
This will require an assessment by the physio/chiro to see what exactly is happening there.
Philip Isaiah here, came from your winged scapula post and i’m very thankful for the free advices online. Although I am really recovering, I just can’t stop my anxiety from spreading further from all of the things happening. Recently I started to feel stiffness in my front/anterior deltoid in my much more worse shoulder, and I just can’t help to stop being bothered by it. I still have 99% ROM but I try my best not to move my shoulder. Could this be a start of something dreadfully new?
Hi Philip, There are many structures in the shoulder complex, all of which are inter-connected and reliant upon one another.
It is common to have a few issues at the same time in the shoulder. (most likely due to compensatory patterns)
Pain at the front of the shoulder is commonly long head biceps tendon. (But depends on exactly where you are experiencing the pain).
You might need to do some specific exercises for the tendon involved as well.
I had shoulder surgery: supraspinatus suture and biceps suture. I did 80 physiotherapy sessions. I was left with a deficit of external rotation. What exercises do you recommend?
You will need to determine exactly why you have limited external rotation in the shoulder (ie. pain vs tightness)
A common culprit is a tight subscapularis. Did they address this muscle?
I’m 40 years old. About 3 years I injured my shoulder from doing military presses in the gym. I was going particularly hard that day (regrettably). After that, I couldn’t reach my arm behind and scratch my back. I thought the pain would just go away after a few months or a year but it didnt. I still tried to get back into lifting weights although gently. Then almost 2 years after the initial injury, I seemed to aggravate it again. In addition to cant scratching my back, I couldn’t now lift or rotate my arm! After that, I went to a PMR doctor and I was diagnosed with mild bicep tendonitis. She suggested physical therapy and icing which I’ve been doing for several months now. I’ve increased my range of motion, but it seems only improvement mostly from the problems I gained from my second injury like lifting/rotating my arm. I still can’t scratch my back with my arm with lots of pain! Couldnt scratch my back for 3 years now. What can do to improve this? Seeing as I didnt see a doctor for 2 years from the initial injury, do you think it’s too late to fix or a permanent problem? That’s my biggest concern… Im worried but highly motivated to fix this. Your thoughts would be appreciated. Thanks.
Inability to scratch your back is likely due to limited shoulder internal rotation.
This is commonly limited by issues of the posterior deltoid, posterior capsule, infraspinatus and teres minor. (located at the BACK of the shoulder)
If this is the case, you will need to focus on specifically rehabilitating these structures in their elongated position.
Given that your doctor assessed your shoulder and concluded that the biceps was the issue, I assume that your pain is in the front of the shoulder?
If this is the case, You might have a lack of shoulder extension which might also be limiting your ability to reach behind your back.
You will need to strengthen the biceps (I assume long head biceps tendon) in the lengthened position.
It’s never too late to fix an issue. There is always something that you can improve upon.
Awesome! Each exercise is explained so well and so many exercises to help all of us. Thank you for sharing.
Hi, Mark. I dislocated my shoulder in 2016. Occasionally I get some pain but it goes away. Last week, something happened. Not sure what. Small movements cause lots of pain. If I lay on my back and bring my arm over my head, I physically cannot bring it back down. I don’t know what to do or what the problem is. Thoughts?
It would be hard to say exactly what structure might be causing your said issues without performing some shoulder tests on you.
Where exactly are you experiencing your pain? And what movements cause the pain?
As part of the Dynamic Exercises intro, you mention don’t try these unless you can do the ‘previous’ internal rotation exercises easily. I can’t find any reference to these. Please can you clarify?
Apologies. I had shuffled some of the exercises around and placed the internal rotation exercise in the dynamic section.
Thanks for letting me know.
Hope all is well! First of all, thank you for the pictures and information! So, I started working from home April of 2020. I have a desk position. So I type and mouse most of my shift. At the time I did not have a stand up desk and opted to use a office chair from home. the office chair did not provide the same support as my ergo chair at work. it did not have much back support. I used a couple pillows for that. I used the office chair for about two weeks and sure paid the price. On a very busy day, my shoulderS started hurting. I know your first step is to stop doing what causes the pain, unfortunately cannot do that. It became worse and I spoke to my doctor who diagnosed me with bilateral shoulder impingement. I was able to bring my work chair home and have a stand up desk now too. It has been 3 months of this pain. Constant pain, not just at work. I am taking ibuprofen, fish oil, tumeric capsules. I will order the arnica cream today. I had been doing some of the similar stretches that you posted, but I will definitely do these posted. Since the pain is not going away, my doctor is advising a cortisone injection on each shoulder. I want a permanent fix, no a temporary one! Thank you in advance for your help.
Main thing for working from home is get your positioning correct.
When sitting: Keep elbow by your sides, Bend your elbow to roughly 90 degrees. Look at your hand position.
This is where your keyboard and mouse should ideally be. No other position! Do not flare your elbows out to the side.
Otherwise – it is common to develop some shoulder issues (especially impingement)
Start with the exercises mentioned on the blog post. They should help you nicely.
Hey Mark, I’ve had this shoulder impingement for almost a year now and it only seems to get worse. I have an aching pain down the left arm and even into my hand. not really sure what to do and I feel stuck. my job requires heavy lifting so its hard to catch a break. I’ve finally dedicated myself to fix this problem so I can get back to lifting in the gym. any advice. also if it doesn’t hurt my shoulder would it be a problem to train in the gym. thank you
If you have shoulder impingement, running through these exercises would be a good place to start.
Sounds like one of your biggest challenges would be the flare ups due to work. You will need to get this under control. Otherwise – you will need to really focus on the strengthening exercises to increase your load tolerance of the shoulder.
Gym exercises that don’t hurt your shoulder during and after are completely fine.
Your website is great and so informative!
I hurt my right shoulder a while ago by the shoulder blade while doing a kettle bell snatch
( overhead). It didn’t really bother me just Some pain now and then. Was doing Orange Theory as well but light on the right shoulder. I got shingles about 4 weeks ago on the left side and It seems to have exacerbated the condition a lot on that right shoulder.. Maybe I was sleeping on the right side a lot and not being able to do and stretching etc ( shingles is so painful!)
Shoulder hurts at top of bicep area ( near rotator cuff) and some parts up and down the shoulder blade are very tender( where I hurt it maybe). Pain radiates in forearm area and palm of hand sometime and feel weakness sometimes while lifting a bottle to drink water. Can only raise my arm halfway on side and not all way to top in front…maybe 3/4. Nights are super painful. I try and elevate my arm on pillow but hard to find a comfortable position. ( any recco on sleeping position?)
Just saw your blog so haven’t started any of the exercises you recommend yet. Shoulder is quite painful so have to start very slowly. I am rolling on a foam roller. Some shoulder shrugs etc. Please advise what you think this might be. Sounds like a shoulder impingement. I have not been to a professional yet but the symptoms seem to align with SI, not sure. How often should I exercise at this point. Also will a hot water bottle help at night? Taking fish oil and Curcurmin.
A massage along the shoulder blade provides relief to that upper bicep/rotator cuff pain.
Thank you so much!
It would be hard me for to diagnose your condition without assessing you in person.
As you have stated that you had shingles, night pain and the pain/weakness refers down the arm, this leads me to believe that there could be a nerve involvement.
Although having said that, Shoulder impingement could also produce these said symptoms.
I would try to get as much pain-free movement in the shoulder for now. You can still use the same ones mentioned on this blog post.
If the pain doesn’t get better, then you might need someone to assess you for a nerve issue.
In regards to sleeping position: Try to avoid sleeping on the shoulder. I would recommend sleeping on your back with a big pillow under the bulk the upper arm.
I appreciate the detailed guide but i had a question. If the impingement is caused by the rounded shoulders then shouldnt i be focusing on strengthening the back muscles that are the cause of it? But then most of those exercises i cant do because of the pain so there is that problem.
I would do the exercises mentioned on this blog post first, then follow it up with Exercises for Rounded Shoulders once you are essentially pain -free.
Just like most on here we all have shoulder impingement. Mine is from the military we didn’t take good care of our shoulders. It was all Push-ups, situps, and run. I have had a shoulder impingement for about 6 months now and I am going to do what you said on your site.
I seen you said once a week then work up to more and you said that it could take a while to fix the shoulder. How long should I do this for before I start seeking surgery?
Persist for 6 -12 weeks. There should be some sign of good improvement by then!
If not – you might need more specific exercises for your individual presentation.
I have been doing the recommended exercises for one week now and i wanted to give you an update. After about the third day i started to notice a difference. Its been one whole week and there has been tremendous improvement. I no longer get pins and needle feelings in my hand and i can now rest at night much more comfortably. I wish i had found this site last year.
Thanks again for posting it.
WOW. That is awesome news!
Thank you so much for letting me know.
Please keep me posted.
I have had a shoulder impingement for months. I go and get a shot every 6 months or so but as you said it doesn’t last very long. I have also been to physical therapy but i didn’t really notice an improvement. Right now i am in a lot of pain mostly at night when i lay down. Also my hand on that side also throbs going down to my fingers and i can’t sleep. Any suggestions? I just tried some of the exercises you have here but are there any i should concentrate on more than others? Thanks, Deb
Shoulder issues can refer pain down into the hand. If you have inflammation in the shoulder, the swelling can potentially trickle down into your hand causing a throbbing sensation down into the fingers.
Before you sleep: try to keep your hand elevated and open and close your hands for a count of 100. In extreme cases, you can wear a compression glove.
Without assessing you, I won’t be able to tell you which ones to concentrate. I recommended performing all of them first to see how your body responds, then focus on the ones that you feel are helping you the most.
All the best.
I am a 18 year old Bodybuilder and I got myself a shoulder impingement.
I wanna try these exercises and stretches, if this wont help I have to get surgery.
But my question is how often should I do the strengthening exercises, Once a day ? twice a week?
1/day is fine.
As you improve, increase the load and aim for 2/week.
I was diagnosed with left shoulder impingement about a month ago. Started with shoulder pain and limited rom in January. Avid weight lifter for 30 plus years. No weights since January for upper body. Started pt 3 weeks ago. Making some progress as I notice less pain with the exercises. Most painful to me is trying to put my hair up because it involves keeping my arm up . Anyway, my question is, with this whole virus thing I’ve been walking several miles which seems to aggravate my condition. Should I use a sling when walking and how long does it take to get better. The most aggravating thing for me is sitting at my desk to work. I try to get up every half hour to stretch.
Try to avoid using a sling if possible. (put it into context – I generally only recommend wearing a sling after a shoulder surgery)
I haven’t assessed you in person so it might be hard to give you specific advice.
But based on what you have reported:
– Try to keep your shoulders wide and open as you walk. If you walk with rounded shoulders, esp. if you are swinging the arms whilst walking with a bit of speed, this can flare up some of the tendons involved with shoulder impingement.
– If your pain gets worse at the desk, make sure your elbows are kept next to the sides of your body. Most people tend to have their elbows flaring outwards for some reason (most likely due to poor work station ergonomics). Also try to keep the shoulders wide and long as well whilst on the computer.
– Pain with elevation such as when you are doing your hair, try doing it with your elbow pointing directly towards the floor at all times. This should take some pressure of the muscles in the shoulder.
Hope this helps.
I saw your whole shoulder impingement guide and was curious if you could answer some questions.
I first got rotator cuff tendonitis mid December while sitting in the car and then trying to pull my arm up in a funky way. I then continued to lift and then my left shoulder got tendonitis. I stopped lifting for weeks and I’m still not lifting but then went back to the doctor because the pain never went away and the doctor said I had shoulder impingement of both shoulders.
I have been doing some external and internal rotation exercises with a band but I’m not seeing any progression. Should I continue but follow your guide instead or what do you recommend I do?
Internal and external rotation exercise are good to start off with. However – you will need to find the exact position and direction as to which your shoulder is weak in.
Perhaps you can give the exercises as mentioned on the blog post and see how your shoulder responds from there?
Thanks for all the information. I started working out in October 2019 and for the past month have been experiencing what I am pretty sure is shoulder impingement. I think it occurred from doing face pulls with too much weight.
I am sad that I will have to stop working out overhead to improve my condition because I have worked so hard to get to where I am at today.
Would this have to include bench press?
Thanks for all your information.
Some great info here – thank you
I’ve been suffering with shoulder pain (which spreads to my rear delts/shoulder blades at night) for around 5 months now, Physio has helped with the mobility element but not the pain – I am leaning towards having a shot in the next month or two, anything else you could recommend (I try and only take anti inflammatories when pain is over 5/10)
If you have persisted with physio and exercises for 5 months and the pain is still evident, it might be an option to try the cortisone shot.
However, more often than not, you might need to find an exercise that specifically targets the structures that are causing you pain. I assume the physio has done this?
I felt a pain in my shoulder after swimming once.
The pain lasted for some time and then I took a long acting corticosteroides shot which relieved the pain but now it hurts again,
I visited a physician and he asked for x-ray and after doing it and I found out that I have shoulder acromion type II. It hurts with any push exercise and with any rotation of the shoulder and I have been resting for more than month taking anti inflammatory drugs with no improvement, so what do u think I should?
Thanks in advance.
I would start the exercises mentioned in the blog post and see how the shoulder responds.
Generally speaking – injections only give temporary relief.
Type II Acromion does not necessarily mean it is involved with your shoulder issue.
I have been doing physical therapy for about 4 months now, and I still have an issue with the front part of my shoulder whenever I do my exercises. My impingement has almost healed as I am able to move my arms up vertically and horizontally but hurts when my thumbs are pointed down. My therapist still recommends I do my therapy exercises but do you think a steroid cortisone shot would help? Or is continuing my therapy the best thing I can do still?
If you have full movement in the shoulder, I don’t think you would need a cortisone injection.
If you are still having problems with lifting your arm with your thumb pointing downwards (lifting the arm from a shoulder internal rotation position), I feel that you need to focus on strengthening the rotator cuff (most likely supraspinatus and infraspinatus) in a LENGTHENED position.
The 90/90 arm crank whilst holding a weight is great for this. Only lower as low as you are comfortable with.
I would also suggest that you ask your therapist to check to make sure you have full glenohumeral joint internal rotation in the 9090 position with hitching.
Another thing you can check is posterior capsule tightness.
I have been playing softball for about 7 years now and recently had to take about 4 months off because of hip surgery. My shoulder has been causing me pain for a couple years, but started hurting more this past summer. ( I am a catcher, but I played 2nd base more that summer). I thought that by taking time off for my hip surgery, it would rest my shoulder, but now that I’ve started throwing again it’s very painful. I haven’t been throwing hard and lifting my arm above my head hurts.
I am a senior this year and can’t/won’t take more time off because softball is my life. I’ve been doing physical therapy for my hips but can’t afford to do any for my shoulder or to get it looked at in case they insist I can’t play softball. I have been doing the band exercises for the shoulder. The pain is mostly in the center of the shoulder, also somewhat in the back and it feels like it gets stuck when I raise it. If I force it up, it’s very painful. Throwing doesn’t hurt until the arm is up higher. I did use to throw side arm so that might have messed it up some. I do try to stretch them as much as possible.
Do you think this is shoulder impingement? And should I try to get physical therapy for it? I can’t take any more time off though.
(Also, I’ve been swimming for 13 years and I do a lot of butterfly)
Prolonged rest to injuries will generally make them weaker. This is probably why your shoulder started to hurt as soon as you started throwing again.
It could be impingement. But when you say the pain is in the center of the shoulder, where exactly are you referring to?
How’s your internal and external rotation movements?
Hi Mark and thank you very much for this info. I think it will turn out to be extremely helpful. At the moment my whole shoulder hurts as if it were inflamed (started as mild strained feeling and has deteriorated over several months – no trauma) and then there are movements that I just can’t do because the shoulder just locks and it hurts so much, putting on a coat is the worst or trying to scratch my back! Left arm reaches all the way up to mid shoulder blade, right arm can bare reach behind me and no lifting arm at all! Are there any exercises I could do to slowly regain range of motion and become pain free here? Thank you!
Sounds like you might be having issues with shoulder internal rotation. (hand behind back, reaching backwards to put on a coat)
In order to know what exercises to do, You will first need to find out exactly what is limiting this movement. (Eg. Is it tightness? Is it pain? Combination? What’s tight? Whats hurting? When does it hurt)
Thank you so much for taking the time to reply. It’s def. the pain that limits the movement, no idea where it comes from…. Physiotherapy in Thailand has presented some communication problems and not that great results…
Can you pin point the pain?
Thanks for the reply. Surprisingly the pain begins more on the front side of the shoulder, roughly pec minor region/head of humerus and only when I push it does the posterior capsule region start to hurt and resist movement. Is there anything I can do on my own to alleviate this? Am doing your recommended routine daily (not the advanced exercises) Thank you.
There are many muscles at the front of the shoulder.
The 2 main tendons I am thinking of are:
2. Long head biceps.
(Have a quick google to see if it fits your pain location)
Great information and explanations. I wonder if you can help me? Three weeks ago I fell two feet onto a concrete floor and landed directly on the point of my shoulder/humeral head. Initially could only passively raise arm above shoulder height but quickly regained power (7 days). It really only hurts at night! (Not sleeping on that side( However it wakes me up. Looking at your tests – I can raise it above my head (mild pain mid range) but can’t even get it to a right angle in front of me! Hand is at least 30 degrees higher than elbow and v painful around the top of my arm in a band. Thumb test very slight pain. Ironically I have no pain playing tennis , mucking out the horses, lifting etc. I hVe had chiropractic treatment which helped considerably as neck and thoracic were locked. And sports massage also helped. Been using laser on it too. Do you think it’s bursitis?
Hope you’re okay after falling!
It is quite possible that you have bursitis.
(Especially if you don’t really have any issue with playing tennis, mucking on horses, lifting (which I assume you are referring to movements below shoulder height.).
If this is the case – the inflammation should subside and normal movement should return.
If you are still having issues in the next couple of weeks, I would feel you may have done something to your tendons/muscles.
Best of luck!
Mark, I am a 67 year old male who has been working out since 15. I have all kinds of grinding noise in my right shoulder. this has not been a problem. Recently, last 4 months, my shoulder would ache after sitting, while working on computer. The ache would go away once I got up and started moving. Recently, I am having numbness down my arm and into the thumb and index finger on right hand. I have gone to physical therapist and was given stretches. There is no weakness in arm and tingling and numbness comes and goes. I can recreate the numbness by holding my arm out and pointing my thumb down, your pendelum exercise also recreates the symptoms. Any idea what this could be and how to resolve. I can live with this just want to keep from getting worse. I can play golf, it does get numb but no pain. Please help. Thanks Jimmy
It sounds like a nerve-related issue.
Based on the information you have provided, 2 main things that come into mind are:
– C6 and/or C7 Nerve issue coming from the neck.
– Radial nerve issue
C6 and C7 can be checked with an MRI to the neck.
Radial nerve can be checked with a nerve conduction test.
If these tests come out clean, it could also be Thoracic Outlet Syndrome (not too common).
Once you find the cause, then you can start to get specific exercises to treat it.
So mid November I was doing the rowing machine at an orange theory fitness class – felt some pinching – but was eventually able to move onto the free weight station with no issues and no issues the remainder of the day. The next day while attempting to do pushups at home, my shoulder gave. After about a week I went to the orthopedic after still being in discomfort and never experiencing any real serious type of injury before.
Did an xray and sent me for PT. Long story short now. Now end of January – I have plenty of strength and full range of motion. I can do pushups and most exercises. But do still experience minimal discomfort if I end up sleeping on it – and some pinching sensations with certain movement – reaching down for something once in a while or across my body. And if I am doing pushups or planks – it probably does irritate a bit after the fact – He doesn’t think I need the PT any more – and I’ve really been trying to focus on trying to create space in my shoulder joint. Stretching my chest. Rows for my lats to bring more strength there to help pull my shoulders back, being aware of my posture and retracting my shoulder blades on my own as I walk around.
I went yesterday and he says we should now just monitor for the next couple months and if in March I’m still experiencing this low level discomfort and pain – send me for an MRI. A lot of your exercises above are similar to what I discussed and did at PT. Recently we talked about hanging as well, I don’t have a pull up bar though so I’m considering getting one. But would you recommend any of the exercises for me to do more so and to focus on after sharing this info.
Have you tried the Side Lie Shoulder external rotation with 1-2kg (strict form) focusing on end range contraction?
I find a lot of people with shoulder issues having difficulty with this!
Another thing to check is to make sure you have full shoulder internal rotation (without scapula compensation).
You can check this by doing this:
Lie down with your shoulder at 90/90 position. (see above)
Drop your hand down towards the ground.
Results: If your shoulder pops up before you reach 60-70 degrees of pure shoulder movement, then you lack internal rotation.
I am 20 years old and have been facing shoulder impingement for 1 year now. I have tried physio as well and it did helo a bit but then I stopped doing the exercises because I got busy with exams. I have just recently started following your article and I’ve tried all the exercises mentioned here. The only problem I have is the flexion and the abduction against gravity. I seem to get a sharp pain whenever I try them. Even if I lift my arm a bit, I feel the sharp pain. the rest of the exercises are fine. what can I do since it’s been so long since I’ve got the impingement.
Hey hey Roman,
If you have pain on initiation of the movement, you might be over straining the tendon in the shoulder. (most commonly Supraspinatus)
If this is the case: I would focus on ISOMETRIC contractions of shoulder flexion/abduction at the height where you get the sharp pain.
Push your hands into a wall as hard as you can, without reproducing significant amount of pain (>3/10 pain scale). Hold for 45 seconds, Repeat 3 times.
Keep doing this until you can push 100% intensity. Progress to a higher shoulder angle and repeat.
Once you can clear all these angles, the shoulder flexion/abduction with the resistance band should become easier.
Hey Mark, I have had a shoulder impingement for awhile and PT has helped me significantly and the shoulder pain is significantly gone (really dont have much at all) however my PT tells me of serratus weakness and that it “sticks out and we need to strengthen it.” I have been doing the stretches and serratus exercises I am supposed to be doing but not noticing a significant improvement in my scapular movement and im noticing many workouts I do in the gym I have a difficult time with getting the same feeling of muscle contraction as I do on the noninjured side and I also see visible muscle imbalances between both sides of my body. What do you suggest I do to fix the muscle imbalances and fix my scapula issues. Thanks
If you would like some serratus anterior exercises, check out this post: Winged Scapula.
(When you say “it sticks out”, I assume you are referring to your scapula. This is called scapular winging)
I took a terrible tumble in the shower and hurt my shoulder. I went for acupuncture and also had the cortisone injection. I eventually went for the surgery in November of last year. Although I am feeling relief, the shoulder seems to get better in some sections and then another section starts to pain. I have been battling the impingement since August.
Hey Marc thank you for those informations.
Im doing yoga for almost 1,5 Years and im planning to do a teacher training this year! So there are alot of shoulder Streches involved in my Practice, suddenly I couldnt lift my arm and im 100% sure that this is a shoulder inpingement. I also have a horrible posture while standing, so much shoulders are more rolled forwards (I guess thats the cause). I already do the recommendend exercises and it already feels better.. Do you recommend do stop doing yoga until it feels better? im pretty close do get into a forearmstand, and i really dont want to loose the muscles etc. for that? Excuse me for my englisch, im from germany:) and thank you a lot for the help youre providing here for everyone!
My general guideline in regards to continuing your sport is to continue doing as much of it as you can, provided that you are not pushing pass your shoulder’s capacity.
There will be certain exercises in yoga that you know for sure will flare up your symptoms.
In this case – reduce the intensity or do a different exercise.
If it doesn’t increase in pain during or after the exercises, and you have good control of doing it, keep doing the exercise!
I have started doing the exercises you have mentioned. Just a few concerns. When i try to activate the serratius anterior muscles my shoulder feels uncomfortable. I dont know whether its a stretch or pain. I also have some pain near my collar bone near AC joint when i do some exercises or try to get my scapula in the ideal position. And also when doing the extension and adduction i feel some pain in ny upper back. Is that normal?
If your shoulders get an uncomfortable feeling when activating the seratus anterior, try not tip your shoulders forwards (anterior tilt of scapula).
This position can place more strain on the shoulder muscles and even on the AC joint.
When doing extension or adduction, you might be over using the muscles in that said area. I would really have to see how you do it to give you a more accurate response.
Hey Mark, this site is a gold-mine! Thanks for all you’re doing.
I’m 32 years old, weightlifting the last 5 years. Three weeks ago, I grabbed my warm-up for flat dumbell press, and was immediately humbled. Surprisingly I had no pushing power, it felt like I couldn’t fire my left tricep, but no pain.
X-rays of neck/shoulder, and MRI of shoulder were unremarkable. PT found some impingement in my left shoulder with testing, and some minor scapular winging. While I think he is right, this has been present for years, and not the issue causing my sudden weakness.
Dr and PT still think impingement or a minor muscle tear, but everything I read indicates I would have significant pain or compromised ROM if these were true – I have no pain and full ROM! No tingling or numbness either. Dips, overhead pressing, flat pressing, and pushups have all become very challenging! Do you have any ideas what could be wrong?
Interesting! So – all of a sudden there is no power at all in the triceps?
This would not be explained by purely a shoulder impingement/minor muscle tear. (esp. in the absence of pain/loss of movement)
Without actually assessing you, the first thing that comes into my mind is some sort of nerve issue.
Any issues in the neck? The C7 nerve that comes from the bottom of your neck directly controls elbow extension (ie. triceps). perhaps you might need a MRI in that region to see if the nerve is being impinged.
The other possible cause may be thoracic outlet syndrome. I would check to see if you have DROOPING SHOULDERS. If you do, upper trap endurance training will help. You would also need to be careful of exercise that pull the shoulder down (eg. dead lifts is the main one, but anything where your upright and holding weights by your side)
All the best.
Some triceps power remains, but very compromised. Some neck strain, albeit in the opposite side.
Your mention of thoracic outlet syndrome is interesting, while I don’t think I have drooping shoulders, I do have some symptoms of TOS:
Pain or weakness in the shoulder and arm – Check! This is my primary issue, weakness in the arm
Tingling or discomfort in the fingers – Interesting, as I’ve always felt circulation to my hands has been poor. Girlfriends have always commented on my hands being very cold, and I’ve had bouts of numbness that I never put much thought into. I find myself regularly wearing gloves through the winter as my hands get very cold (I’m in sunny California!)
Arm that tires quickly – my left arm fatigues quickly when being held overhead, even with no weight
As of this morning, my doctor has ordered an MRI of my cervical spine. Would this help diagnose if TOS is a possibility, or would there be another better examination? I hope this MRI would be good for assessing the C7 nerve as well.
Thanks again for all your help and consideration
Good to see you getting this sorted out with a MRI.
The MRI of the neck can check if anything (disc bulge, foraminal stenosis, canal stenosis) is squashing the C7 nerve.
Xrays can check for a cervical rib.
Electromyography and nerve conduction tests can check out the nerves.
Hey Mark, just wanted to get back to you with what the MRI found in case you were curious.
C5-C6: Moderate right, mild left neuroforaminal stenosis. Mild spinal canal stenosis.
C6-C7: Severe left neuroforaminal stenosis.
About a year ago I started practicing Sirsasana (yoga headstand) poses quite a bit. Hadn’t done much lately, but I think its safe to say these probably didn’t help. Not sure if heavy deadlifts of squats could have had a part as well.
Anyways – just wanted to thank you again for taking your time and running an awesome site! Thanks!
Thanks for coming back to let me know.
As we suspected, the C7 nerve on the left side of neck seems to be compressed secondary to the “C6-C7: Severe left neuroforaminal stenosis”. C7 controls triceps extension.
2 things that pop into my head are :
1. If your MRI recommended a cortisone injection, you can try a strong dose of Ant-inflam meds for 2 weeks to see if it helps before considering the cortisone. If your C7 nerve is swollen, this should help out quite a bit in the initial stages. (of course – always seek medical advice regarding medication).
2. Need to open up the hole (foramina) as to which the C7 nerve is getting squashed in.
Here is a quick and simple way to DECOMPRESS the side of the neck:
– Sit down on a chair.
– Hold onto the left side of the chair with your left hand.
-Lean your whole body and head away towards the right.
(Your essentially resting your whole body weight onto the hand that is gripping the side of the chair.)
– Aim to feel a stretch on the side of the left side of neck.
– Hold for 30 seconds.
3. Do nerve glides/stretches
4. Eventually address Forward head posture (if you have it)
There’s a lot more you can do but that should be enough to get you started at least!
Good luck Tom!
Thankyou for the amazing post. I wanted your opinion as to what I should do right now based on my current situation. I have been diagnosed with suprasinatus tendinosis, bursal and biceps sheath effusions and edema in my left shoulder. I have been in pain for exactly 10 months now with little improvement. I have taken 2 cortisone shots (no improvement) and have done many session of physiotherapy. All therapists say that this is an impingement. I have also tried doing all the exercises regularly but i dont feel a difference. What should i do now since i dont feel any improvement and havent been able to workout since 10 months either.
Whoa – 10 months is a long time.
Unfortunately – cortisone only removes some swelling in the region and does not address the main cause of the shoulder problem.
If you tried every treatment/exercise for shoulder impingement, you might need to start thinking of other areas that might be impacting the shoulder.
Have your physiotherapists had a look at your scapula control and the shape of the thoracic spine?.
Yes they have looked at my scapula control and thoracic spine and they seem to be fine. They say that the problem is that there is less space in my shoulder which pinches the tendons. I experience a lot of shoulder grinding when I externally rotate and have a lot of shoulder weakness i.e vibrates when i do any exercise.
If the shoulder is weak, it will tend to compress the joint.
This can lead to decreased space in the sub-acromial space where the rotator cuff tendons (supraspinatus) and bursa live.
Have you been able to progress the intensity and range of motion in the shoulder with the exercises?
This point is the most important.
I have been able to progress but not significantly. My range of motion is fine but when my arm is behind me after a full rotation, my shoulder clicks and hurts. I was told by doctors to get an arthroscopy done but I dont want it. I just want to heal it naturally without any operations. Should i just continue with exercises and apply heat packs or should i consider something else.
I cant find any way to make it better.
Thankyou for taking your time to reply to me. I truly appreciate it. Just a last question: should i get a massage for my shoulder and elbow or will it increase the pain.
Massages are fine.
Just make sure they go don’t go too hard in the painful areas.
Its been 2 weeks since ive been following your 8 steps mentioned in the blog. I am doing the shoulder exercises every alternate day. Unfortunately, I can not feel any improvement in my condition. My shoulder hurts when I raise it directly above my head( its like a crushing feeling in the tip and the front of the shoulder). Its been over 10 months now but I still dont see any improvement.
What is the best thing i can do to improve my situation. Continue with the exercises along will something extra? Or something else that you suggest?
You might need to do more specific exercises for your shoulder.
Given the time you have had this issue, it sounds like you will need a more specific assessment from a health professional.
Are your physios 100% sure they have the correct diagnosis?
Love your articles they are pretty much the only thing keeping me sane. The physical therapists I’ve been to lately haven’t been helping much.
I’ve been having shoulder pain for as long as I remember.
I’ve been told I have many different things. I would love your opinion since you seem extremely knowledgeable.
I’ve had an MRI of my right shoulder and it read that I have supra tendiopathy and subscap tendiopathy. On top of those two things my internal rotation of that shoulder is Horrible and Im possitive on the lift off test, but the external rotation is too good.(And I was never a overhead sports guy). But that’s not all. That shoulder is depressed and pushed forward a little it even make my right nipple look quite a bit lower then the left, and that scapula tends to wing just a bit though. I’ve tried many many things to fix them but nothing seems to be helping.
Thank you for your time!
If your issue is purely a tendon issue with the supraspinatus +/- subscapularis, you will just need to progressive load the tendons.
If there is a postural component leading to excessive amount of stress on those said tendons, you will need to address this as well.
As you mentioned some scapula position issues, this might be a good place to start. If your scapula is depressed/forwards/winged, working on your Trapezius and serratus anterior will help improve this position.
Check out this post for a forward/depressed shoulder: Uneven shoulders.
If you feel the winging is the main contributor to your tendon over load, check out this post: Winged Scapula.
Poor glenohumeral internal rotation may suggest that you have tight infraspinatus +/- posterior capsule. Without full internal rotation, you are a higher risk of injuring your shoulder (esp when you reaching behind you)
If you’re seeing your Physical therapist, try suggesting addressing the above and they should be able to point you in the right direction.
All the best mate.
Great advice! one little question,
How do I know that I am able to progress from the decompression stage to the strengthening stage, I have been doing this for 2 weeks and have seen significant improvement but I don’t want to try and strengthen my internal and external rotation unless I know i’m ready to progress,
I can hang loosely on a pull up bar for 20-30 seconds at a time if that helps to give you an idea of where I am at,
After 2 weeks, you should be able to start the strengthening.
If you are unsure, try going very light and only go half the movement.
If you feel good, progress it to the full movement and take it from there.
Strengthening is key when addressing this shoulder issue.
I’ve been doing light internal rotation strengthening exercises, x2 for 10 seconds on each side (pressing inwardly on a doorway with elbows by my side) and am still getting some mild burning pain in my shoulders that comes about 6 hours later and last for a day or two,
should I scale it back and just focus on the decompression and scapula activation or is mild burning pain part of the initial strengthening process for the rotator cuffs when recovering from impingement,
A little bit of pain after exercise is fine. The priority here is loading those tendons as much as you comfortably can tolerate.
If in doubt, drop the intensity by 10-20% and see how it goes from there.
Hello Mark, I have been recently diagnosed with shoulder impingement. I play alot of baseball several times a week and tournaments on weekends. I also paint houses for a living so I spend
a lot of time using my shoulders. Most of my pain comes when i throw a ball. the pain starts at the top of my shoulder and goes down to the front side of my shoulder. I was wondering if you can give me a routine/exercises or some information that is helpful for people that have problems with there shoulder impingement while throwing a ball? Any information you can give me will be greatly appreciated. Thanks!!
Interestingly enough, I don’t get pain when I do Painful arc test, Hawkins Kennedy test
or Neer’s test, but I get impingement in my left shoulder when I keep my shoulders down and back.
Have you had an ultrasound scan to check for a supraspinatus tendon issue?
If you have pain when you depress the scapula (pulling shoulders blades down), this can actually cause more tension onto the supraspinatus tendon.
Keep your shoulders wide and long.
Don’t worry too much about pulling the shoulder blades down. For some people, this is actually more harmful than good!
Firstly, I’ve found this SO helpful. I’m a professional Trombonist and have recently been diagnosed with Shoulder Impingement due to years of bad posture and stress positions.
I am being treated once a week to release the major muscle groups surrounding the shoulder as you have suggested. My question is, how often should I be doing the exercises per week. Do the rotator cuff muscles require rest like the major muscles do? I don’t want to overdo it and step backward. I’m past the mobility phase and into strengthening and scapular positioning. Thanks in advance.
It really depends on the capacity of your shoulder muscles.
I would start with 1/week and see how the body responds.
If you feel you can handle more, you can progress by increasing weights, reps, reducing rest time, doing the exercise slower, doing the exercises 2/week.
This was incredibly helpful. I think the beer test nailed it for me, the pain is at the back of my shoulder and is greatest when I do chin ups- palms facing me (less with pull ups-palms facing away from me), position my arms for a back squat, and strangely when I do bicep curls and one-arm rowing.
I suspect it’s the pull ups over time that have ravaged my shoulder, all the same I’ll need a sling, analgesics (pills and gels) plus these exercises for a while before I can train again, so thanks.
You’re on the right steps to recovery.
Also have a quick google search for: “Teres minor strain”, It could also be that too!
I have not read all of the posts here, but appreciate the good work you are doing. How do you feel about chiropractic adjustment for shoulder impingement?
Thanks for your comment.
Adjustments can help, but it should never be the only thing you do. Exercises are very important.
I had a shoulder injury during my Benchpress. It happened 3 months back. I’m taking rest from past 3 days. Still I didn’t get full range of motion. I’m getting little bit pain while I’m stretching backwards and I’m not feeling comfortable as another hand. How much more time do I need to take rest? I’m really eager to hit the Gym as soon as possible. When can I start lifting the weights?
I had a shoulder injury during my Benchpress. It happened 3 months back. I’m taking rest from past 3 months. Still I didn’t get full range of motion. I’m getting little bit pain while I’m stretching backwards and I’m not feeling comfortable as another hand. How much more time do I need to take rest? I’m really eager to hit the Gym as soon as possible. When can I start lifting the weights?
Hi Mark, thanks for making all this information available for us. It really helped alot. I started to feel some major pain in the shoulder and the biceps tendon, after I overdid my tennis serve some years ago. Since than I am mostly pain free except if I try to serve at tennis and other overhead throwing movements. I was diagnosed with a parital rupture of the supraspinatus and an initial bursits subacromialis. Since the pain only occurs with some kind of throwing motion, what kind of excercise can I perform to strenghten this specific movement. Furthermore should I start with the given 7 steps if there is an obvious inflammation of the area?
Thanks again for all your effort,
If there is a significant amount of inflammation in the area that makes exercising difficult, you might want to settle that down first.
If you are able, I would practice shoulder flexion exercises with the palm facing upwards.(mimics the ball toss movement)
Apply resistance by holding onto a weight/resistance tubing.
Increase the speed, height of which you lift your arm to and amount of weight as tolerated.
You can do the 7 steps, but it is better to tailor your exercise specific to your sport.
Thanks Mark, sorry for commenting again, but I’m afraid I was a little ambiguous. It is not the ball toss that is making problems but hitting the ball overhead. Same with other overhead throwing movements. I guess that the shoulder flexion is not really applicable there?
Sounds like your pain occurs when you cork your arm back.
Is the pain in the supraspinatus tendon, sub acromial bursitis region or the biceps?
Well the pain occurs when I hit the ball, so the arm is overhead but in front of the body and most likley rotated inwards. To me, it feels like the pain is located on the biceps tendon, but it could also be the bursa. I do feel it in the front part of the shoulder/biceps area and not at all in the back where I think the supraspinatus is placed.
Try out these shoulders. (might need to have a quick youtube/google search on how to do it:
– shoulder INTERNAL rotation from a 90 degrees abducted position (aka 90/90 position).
– high chest flyes
– Shoulder extension from full shoulder flexion position using theraband
You want to mimic the a similar position as the serve.
Do not let your shoulder roll forwards . Keep shoulders in neutral position.
Mark. Does impingement come with any kind of burning sensation? Ive had a sore shoulder for 6 years now. Woke up one morning and it hurt bad(no injury). Had a painful burning feeling, tingling that went down to the hand, and some numbness. Had a sharp pain(once/twice a year) when usually reaching up. Physical therapy helped some. When sitting on the couch, if the shoulder blade hits just right, it hurts with a slight burning feeling. Physical therapist said the muscles feel like little knots around the right shoulder blade and the bone isnt holding tight(it flares out slightly). If you feel around and find the right spot and push on it there’s a lot of pain.
You can get a burning sensation with impingement, however, since you have burning,tingling and numbness referring down the arm into the hand, this sounds more like a nerve issue.
If you need some relief from the pain between the shoulder blades, check out this post: Shoulder blade pain.
If your scapula flares out, it might be that you have a winged scapula. See post: How to fix a Winged scapula.
Hello Mark, thank you for this great post. I especially liked your suggested excersices. I am not sure if I have an impingment syndrome, as I can move my arm completely freely in any direction. However it hurts when I -apply force (shoulder or benchpress (which I don’t do anymore) and inward arm rotation or rapid movements), -strech my arm behind my head, -apply pressure to the middle of my shoulder, -try to move my streched front facing arm up from 90° if it is held down. To me it seems like a tendon/muscle issue. I have been in this state for the past half year. Any suggestions of what it might be or recommended excersices would be very much appreciated. Thank you.
Sound more like a tendon issue in one of the shoulder muscles.
Most common tendons being: Long head biceps, and Supraspinatus (depending on exactly where you are experiencing your pain)
If this is the case – it is best to start a progressive strengthening program that is specifically aimed at the tendon that is injured.
You generally want to pick a movement that is painful for you, eg. bench press, reduce the load so that it doesn’t hurt any more, and slowly increase the weights over the next 6-12 weeks.
You may also need to consider doing partial reps, experimenting with different angles of the shoulder joint etc .
Thanks for the informations! If I have shoulder impingement because of spiking in Volleyball, are there any recommended specific exercises that I could do? My posterior capsule becomes very sore after I spike. Something deep in my shoulder also pinched and hurts when I do a spiking motion, with my arm bent and my elbow at its highest and ready to swing down. I think that’s what’s restricting me to hit hard, because my shoulder would hurt when I go into that position. Thank you very much.
Sounds like a strain to one of the rotator cuff (perhaps the infraspinatus tendon).
– Try to massage the area with a ball.
– Gently stretch the back of your shoulder with the cross-body shoulder stretch.
– Work on external rotation whilst lying down on your stomach arm out to the side (spike position)
– Modify volleyball activities to avoid any painful positions.
Thanks a lot for the really insightful article. My girlfriend already has symptoms of shoulder impingement and medial epicondylitis (both caused by climbing) for about 10 months and she spent about 8 months going to several physical therapists. The pain in her shoulder slightly decreased, while the pain in he elbow is still the same.
Her therapy so far included dry needling and strengthening exercises for shoulders and elbows. However, she never got any anti-inflammatory drugs.
A. Could it still help to start taking NSAIDs in this stage?
B. Is there something else you would recommend?
Given the time frame of 10 months, the initial inflammatory stage has likely passed and there would be no need for the anti-inflam meds. (unless she has recently aggravated the shoulder? If this is the case, then yes, NSAIDS will be beneficial).
I would recommend doing all the exercises here to begin with.
If she is still having issues with the elbow, I would start her on this blog post: Elbow tendinitis. (it’s an old blog post, but I will be updating it soon)
Thank you. Since even light exercises still cause some pain, it is difficult to determine the right threshold level for her exercises, without aggravating both injuries. On the other hand, the pain also didn’t disappear by seizing activity for more than a month.
Your posts are a great source of new inspiration for exercises though and she will try those. It was interesting to see that there is a clear overlap between the exercises for elbow tendonitis and the shoulder impingement, as for both a good shoulder posture is important. Thank you, and keep on writing new inspiring posts.
The ideal scapular position is slightly elevated and upwardly rotated. I can’t believe that even trained physical therapists still recommend the shoulder blades down and back cue. It´s simply wrong and damaging for your entire body
I prefer the long and wide cue.
Can you expand on the “long and wide cue” please. Thank you!
Imagine someone grabbing and stretching your shoulders as far to either side as possible.
Hey Mark, around 9 months ago I slipped on a patch of ice and caught myself with my right arm slamming all my body weight into it as well as my knee. Right after I felt numbness in my shoulder and arm and was not able to move it very much, within the next few days after i gained about 90% of the mobility back and experienced very little pain with movement which eventually went away. Months later my shoulder has almost a completely full range of motion but I hear a click in Munich shoulder every time i bring it all the way up to my ear and i can now move it differently (almost feels like my shoulder is falling) kinda feels like I’m putting it back into place has I rotate my shoulder also experiencing a few other things only on my injured shoulder.
If I bend my pointer finger I can feel a strange pull and slight pain in my hand.
Could these symptoms be from shoulder impingement?
What would you recommend I do?
Thank you very much for you time
HI there. First of all your info on here is fabulous! very practical and well laid out.
Last year (Feb 2019) I was downhill skiing and crashed on my right shoulder. IT was fine immediately after the accident but started to be painful and immobilized after about 4 hours. I have never had a shoulder injury and I cannot believe how LONG it is taking to heal. I stopped doing wts on advice of Dr. and have been paddling, running and doing other sports but nothing extreme. I have been diagnosed through various radiological workups and also from my GP/Physiotherapy/RMT etc that I have a right shoulder impingement. Radiology said ”
Good thickness and congruency is maintained of the infraspinatus tendon. Focal
hypoechoic 4 mm lesion is noted within the supraspinatus tendon approximately
1.7 cm from biceps tendon.” but said no fluid in bursa, no calcification etc. Suggested impingement and “Underlying labral tear, arthropathy or rotator cuff tendinitis/tendinopathy are not excluded.”
I am an older (60’s) high performance athlete and have played many different sports my entire life… some like paddling at an international competition level. It is now 6 months from the accident and it still flares (keeps me up at night etc) once in a while. Usually it is around overdoing it (planks for instance). I am not sure where to go with this … wondering if after 6 months it should be stabilizing and not flaring. Any suggestions?
Thanks for you question.
If there is nothing structurally wrong with your shoulder, I would be searching for ways to increase the strength in the shoulder ranges where you are experiencing pain.
Once you identify what movement is impaired, you can start to tailor exercises specifically for that.
Resting is good in the short term, but it is best to progressive load the weakened/injured tendons/muscles.
Thanks a lot for the article, really appreciate it. I have been experiencing shoulder pain for about 4 weeks now, being a nurse, my job does include work excessive use of the shoulder, but controlling as much as possible. I do believe i have a slouched posture too, for which I have recently started wearing posture correction brace, do you think that would help with the above exercises. Along with that, I do weight training too, so what muscle groups should I avoid and for long? I would appreciate your response.
Posture braces are okay in the short term. Try not to get reliant on it!
You can continue with any gym exercise (… even if your chest is tight). Just try to keep a good posture!
Thanks for this useful article. My right shoulder began to be painful 4 months ago when I was playing badminton (especially when I do smash). I went to 3 doctors and every doctor have different diagnosis.
1st doctor (physical rehabilitation doctor): my supraspinatus was torn around 4 mm (checked by USG), the doctor ask me to rest and do physical therapy (heat and electric), and wait the tear recover itself. I did the therapy for one month but no improvement, then I went to other doctor.
2nd doctor (orthopedic doctor): he checked my supraspinatus by USG, but found no tear. He said by problem is shoulder impingement, coz my bad posture (hunchback) asked me to train my back muscle, and do physical therapy (heat and electric).
Coz I’m confused with different diagnose, I went to 3rd doctor (orthopedic specialize in sport injury).
3rd doctor: he diagnosed I have SLAP tear, asked me do MRI. The result show no slap tear. He also checked by USG my supraspinatus and found no tear. Then he said my problem is shoulder impingement, he asked me meet physical therapist to ask some therapy. The therapist said that my scapula and back muscle are too weak, and because I did overhead activity (badminton), my right shoulder tended into front direction. He asked me to do scapula stabilization exercise with tennis ball and elastic bend. I also do several exercise that you mentioned in the article.
Mark, how long should I take this exercise? I already stop playing badminton and go to gym for 4 months, and it make me depressed since I always do sport 1 week at least 3 times before this injury. I want to go back to play badminton and gym as soon as possible. Actually the pain degree is only 3/10. I still can go to gym and play badminton, but I’m afraid some tendon will torn if I overuse.
Can you give me some suggestion?
Thank you very much
It sounds like you need to strengthen the tendon that is involved. The exercises mentioned in the blog post will be a good place to start.
Prioritize getting full range of motion. Follow that up with strengthening of the tendons involved. Then progress functional movements. (in your case, you need to do exercises that mimic the shoulder positions that you adopt whilst playing badminton)
Ps. Physical therapy should be more than just heat and electrical stimulation (in my opinion!)
Hi Mark! Thanks for this valuable info! I have been dealing with shoulder impingement for over 5 years after trying physio, PRP,etc. I finally was not feeling any pain for about two months but it just came back.
I’m not sure what do to since I have tried everything before and nothing really seems to work.
I would start with the protocol as mentioned in the blog post.
It’s all about strengthening the range of motion that is currently available.
I’m Dinesh. I am 32 years old. I have been in martial arts training for 5 years, kickboxing for 3 years and gymming for 10 years. I was trying to increase my lean muscle mass last year. While doing bench press I got a pain in my left shoulder. I couldn’t find out what it is. I tried to find info from many websites. My pain is in the front and deep inside the lateral delts. I can do normal works. But when I try to do bench press and overhead press I feel the pain in the shoulder. I stopped the workouts for almost five months. By seeing your article it seems like I have got shoulder impingement. Will I be able to do workouts again? I have a slight pain now. I would rate 2 out of 10. I don’t like my present life style. I want to hit the weights again. How to get back to workouts?
I wouldn’t stop the gym if that is what is important to you.
You will need to stick with exercises that you are very comfortable with.
If your pain is shoulder impingement, I would trial the mentioned exercises first. From here – you might need to do more specific exercises, however, it;s hard to say without assessing you in person.
This article is absolutely amazing, thanks so much.
everyone elses info on the internet is so incomplete and barely skims the surface
my left shoulder has always been the issue
I have a weak / inactive Serratus Anterior, and I also have a huge knot in my back on the left side around the supraspinatus and infraspinatus. Scapula Retraction / Protraction is knotted and painful.
I have a heavy gym background, too much chest day.
I find releasing the pecs and lats help free everything up so much!
during my chest movements I also keep internally rotating too much, so will have to learn not to. and start doing them with a flat scapula
Lateral Raises have always been the lift that hurts, I get a huge pinch where the 3 deltoids meet together (below the lateral deltoid). once I release everything and do some light lateral raises / serratus anterior strengthening / External rotator strengthening everything feels amazing like its gliding and getting stronger
but then I wake up the next day and its very tight / knotted and painful again?
and there I am thinking what went wrong?
Hello Mark. I’m not sure if I do have a shoulder impingement but after years of suffering with a neck/shoulder problem I’m trying anything to try to fix the problem. I suffered a concussion in 2006 and I’ve been dealing with problems since. I’ve seen just about every so called professional, from chiropractors, neurologist, doctor, physiotherapist and no one seems to know how to fix me.
There doesn’t seem to be anything seriously physically wrong with me since the chiropractor straightened out my pelvis but I do have uneven shoulders on my injured/dominant side. An MRI also showed there’s nothing wrong neurologically.
My head pulls to the same side as my injury (the right side) in a tilted fashion and anytime I try to straighten up it causes my head to shake due to the muscular tension. I’m basically having to fight what my body wants to do and what I want to do. I can move my neck around in full motion and when I support it with my hand it doesn’t shake but when my neck is doing all the work it keeps wanting to pull to the injured side, using the muscles on the uninjured side.
I’ve tried and I’m trying lots of neck/shoulder exercises but nothing really seems to be helping that much.
I do sleep on the right side with my arm under pillow and wake up with pain on that side which I try to stretch out. I think I might have to change my sleeping habit.
I feel pain in the right shoulder and I think my mind is connecting to the pain and pulling away from it by tilting my head causing lots of neck tension. It’s worse when I’m standing or sitting still because that is when I feel the pain.
If you could advise me when nobody else has an answer for me I would be in your debt!
Ive been doing most of this for about a month. My posture has gotten a lot better, but my arms and shoulders have become very weak and i can feel a tingling/numbness through my arms/hands and the thumb and two fingers closest to. Do you know why this has happened, or how to fix it?
Tingling in the first 3 digits could be related to:
– carpal tunnel syndrome
– C6/7 nerve issue
– Tight forearm pronators
Is there someone you can get an assessment from to rule these out?
How many times per week should I be doing this?
Start with 2-3 times a week and see how the shoulder responds.
Thanks for this article. I’ve been weight lifting since Febuary of last year and noticed weak shoulders from the beginning, which was perhaps a lack of good form in pushing exercises. However my impingement has probably been there since the start (particularly on the right) and I only went to see a physio at the start of this year who put me on a bit of a rehab programme (which included a lot of the exercises above, with resistance bands). However my impingement keeps coming back after a week or so of little to no pain. I constantly get the clicking when I rotate both shoulders and my shoulder press is non existent because of this issue. Is there anything in particular you’d recommend without having to abandon gym/pushing exercises completely. Would also like to start building muscle in my shoulders which I haven’t really been able to do.
I hope this works well. BTW thanks
I hope so too :)
One of the best posts on the topic! What’s your view on posture correctors/braces?
Thanks for your comment.
They are fine to use in the short term.
I wouldn’t rely on it in the long term though.
Thanks so much for always posting free and quality content. I’ve had postural issues for several years, and because of your website, I finally have hope of curing my issues.
I wanted to ask, I saw you answering another commentor before but I have a similar issue. So when I press this spot on my neck, I also get like a sore pain radiating through my left arm:
Is this from shoulder impingement?
I don’t have shoulder pain, but I do have shoulder weakness radiating through my left arm. When I do the three tests you have shown, I feel like a soreness/ache through my whole arm. It’s not pain but it’s not pleasant. When I massage the areas near my clavicle bone and really near the shoulder bone (it feels like a tendon), that’s when I get that ache. What do you think this may be? I have postural issues as well – do you think it might come from things like rounded shoulders, winged scapula forward head and so forth?
I’m trying to find a physio as well (the physios I’ve tried so far didn’t really diagonse me and only gave me band exercises and head nodding exercises to fix my muscle weaknesses) – do you know any physios outside NSW that you can recommend me?
Thanks so much!
That spot you are referring to is the scalene muscles. It is usually associated with neck issues and not specifically shoulder impingement.
Can you locate the painful spot you are referring to. The one near the collar bone/shoulder bone.
Posture may be influencing your symptoms, but can’t say for sure if it is the only factor.
Great article. I am now following you on fb :) In terms of strengthening for functional movements, I was wondering what exercises/movements you would suggest to get back into surfing/freestyle swimming/front crawl. I have the dreaded “swimmers shoulder”/shoulder impingement. I’ve been doing physio for months and months, but my shoulder continues to flare up likely because of poor posture at my desk (Trying to break that habit) . I just want to surf again! :’(
If you have already addressed the inflammation, here are some other things you might want to consider looking at:
1. I would invest a lot of time doing Shoulder CARs
Try to do as big of a circle as you can without causing any pain.
2. Make sure to address any Rounded shoulders issues to create more room for the shoulder joint to move.
3. Address any thoracic kyphosis that may be pushing your shoulders forward.
4. Make sure you have full shoulder internal and external rotation.
I have an impingement in my supraspinatus (got diagnosed 5 weeks ago) and my neck is starting to get more and more stiff. Is this normal? Also, how often should you perform the various steps? Should you go through all the mobility/tension releasing excerices everyday, or even multiple times a day? Additional info: It feels like my neck loosens up a bit when excercising, even if I don’t workout my upper body – as if moving around makes it better.
Looking forward to hearing from you!
It is quite common to get neck issues when you have a shoulder problem. This is due to the fact that the neck muscles will start to compensate for the shoulder.
You can perform these exercises every day… but it depends on how far you are pushing yourself with the exercises.
If you are every tight, perhaps you may benefit more from the mobility and releases for now.
I`ve been struggling with a shoulder impingement for a few years now. I dont get any pain when completing this menu which is great, but what aggravates my shoulder is when i bench press and/or chest fly; Ive stopped doing these exercises because so. It doesnt hurt immediately, but a day or two after im in agony. This leads me to think that my shoulders are rounded due to tight pectorals and weaknesses in my back. what are your thoughts on this?
And also, in step 4 of your menu, it says to mimic the exercise that cannot perform due to impingement with resistance band, why is it good to do that? would strengthening my chest not bring my shoulders forward even more?
Thanks for your help, your website and information is brilliant.
You would have to have a look at how your shoulder is specifically moving as you perform the bench press.
Look at the shoulder position when you have the bar at its lowest position. It is common to let the shoulder tilt forwards which can then stress out some of your structures in the shoulder.
If you feel your rounded shoulders are the main factors, check out this post: How to fix Rounded shoulders.
In regards to step 4: This relates to your goal. Why do you want to get your shoulder better? It is to get back into pain-free bench pressing. If it still hurts, you perhaps will need to focus on other exercises for now, change your bench technique, adjust how low your drop the bar etc. so that you can perform the exercise.
Thanks for your comment.
Hi Mark! I love your blog. I have been using a bunch of your suggested exercises to correct impingement in my left shoulder and they’ve been very helpful.
I keep irritating my shoulder by sleeping on it, though. I try to sleep on my back but always end up rolling onto my left side during the night. Then I wake up with a sore shoulder. Do you have any tips I could use to train myself to sleep on my back?
I’m not going to lie to you… changing sleeping habits are not easy!
You can block the left side of your body with a pillow wall so that essentially stops you from rolling onto that side.
You could even lie slightly more so onto the right shoulder with the left half of your body propped up and supported by the pillow wall.
being a therapist myself, I am also an easy victim to impingement and I am constantly fighting it after 17 years in business. Thank you for your website and for all the tips, tricks and exercises. I started applying them today and will be happy to teach them to my patients, too. I will direct some to your homepage, but as I am situated in Germany, most of my patients will not understand the English instructions.
Thank you so much for your comment.
So happy that you have found the blog helpful :)
Keep up the great work with your patients.
Ps. I might have to get the website translated in german one day!
I’m really sorry to add to the long list of people asking for advice but I really enjoyed reading your article. I get an uncomfortable but not painful sensation when I go from arms outstretched over my head and then rotating the shoulder to reach behind my back. I’m a skydiver and this is how you throw the chute (so it opens) the click happens at the top of the shoulder during the transition. Any advice on what that might be would be REALLY awesome. Done lots of research but can’t find an answer ?
Don’t be sorry for asking for advice. I’m here to help!
To perform the motion you mentioned, you need a good amount of Shoulder External rotation.
Having tight lats, pecs, anterior capsule and/or triceps might cause issues in this position as well.
What exact structure you have implicated is hard to say! I would have to see the specific area where you experience the symptoms.
That’s perfect Mark thanks for helping isolate the issue. I’ll look into what might be right and make it right ???
I have been dealing with subacromial impingement for nearly 9 months. My condition has not improved. I feel I am exasperating my shoulders by continuing to do the wrong exercises for rehab. Would you be able to advise me if any of the following exercises I am currently doing will aggravate my subacromial impingement?
– One armed rows (35 lbs)
– Face Pulls with resistance band
– Face down Y’s , I’s and T’s
– Horizontal Pulling Rows with Gymnast Rings
That’s a hard question to answer without seeing you.
If you have the pre-requisite movement and strength in your shoulder to do the exercises, then it should be fine.
Best way to determine for yourself is to go by how you feel. Does it hurt during or after doing the exercises?
If so – consider modifying the exercise to an intensity/range/speed/depth that you can control comfortably.
It definitely hurt doing the Abduction and Flexion exercises against gravity (even at the lowest point). However, I could do external rotations no problem. I also tried Serratus punches (lying down) with 15 lbs weights. I felt discomfort doing these as well.
I even tried passive hanging on my pullup bar (~5 min). I don’t know if hanging is aggravating my shoulders.
Right now, I’ve taken 2 Naproxen and still feel pain just by standing with arms down at my side. I have pain all day every day for the past few months and I don’t know what exercises to do because during exercise it might feel okay but then a couple hours later the pain hits me.
Thank you so much for this wonderful article!! Every single post of yours has been extremely enlightening, uplifting and very helpful! I’ve been suffering for months with shoulder pain and have been so frustrated!! I’m seeing a physical therapist who is trained in PRI techniques and am working on my posture but the pain is overpowering on many days..your posts help me understand what is going on and give me some hope that I may be pain-free one day and be able to lead an active lifestyle.
Great to see you are seeing a PRI physical therapist. I have taken the PRI courses and they are very indepth!
All the best.
Thank you Mark! All of the PRI concepts are finally starting to make sense, but the pain cycle is definitely tiring. I work a desk job with computers and realized after seeing my current PT,that, my posture has been wrong for many years . I was told I have APT and laterally tilted to my right as well. I’m still in a lot of pain and not leading an active lifestyle like i want to because even basic things like walking for 15 mins or standing hurt so much! Lingering question in my mind is how much stretching vs strengthening vs activation should be incorporated daily? Some days I feel I cant move my pelvis to the correct position for sitting, standing or walking as the pain is stopping me and other days i can do it. I have ups and downs where I do great with exercises taught by the PT and sometimes cant do them at all. For Example, I started doing planks and in 2 weeks or so my left shoulder was hurting really bad, my nerve was tingling in my upper arm, tricep swollen so much I had to back off. That small set back threw my posture off again as my left shoulder was hiking up from tightness and pain. What’s the right balance and how much should we do at a time with posture correction?
Sorry for the lengthy comment and Thank you for taking the time to read it!
Thank you so much for posting such a simple to understand yet detailed shoulder impingement recovery. Also, I’m sure everyone one here appreciates the time you take to respond to our questions.
I was diagnosed with shoulder impingement in November 2018. It basically put a complete halt to the powerlifting style workout regimen that I usually follow (apart from Deadlifts).I have quite a stressful job and going through a tough time in general, so the strenuous training was fundamental in keeping me mentally happy and physically in shape.
I wanted to ask the following questions:
1. I’ve been following a physio routine (not yours – I did start yours last week) for nearly 5 months now and while the pain has subsided, I still can’t even do a pushup or bench press an empty bar without setting off the inflammation again. Do you have any advice for how to get back into being able to do Bench Press, Overhead Press and Pullups?
2. The inflammation for the most part has subsided and my left shoulder has started feeling much more strong and stable. I honestly can sometimes forget I have the injury but as soon as I do specific movements like the cable internal rotations (in your program)/ bench press/push-up, it hurts quite bit. Would you know the reason for this?
3. I have had this injury for 5 months despite being very committed to my rehab protocol (and will incorporate your protocol too now). In your experience, can this injury be permanent? I really hope not has weightlifting is something that genuinely makes me happy and keeps me from getting overweight and the mental health impact of the injury has been far worse than the physical!
Thanks in advance for taking the time to answer my questions. I’m definitely going to be a regular visitor on your website!
1. My advice would be to focus on partial repetitions. Over time, slowly go lower in depth. Try to utilize isometric pauses at this deep level.
2. Sounds like a Subscapularis tendon issue to me. Issues with this tendon can explain pain with shoulder internal rotation, deep bench,press ups and push ups. Have a quick google on the location of the subscapularis tendon and let me know if that is where you feel your pain. (you might have shoulder impingement AND subscapularis tendon issue)
3. In the vast majority of people, this injury is not permanent. You just need to find the right strategy and exercise to help fix it.
Best of luck mate.
Thanks very much for your reply. I’m glad to report that the shoulder impingement in my left shoulder (which came along with an AC Joint Tear) has now healed following your advice and additional exercises provided by my physio.
Sadly and annoyingly,I picked up a similar issue in my right shoulder almost immediately after recovering from my left side in August 2019. This time I got an MRI and it shows “evidence of some degeneration and inflammation within the ACJ as well as subacromial bursitis but with intact rotator cuff on
I have been doing physio and activity modification (stopped benching and overhead pressing and instead doing scapular pushups and shoulder raises) for the last 4 months The Surgeon recommended I get a Cortisone shot and a new physio programme to resolve the issue ASAP. While I didn’t get the shot last time and didn’t want to, I’m very seriously considering doing it this time as the physio doesn’t seem to be working and I don’t want to wait another 4 months like I had to for my left shoulder to recover. My questions are:
1. Do you think I should get the cortisone shot due to physio not being effective past a certain point and my inability to perform BPs, OHPs, Barbell Squats with no pain? I’m concerned about it causing tendon weakness and that not having the pain as a guide may cause me to stress and damage my ACJ further.
2. Do you think I should still follow your programme given there that my diagnosis isn’t actually shoulder impingement? However, there don’t seem to be any programs online for ACJ tears so I may have to stick to what my previous physio have me.
Great to hear your left shoulder has healed now!
Sucks about the right one though!
In regards to your questions:
1.You can get the cortisone, but make sure you do the rehab work (and not go straight into your normal heavier lifts).
The analgesic effect may suppress the pain, but could actually still be aggravating the shoulder.
The cortisone may give you a “window of opportunity” to start to push the rehab exercises.
You shouldn’t get significant tendon weakening after just 1 injection, in my opinion.
2. You can still do the exercises on this blog post for ACJ issues, but you will need to soon progress to OVER HEAD and WEIGHT BEARING exercises as soon as you can.
On top of this, I would encourage you to have full (or perhaps just more than what you have) external rotation of the shoulder as this will help with over head positions
Make sure your scapula is not in an anterior tilt position. If this is the case – you will likely need to release pec minor.
All the best.
Having had impingement issues my adult life, this has been the most helpful site I’ve seen. Clear, good information and well designed, the tri-fecta of usefulness!
Thank you. I will certainly pass your site on to others!
Thank you so much for the comment, Steve!
I wish I looked for your article before!!
Started backcountry skiing last winter so suddenly lots of shoulder repetitive movement with a heavy backpack. And soon I could not lift my arm especially fwd (like trying to grab the steering wheel in my car)…
I waited, thinking it will pass, but not and it’s been over a year and doctor suggested we tried the cortisone injection. Just happened so not sure of results yet.
But oh! I feel I’ve done things wrong ready your great article.
Just had an Echographie and diagnosed with a ‘tiny’ tendinitis in the supraspinatus. Pain is not tiny but I waited so long…
I feel doctors been misled because I keep insisting all the pain was in the acromio-scapular joint.
Now I realize maybe it is the supraspinatus that caused this pain there… could it be right?
Ill guess now the plan is to let the cortisone settle Nessie’s now it’s just worst. Then start slowly your program. When should I start?
Thank you so much for making this info available:)
You can start straight away.
If there is a lot of pain/inflammation, it is very important to listen to how your body responds to the different exercises.
Small amounts of pain is acceptable (<3/10 pain) whilst doing the exercise, but ideally try to keep in pain free.
Do you have a Youtube channel? If, say, each page of your website were a video, there are a few “pages” I would add to my physical therapy youtube playlist. Each morning I could just press play and follow along. Your images are very good, but for some reason I get overwhelmed trying to reproduce movements from images. Thanks for all this wonderful information.
I really need to start making videos!
Make sure to follow me on Facebook to be notified when I do start to make videos.
Can shoulder impingement cause a catching sensation in the clavicle area?
I get this occasionally when i turn my head or use my arm?
Your exercises really helped my shoulders, but sadly still I’m having this issue alongside right shoulder pain which goes into upper arm and inside posterior arm. It weakens much quicker than the left arm as well.
Where does the catching occur exactly?
The shoulder impingement might be a factor, but hard to say without assessing you.
It’s weird Mark, but it feels like it’s catching kind of half way along the clavicle? Similar catching feeling on left side clavicle as well.
Although it’s intermittent with both.
It’s weird, almost feels like it’s out of position, or moved up?
I do have intermittent rubbing/grating sensation on outside of right shoulder. But it comes and goes.
Many thanks again.
Thanks so much for responding!
Yes, it does Mark, all those areas,
as well as a tender serratus anterior.
Is this impingement?
It may be referred pain that you are experiencing.
You can try gently pressing into the muscle (Scalenes) where it is marked ‘X’ on the picture of the last comment I sent to you.
(If you are not sure, it might be better to get someone trained to do it on you)
This might help release some tension off the muscle and reduce the symptoms that you have mentioned.
Hi mark ,
Firstly thank you so much for providing such a great in depth article . Through using your exercises I can now do all abduction excersies and rotations without pain or discomfort.
The one thing that seems to still be bothering me is front raises and the exercise involving standing on the band and going up . I have strength now in abduction but anything with my arm straight in front seems to cause pain (irritation ),any advice on how to get through this last hurdle ?
Thank you so much again
Great to hear of your progress!
In regards to pain with shoulder flexion, you might need to reduce to a load where you can comfortably handle.
From here, start to increase the number of repetitions. Once you get can 20-30, start increase the load.
Best of luck!
I have a shoulder (+neck+elbow+wrist) pain whenever I am working at my desk/on a computer.
The shoulder is the worst and then the pain shifts the neck, elbow, wrist etc area and keeps worsening.
I see this tendency of my head tilting forward and someone told me the weight of the head stresses the neck, shoulder and hence the pain. Whenever I realize this I try to pull my head back. Also m so confused about desk height, position of elbows etc. Also what exercises can I do to alleviate this and what is the best posture when sitting at a desk?
Also what medicine/ointment can I use to reduce the existing inflammation as the pain keeps piling on as its my job to work on a computer.
Make sure your keyboard is at right height as this can place extra strain to your neck/shoulder/elbow/wrist.
You can get more info here:
How to set up your workstation.
I would also recommend having a look at this post:
How to fix Rounded shoulders.
Thanks for all the fantastic content on this site!
I’m a 36 year old male who, ever since college had been out of shape. That was until about 14 months ago I decided to change that.
I started working out 4 days a week. Mostly lifting weights under the guidance of a personal trainer and HIT Cardio twice a week along with a complete change in eating habits. Glad to say it paid off!
In those 14 months I dropped over 50lbs, dropped several suit sizes and have muscles definition I didn’t think I’d ever have. I went from only squatting 95lbs to now able to do over 300.
I was feeling great until a week ago when I was hit with severe shoulder pain in my right arm.
I’ve been well aware of the potential problems with shoulder impingement and rotator cuff tears so I’m sure to do almost all of the exercises you list above specifically to try and prevent this from ever happening.
Well my GP diagnosed it as shoulder impingement and is sending me to PT.
My question and concern is this: will I be able to return to my workout routine? Obviously I can’t damage my shoulders or live the rest of my life in pain. But on the other hand, it’s the bench press, pull ups and military press (and the like) that basically “saved me” and got me back to a healthy weight and in good physical condition. So the thought of having to give that up breaks my heart and makes me fearful of returning to my old body only 14 months after gaining my new one, and all at an age that feels too young to HAVE to give up lifting. There’s guys in the gym 15 years old than me that are still lifting and in better shape than me haha!
Is there any hope for me??
By the sound of it, the drive and motivation you have will definitely get you back into your normal work out routine.
Try to keep the shoulder as active as possible! You might just need to modify some exercises at the gym so that you can perform it safely.
Let me know how it goes.
I started getting pain in right shoulder after starting to bring barbell lower to my chest during bench press and doing heavy chest flys.
I can recreate most pain when I press my hands together in front, in the positon you’d use to prey.
Lifting my arm higher creates pain, as well as reaching out to get the baby from his cot or returning him.
I went to gym and did exercises that don’t involve overhead movements such as deadlift and rows and I have no pain during the exercises but not sure if I should rest from doing any resistance exercise.
Are these other exercises fine if I don’t have any pain while doing them?
I do have a faint tingling in my right arm so not sure if there is some nerve damage? Impingement seems like the most likely issue I have.
Also would you recommend doing these reehab exercises for a few weeks and then gradually reintroduce chest and shoulder workouts?
Many thanks in advance.
All exercises are fine to do if they are pain-free. Just be careful when you are near fatigue as your technique may give out.
Tingling is a sign of nerve irritation somewhere along its pathway. Based on your mechanism of injury, if it’s anything, you might have just strained the nerve. (should self heal with time)
Have a quick google of “Subscapularis tendon”. Is that where your pain is?
It looks like it is the subscapularis. Just looked at one of the tests with arm behind the back and I can move my left arm away but the injured one I can’t.
Tingling isn’t there anymore. Which of these rehab exercises (if any) are best suited for helping with this?
I’ve taken a couple of weeks off the gym altogether as not aggrivate anything for now.
I would focus on internal rotation exercises. (heaps of them on youtube).
Make sure to feel the contracting of the muscle where the pain is located.
See how you go with that for the next couple of weeks. If the pain is still there, you will likely need to address other aspect of your technique/posture to help it heal 100%
Normally I’m very fit and healthy, but since a Ceilidh dance 5 days ago I’ve had a sore shoulder, which has been getting progressively worse, until almost unbearable no matter what position I’m in. I’m struggling to dress, and can’t drive. I visited. My GP today, who has diagnosed shoulder impingement. I have 3 days to wait until I see an orthopaedic consultant, and my question would be what you would advise in the immediate short term to get me through the next few days. Even sitting still is very painful, and no position in bed seems comfortable. I’d love to try your recommended exercises, but for now, pretty much anything is too sore. I’m taking ibuprofen and trying not to move my arm in any way the hurts it, but that’s proving v difficult. Are there any positions that you could recommend to minimise the pain? Not sure what consultant will recommend but I really feel that if I get offered a cortisone injection I would take it, so I can get temporary relieve to allow me to start to build up my shoulder strength. Does this seem a reasonable approach?
Sounds like your shoulder is very sensitive/irritable at the moment. This may be due to an increase in inflammation to the area.
Here are some things that might help:
– Get some ice on to it
– Try to move the shoulder as much as you comfortably can without making symptoms worse. (Even if you have to do very gentle “shoulder pendulum” or “shoulder cradle” exercises.)
– Get stronger anti-inflam (over the counter may no be strong enough)
– Wear a shoulder sling, but no more than 1-2 days MAX.
– Apply anti inflam cream to the area.
– You will need to use trial and error to find the best position for your shoulder. If there is a significant amount of inflammation, all positions may be uncomfortable for now.
Thank you for this page. It really contains valuable information.
For the past 6 months or more, I had pain in my arm; specifically on the biceps tendon. I took anti-inflamatory pills and 2 cortison injections. But the pain remained.
My doctor informed me that I need a surgery Biceps Tenodesis.
I am doubtful about the surgery and keen on finding other solution to releive the pain.
Do you think the exercices are enough or I need additional or different ones?
Waiting your reply.
Thank you again for your time.
Is the Long head biceps completely torn or severely frayed on scan? These are the main reasons one would even consider getting a biceps tenodesis.
In regards to which are the best exercises for you… It really depends on what exactly is causing your pain. Is it the impingement of the biceps tendon? Or is it hurting with certain positions. Or even with use? Weakness of other muscles?
Based on that, you will need to do specific exercises to address the specific problem.
I would also opt to avoid surgery… even if there are tears! (Some people get worse after surgery!)
Thanks for previous reply, I really Do appreciate it.
A couple more questions for your advice/opinion please. (Thank you).
Both my shoulders have a catching sensation in certain positions is this typical?
Also I have deltoid tenderness, my serratus anterior are tender, my scalenes and upper traps feel tight. If I raise my left arm for a short duration I get tingling in my hand.
Are these all shoulder impingement symptoms?
MANY THANKS in advance that you give your time, help and expertise freely.
You help thousands, God bless you.
Is it possible that you may have Thoracic Outlet syndrome? This may explain all the symptoms that you have mentioned.
Pure shoulder impingement (subacromial) should not generally give you tingling in the hand.
Thanks for responding again!
I have extremely tight scalenes, trapezius and shoulders. Possible fibromyalgia diagnosis. Is it possible that extremely tight muscles can cause thoracic outlet syndrome or shoulder impingement Mark?
Yep! That can be all part of Thoracic outlet syndrome and impingement.
However – I do find that doctors tend to diagnose people with Fibromyalgia when they have no idea what exactly is going on. Usually – if you have multiple areas that hurt, they automatically classify you as having Fibro.
Thanks again Mark, you’re such a good man, helping so many
I wholeheartedly agree, Dr’s tend to diagnose fibromyalgia when they just don’t know or have given up. (As gas my physio)
I KNOW I have forward head posture, rounded shoulders and a tight thoracic area. And know suffering from shoulder pain (both sides).
Do you have ANY suggestions which area to start addressing first?
Thank you so very much Mark.
Hey there Angela,
You can address any region first!
But since your shoulders are specifically giving you issues, you can start by addressing your rounded shoulders and see how you respond to that.
If nil improvements, you might need to have a look at the nerves via a scan.
This is by far the best resource on the web right now. Thanks for all the detail. It has been a huge help. If you don’t mind, I have two questions.
1. How do we know when to progress from stretching to strengthening? I typically start as soon as the inflammation has gone down and I have full range of motion but the last two times I’ve done that, the inflammation flares up again the day after. Maybe I’m doing too much resistance?
2. Have you heard of Dr. John M. Kirsch and his fix for impingement? He stopped doing shoulder surgery and just asks his patients to do dead hangs from a pull-up bar. He claims this pushes the acromion upwards and creates space in the shoulder.
Again, thanks for everything, Mark. Your work has changed the way I heal my shoulder and I’ve seen huge improvements. It has been a life changer!
You can start strengthening any time really. But you need to make sure that it is not making things worse in the process! Go a bit more gentler and see how you respond to it.
Match the exercise intensity with your shoulder’s capacity.
I have not heard of Dr Kirsch, but yes, the sub acromial space will be decompressed in a hanging position. However that being said- a lot of people with impingement may not be able to even get into that position in the first place.
Without having visited a doctor, I am self-diagnosing shoulder impingement (right), after pushing a heavy box on a roller conveyor belt and having some pain afterward, but no loss of strength.
This injury occurred approximately 3 months ago, and I have been able to lift heavy items to chest level, do half push-ups without much aggravation, and do basic yoga stretches (I am NOT advanced in any way with yoga).
In trying the three tests you provide, each recreates the pain for me. I find I cannot reach upper cabinets without at least some twinge of pain, and if I find myself sleeping with my arm above my head, lowering the arm can be from mild to excruciating pain.
I have been using Ibuprofen to reduce possible inflammation, and use peppermint essential oil for any inflammation reduction it might provide.
I would like to begin the shoulder traction stretch, work on resolving any tight muscles, and beginning the initial exercises you suggest here. Does this sound like a proper plan? I had a similar situation with the left should several years ago and performed basic, pain-free stretches (arm circles and raises) and was pain-free without recurrence within a month. This time, those same stretches seem only to aggravate the issue, which seems logical, based on the information you have provided here. Due to the difference in pain, I have self-diagnosed the impingement.
Thank you for any clarity you may be able to provide. I truly appreciate the clear and detailed information you offer for those interested in self-help without exacerbating the issues.
Sounds like a plan!
Focus on gradually progressing your movements and the intensity of your exercises.
As your shoulder gets stronger, function should increase and pain should decrease.
All the best.
I had to stop doing yoga about 5 years ago due to a terrible shoulder pain that lasted years on and off. I took antinflamatory, did a lot of physiotherapy and exercises to heal my shoulder.
I’ve started doing yoga again 3 months ago and the pain is back. The worst position for me is facing dog. I think my shoulders are week. Any suggestion?
In the Facing dog pose, the shoulder is in end range flexion. This can be a stressful position for the shoulder if there is some sort of underlying issue.
Do you have Rounded shoulders as well? If you have shoulders that roll forward PLUS you force your shoulder into end range flexion, this could cause some impingement of some structures in the shoulder.
Check it out: How to fix Rounded shoulders.
I’ve had a problem with right shoulder for nearly two years now, have had ultra sound, MRI and taken NSAID (Naproxen) and seen Physio’s who have given me some of your exercises mentioned but I will be adding new ones from you, so thank you for that.
The scans have shown Inpingement and Bursitus and my consultant is now suggesting a Cortisone injection. My question is firstly after this amount of time do you think this is for the best? Also afterwards how long should I leave it before starting to do the exercises again?
Also my shoulder makes very loud clicking, crunching noises. Dr’s have told me this is nothing to worry about but it is quite concerning.
Thanks again for all the information.
… After this amount of time (2 years), do you think this is for the best?
The cortisone injection might help temporarily reduce any inflammation in your shoulder. However, since it has been 2 years, I would think that there would be minimal (if at any) inflammation present now. (unless you have acutely aggravated it?) . I am not the biggest fan of the injections, but in some cases, it might give you a bit of momentum in the beginning as you start your rehab.
My opinion: If you can, try to persist with the exercises. Gradually progress the resistance. Remember small amount of pain during exercise is fine. If you are finding it hard to progress, then you can give the cortisone a try.
How long should I leave it before starting to do the exercises again?
The doctor will usually say rest for 5-10 days before commencing the exercises again. (But keep in mind, this is to purely see the result of the injection alone without the interference of other interventions)
I usually find crunching/clicking noises is as a result of poor shoulder stability (which is common in people with impingement).
Hi. Would you recommend ice or heat for shoulder impingement?
General rule that I personally follow is:
– Use ice if the pain is acute. Usually 24-48 hours following the aggravation.
– Use heat all other times.
Hi Mark, your article is extremely helpful and thoroughly explains what many doctors either can’t or won’t. I have had shoulder impingement on and off for 3/4 months although has been consistently painful the past month. I wonder if you have any suggestions that may help me? Im not sure if it’s how I sleep but I can’t pinpoint any other activity that would cause the pain, it’s always worse when I wake up, it can go from 0 pain to 10 overnight. I definitely don’t sleep on it. Although I do sometimes wake up with it laying above my head? Could this cause impingement and how do I stop doing this in my sleep???? Any suggestions welcome. Thanks
It sounds like there is something flaring up the inflammation in the shoulder. This can make the pain shoot up from 0 to 10 over night.
If the pain is worse after sleeping, the shoulder position would be the first thing to look at.
With the position of the arm above your head… this is a potential source of aggravation. As the shoulder goes into flexion/internal rotation, there is a higher chance that the structures in the shoulder can get squashed.
You can’t really control how you move around once you are asleep. Best thing you can do is make sure you are as comfortable as possible in a safe position (on your back, with pillows supporting the back of the arm/shoulder) so that there is no need for the body to move when you’re fast asleep.
Great information. Would a posture correction brace paired with your exercises help or hinder the recovery process? In your experience do the posture correction braces even work?
They are fine to use in the short term when you starting to address your posture.
I would not recommend on using them for the long term as you risk becoming reliant on it.
Hi Mark and thanks so much for all your pages for self help.
Regarding shoulder impingement, I believe I do have it. Both my shoulders are sore and make creaking noises and the left does seem more unstable and it hurts to lie on. Also discomfort reaching behind.
I’ve been trying to improve my rounded shoulders and mild kyphosis, thanks to you. However, I’ve been doing these exercises a few times now, and my biceps (upper outer arms) are really really sore (to palpate as well). Is this normal?
Many thanks in advance.
The exercises should not make your pain worse.
If it has – you will need match the intensity of the exercises with your tolerance and capabilities.
The pain may also be Delayed Onset of Muscle Soreness. (which is basically the normal pain you will feel after doing exercises that you aren’t used to be doing)
Thanks so much for getting back to me Mark, I actually meant deltoid pain, not biceps.
Generally shoulder/upper back and neck tightness and aching.
Thanks so much again ?
Hey Mark! Thanks for all of the great tips and exercises. I’ve been struggling with my impingement for about three months. You mentioned to work on the positions that give you pain. So, what if the pain is significant doing that specific movement? Work through it or…?
All the best! Thanks for your time.
You will need to get to the stage where you can start to do the specific movement.
If you are unable to do the complete movement, you can start by doing part of the movement.
Do not push past pain. A small amount of pain is fine.
Hey Mark, thanks for the great write up.
My right shoulder has been bothering me for quite some time now.I have seen 2 different doctors and both of them decided to use cortisone to treat the issues. The last doctor also ordered an MRA to diagnose the issue. The results showed High grade partial interstitial tearing at the mid to posterior supraspinatus, mild subscapularis and infraspinatus tendinosis and mild fibrillation of the supior labrum. Do you think i would benefit from those exercises and stretches?
Yes – these exercises will likely be a great place to start.
Push your shoulder as far as you can comfortably tolerate without flaring it up.
Hi Mark! Thanks for the great article!
I recently started to experience shoulder pain, which seems to be an impingement stemming from weight lifting and bad posture.
What order would you suggest to address these concerns? 1st- Shoulder impingement. 2nd- Forward neck. 3rd- Hunch back. 4th- Rounded shoulders?
Thanks for your time!
Addressing your shoulder impingement first is a great place to start.
In terms of where to go next, it really depends which area is affecting your shoulder the most.
All of the areas you mentioned could be addressed next :)
Thanks for the article, Mark! Quick question:
I’m pretty sure I have an impingement. Everything you say in this article and both the Hawkins and Painful Arc test recreate the pain. However, the Neer’s test does not. Could my pain be signs of something else or is it normal to pass that test?
The diagnostic tests aren’t 100%.
It is still possible to have an impingement and pass the Neers test.
Great stuff, man!
I’ve been dealing with impingement (guessing it started 4-5 weeks ago) from what I believe was mostly due to lifting weights pretty consistently for the past 7 years or so (with less than perfect form I’ve learned since scouring the net to learn about this problem), failing to strengthen the rotator muscles and likely not so great posture. Maybe a little due to aging as well as I turned 50 last May.
Unfortunately, as you mentioned, my small town doctor recommended (and I accepted) the cortisone shot and anti-inflammatories as well as rest for a month. Before I went to him I’d been doing the stretches and was doing the rehab exercises consistently – before trying just rest. It seemed to get better for a few days but then got worse. That’s when I broke down to go see him.
It’s been two weeks and I’ve been doing some of the stretching but only have done the rehab exercises a few times since he recommended rest only initially. The pain is pretty much gone and I plan on getting more consistent with the rehab/strengthening exercises now.
My two questions are 1) how often do you recommend the exercises? Three or four times a week? And 2) how long do you recommend staying away from lifting before I begin getting back into it, starting with lighter weights to “test it” and ease into it?
Thanks in advance!
Thanks for your questions.
1) how often do you recommend the exercises?
Depending on how you are feeling and how much you are pushing yourself, you can try every second/third day with the exercises and adjust accordingly.
2) how long do you recommend staying away from lifting
As soon as you feel confident with the exercises mentioned in the post, start to include the exercises you were previously doing at a much lesser intensity (partial reps, less weight/more reps, more rest etc). From here, you can start to get back to the level you were before.
Keep in mind that it is a good idea to address any underlying issues that have predisposed you to impingement (ie. posture, technique, etc)
Terrific article. Best thing I have ever read on the internet
Best comment I’ve received today :)
Thank you for posting helpfull information!! Its very well explain, but there are 2 types of impingement, and I have pain in the back of my right shoulder, so I think I have internal impingement and it hurts during bench press not in the front but in the back of my shoulder. So what muscle should i strengthen for internal impingement?
Hi! My shoulder makes a popping noise when I do the the third exersize. Does this mean I need to get inflammation down more in order for it to be beneficial? Thanks!
I am not sure which exercise you are referring to. But you don’t want to have any noises coming from your shoulder when you are doing the exercises. (especially if it is painful)
You might just need to adjust your technique, intensity, resistance and/or range of motion.
I have a shoulder impengment on right side. Pain is on outside of upper arm and shoulder. I been doing the bands for external and internal rotation. I been doing this for 6 months and i have only gotten to where im not in constant mild pain. I still have much discomfort if I do squats, bench press or curls. I have had a MRI arthrogram and it came back clear so i am wondering what is recovery time for this. I also have type 2 acormion.
Hi Mark, I’m a side sleeper which causes me to place my entire arm under my pillow in the last 2 years I have been waking up with tremendous arm / hand tingling which has recently progressed to painful arm / shoulder / neck during the day.
Can you suggest methods to strenghten these areas and also is there any pillow that I can purchase that would put less pressure on my arm.
If sleeping on the painful shoulder is the only cause of your symptoms, I would recommend to sleep on the other side (or your back) for the time being.
Tingling in the arm/hand is suggestive of nerve involvement.
Try to make sure that you ensure that your neck remains in a neutral alignment (ie. don’t let it tilt to one side as this can pinch a nerve).
If you have right sided issues, you can start to stretch your neck towards the LEFT before and after you sleep to see if it makes any difference.
I’ve had problems with my shoulder for a few years now, im finally getting it back to normal, but i often get cold sweats at work once I get tense, have you ever heard of such a thing and if so, are there any recommendations?
Sweating tends to be related to the autonomic nervous system (sympathetic).
This area tends to fall outside my area of expertise, but a great way to reduce an overactive sympathetic nervous system is to work on your deep/relaxed breathing. (kind of like they do in meditation).
First of all thanks for the information Mark!
I was hoping you could help me with one question I have though. I’ve been getting what is most likely shoulder impingement from doing calisthenics/gymnastics kind of training, so it involves lots of overhead movements, like handstands and handstand pushups. I really enjoy that kind of training so I don’t want to stop that activity. I mean I can stop for a few days while I recover but my goal is to recover, strengthen the shoulder and learn to move it the correct way so I don’t injure it again when I go back to my regular training.
So in the specific question of a handstand. Am I supposed to continue to pull the humeral head back in the socket when in a handstand? or should I shrug the shoulders to try and get them closer to the ears? People usually recommend shrugging the shoulders while in handstand (even yoga teachers recommend this while doing overhead stuff like downward facing dog), and it kind of make sense to push up since you are applying a force directly onto the shoulders. But wouldn’t this cause the shoulder to get impinged against the acromion since you are pushing up? This is very confusing.
I would recommend retracting, depressing and posteriorly tilting the scapula + pulling the humeral head back in +… pushing your hands into the floor. This will help activate the serratus anterior which will help with proper mechanics of your shoulder blade.
In regards to shrugging, I feel that you should try to avoid this esp. if you are suffering from impingement signs.
Hello mark. My right shoulder hurt when I was in position, then there was one movement when my hands held above (palms facing up) then slowly fell (front) then a click sound on my right shoulder, please give an explanation, so that I could recover? I am injured from playing badminton, so in the position of taking the backhand ball or defense it is not so agile and strong and sick
Hello Mark. I hope your still around. I have an impingement in my right shoulder from working out and my posture is terrible.
Could you please recommend the best exercises to fix my issue. I had this issue for a year now and it hasn’t let up.
The exercises on the blog post are a great place to start.
If you are having issues with them, the next step would be to get some investigative scans done to rule out anything more sinister.
Other than that – fixing the posture is going to be something you will need to work on to make sure the shoulder is working at its best.
Hi Mark, I’ve had shoulder impingment the last 4 months. at this point it’s sore..Can I now begin pushups or I should wait until zero pain?
You can perform push ups as long as it comfortable and pain free.
You may want to try different variations of push ups such as against the wall, half push ups, incline push ups etc to see which one is most suitable for you.
With respect to correct Scapula position throughout the Scapulohumeral rhythm, if it is dyskinesic or there is shoulder hitching how best to correct these please? Thank you.
First of all thank you for this very detailed and pedagogic topic.
This said, since i have a mild bursitis and mild impingement of my shoulder, could you confirm me that isometric exercices won’t worsen my bursitis/impingement ?
More specifically, is the” isometric lateral raise against a wall” is a safe and non-impinging exercise ? I ask you because i ve got the feeling that this exercice is both quite painless and both developing a bit my side deltoids. So i just want your green light (or not) on this move.
I thank you by advance for your thoughts and excuse for my poor english.
Isometrics are the safest exercise for shoulder injuries.
You should be fine doing them ,however, pay attention to how your body responds to performing them.
Thank you for you answer.
This said, by working out internal rotation with cable, isn’t it going to increase impingement by strenghtening internal rotator’ muscles which are still stronger than external rotator’s muscle ?
Could you please enlighten me on this point (i’m surely misunderstanding) ?
You will still need to strengthen your Subscapularis muscle (internal rotator) without compensating with the pecs, lats, teres major (internal rotators) in conjunction to strengthening your suraspinatus/infraspinatus/teres minor (RC which externally rotate)
Thank you again for your detailed answers and the time they cost you.
I just want to know if i should begin your active rehab since on the one hand, i am totally pain free at rest but on the other hand, i still feel a bit of inflammation when I am typing on my keyboard (im a deskworker) ?
Furthermore, i also feel a bit of inflammation if i put my hand behind my back.
So, even you can’t assess me online, would you advise me to stay on the anti-inflammation/ totalrest/ice phase of your program or should i begin to rehab more actively with your band workout ?
Thank you again for your thoughts
I would begin your rehab.
Be sure to stay within your limits. Do less than what you think you can do, and gradually increase to a level you are comfortable with (but at the same time being challenged)
Thank you for posting this information, if nothing else it hit it on the head exactly what I’m feeling. Tried explaining it to the doctor but now will explain it the way you did, it’s so vividly accurate. Just beginning this painful journey but will be following your treatment as well as my doctor’s. Your confidence gives me hope that I can return to living a normal life. Thanks again, will update with progress.
All the best! Let me know how it goes!
Hi Mark, not sure what exactly i have but when i do elephant trunk/ pendulum exercises and swing my right arm (affected side) from front to back letting my arm dangle freely i get a feeling at front of shoulder like its cramping up and painful.
also feels like there is a slight catching in my shoulder socket when sitting at computer and without moving my arms but moving my shoulder in its joint in a clock-wise circular motion.
also just generally have a slight feeling of my shoulder being out of socket slightly, its strange.
I have full range of movement and no strength loss, however my scapula on the affected side might have some winging and makes a huge crunching sound when raising my arm above head, although this doesn’t cause much pain.
do you think its impingement? any other ideas? some days its no pain but when sitting it computer i start getting ache at top of shoulder and shoulder feels more out of socket.
Thanks for writing these articles…
Cramping at the front of the shoulder during the pendulum may be a sign that one of your muscles in the area is compensating by attempting to stabilise your shoulder joint. Usually this occurs as a result of weakness in another muscle.
Feeling like the shoulder is out of the socket may indicate (among other things) a weak rotator cuff.
If you have full range of motion that is pain free, it is less likely that you have impingement. However, it is still possible.
Have you tried doing strict rotator cuff exercises to see if that helps?
Hi Mark, sorry if you answered these elsewhere, but I have 2 questions:
1. How many days a week should one do the strenghthening exercises?
2. What level resistance for a resistance band should one use? I have a red loop band that looks like the one in the shoulder traction exercise photo above, I believe it has a resistance of 20-35 pounds.
1) Everyday is the goal. But do as much as the body will allow you to do. Some people do it less, but if you want to give your shoulder the best opportunity to heal, you would want to keep the frequency as high as you comfortably can.
2) The resistance you use is relative to your starting strength. Pick a challenging (but not too difficult) resistance to begin with. At the end of the exercises, your muscles should be tired!
This makes so much sense to me Now!!! Have been a swimmer all my life suddenly my right shoulder was painful to point I couldn’t swim any more! Doctor said swollen bursa and calcification of tendon in right shoulder, two of the above symptoms movements where painfully (the last 2) now I hate cortisone but I gave in and had it twice and never again! As you said does nothing except for a couple of days. I still go to the gym and only struggle with chest press or standing delt flies. Now I my right shoulder has rolled forward as well. I have regular deep tissue massage on it but other suggestions would be great.
Thanks for your time
If chest press and standing delt flies are the main concern at present, I would keep working on these exercises in a pain-free manner. (ie. lighter weight, less range of motion, add more isometric holds etc). This in itself will help your bursitis and rotator cuff issue.
If the rounded shoulder is of concern, check out this post: How to fix Rounded shoulders.
Mark, I have been suffering from Pain in my right shoulder for the last 11 months. Had every sort of NSAID, had several physio therapy sessions and once i had an injection on my shoulder which dr. recommended. Pain got released but came back after two months. Let me tell you i have been working out for the last 15 yrs. Heavy weight lifter i used to be but couldn’t continue gym in that way for a long time. It demotivates me alot. Then i just had an MRI last week. Impression i’ve got in MRI mentioned below.
1. Minimal degenerative changes are seen in acromioclavicular joint with intact subacromial fat.
2. Minimal subchondral changes are also seen in greater tuberosity, however no abnormal signals are seen in the supraspinatus tendon to suggest its injury.
3. There is obliteration of inferior glenohumeral recess is seen, suggesting an element of adhesive capsulitis.
I want to get relieved now. Please suggest
This suggests that you may have elements of Frozen shoulder. Is your movement severely restricted at the moment?
The best way to work around this is to work within your current limitations.
For example – do exercises where you can perform it fairly comfortably and pain-free. It is vital that you strengthen the range that you have.
Complete rest is NOT recommended.
The only way to recover from this is through exercises, activity modification and time.
Hello again. Nevermind about the other message I sent you, I already sorted it out.
Hello Mark, I don’t know if you could help me with some questions I have about using an electric massager, one of those that uses electrodes. I’m aware this entry is not fot that, but I don’t have Facebook, and do have a shoulder problem too.
The long story: I had an accident 9 months ago. After visiting and orthopedist the diagnosis was muscle contractions all over the body as well as straight neck, scoliosis of 1.9°, shortened hip and reduced space of 0.6mm in c3, c4, L4, L5, and S1. I was given medicine which caused severe allergic reactions to the point I can’t even use Voltaren cream anymore. Later I saw a physiotherapist, chiropractor and acupuncturist and the results were terrible, now I have dizziness, trouble swallowing, inflammation that swells the veins of the whole body, and after seeing the chiropractor I developed lower back pain in the mornings, unless I place a folded sheet underneath the lumbar area. Raising this part with a pillow also makes the vein swelling disappear completely, but only lasts for a small while after being in that position.
I bought an electric massager which I applied to my legs and now for the first time since the accident I’m finally pain-free when I walk. Surprisingly, it also decreased the pain in the shoulder, arms and lower back but they still seem quite tight, and if I place the massager directly in those parts they tight up even more.
My massager only has settings for 20-30min sessions of either a)2,4,6Hz b) 9,7,5,3Hz and c)1,4,20, 1,4,40, 1,4,60Hz. With each frequency changing every 5 minutes.
Now for the questions, I have thought about applying it for 3 or 5 minutes, but I don’t know if it would be safe to use it for such little time. If it’s only 5 minutes, wouldn’t it be a problem to only apply either, 2Hz, 9Hz or 1,4Hz and no other frequencies?
I tried to keep working that top area through the legs, but perhaps they are too relaxed already becase I get dizzier for the next few days afterwards. Or, do you think it could work if I apply it on the legs for less time as well?
Finally, my massager only gets as low as 200 in wavelength, I’ve used up to 400 on my legs with no problems, but wouldn’t 200 be too high for the shoulder-arm?
In the past, I’ve also tried the muscle release with a ball to no avail, which is why I got the massager. Also, I’m aware I should do strengthening exercises, but it seems I need to reduce the tightness and inflammation first, because right now the vein swelling increases as soon as I move any limb, probably because it pulls the back area too.
Sorry for the long post, and thanks for sharing your knowledge through these pages.
Diagnosed with a rotator cuff issue, final press up of a bootcamp session early March this year, heard/felt strange “creek” noise followed by pain, leading to impaired movement.
Initial physiotherapy restored a good movement range within a week.
After 3 months further physiotherapy, further rehabilitation had stalled and I was referred to an orthopaedic surgeon.
After visiting orthopaedic surgeon, his notes have said:-
Normal appearance to the shoulder from the front.
From the back some wasting to the right infraspinatus muscle.
No pain on palpating of the shoulder.
Range of movement good with regards to elevation and abduction, small disrupted rhythm of movement.
External rotation full, internal reduced several spinal levels.
Power of external/internal rotation is full.
Hawkins test for impingement positive.
X-rays from March show a cyst in the greater tuberosity area and some sclerosis suggesting long standing impingement.
Clinical impression – cuff irritation or subacromial impingement.
A course of diclofenac has eased the symptoms.
Non movement of the shoulder causes discomfort, so, sleeping is not always is restful as pre injury.
Right arm in my clothes, as in normal dressing, is not as easy as it should be, as is attempting to scratch my back with my right hand, which is nearly impossible.
Running and cycling are my main sports, but circuit training and workouts in the gym and free weights room we’re all part of my exercise regime.
I have continued to exercise in any way I can without discomfort, modifying exercises to suit
So, my question to you would be, what would be your advice and suggestions to get me back to my pre injury routine.
Also, why does non movement, as in sleeping, cause irritation/discomfort.
Thanks in anticipation of your help.
Thank you for your great essay. I have got little pain when i try Hawkins but i can do it. I can push up event pull up too without pain but not as powerful as before . So can you give me some advice ? thank you and sorry for my bad English.
Wow Mark, thank you!
The second time this year my schoulder hurts so much I can’t even use my arm. The doctor thinks it could be an inflamed bursa. First time she gave me an injection in the shoulder, and it worked, but I would rather know exactly what causes this pain and solve it.
So I found your post via a pin on Pinterest :)
I somehow found out this movement (hawkins kennedy test) releaved some of the pain (but I do have to lift my arm with my healthy arm.
So when reading through your blogpost I tried the Neer’s test and heard and felt this giant crack. and instantly the pain reduced.
So I’ll be going for my echo tomorow and i’ll be here again for the excercises!
thanks so much!
Exercises are the way to go!
Let me know if you need help.
so the echo en RX showed calcification of the tendon in my shoulder.
I think the excercises might help with the bloodflow in the tendon as well?
Yes – the exercises will still be great for your shoulder.
I have had shoulder imingement since January in both shoulders, worse on left. This was caused by overuse injury but initially thought to be posture related so every single exercise I’ve done has made things worse. Physiotherapist I saw made things worse too with deep tissue massage and stretching exercises. In January the pain was only when I moved my arm in a certain position occasionally, now I’m often in almost constant pain now, down arms and in front and back of shoulders. I have bursitis in both shoulders and subacromial something and tendonopathy. I can’t seem to do anything without pain. I used to be so fit, now even walking aggravates the pain. Sleeping not easy, no comfortable postion – have been sleeping on back for months, side sleeping definitley bad. Rheumatologist wants to do ultrasound guided steroid injection but now I’m scared to after reading on several websites that they’re not that useful. I tried your very simplest exercises and only just a bit and they made the left upper arm hurt. I’m getting so depressed about this and don’t know what to do. Any advice please.
Looks like you have what we refer to as SENSITISATION.
This basically means you sense things as more painful as they should when you do normal (non-painful) movements.
On top of that – excess inflammation may have played a role in this as well.
The best advice I can give you is to just to find 1 simple exercise that you can do multiple times throughout the day that does not significantly increase your symptoms.
Push the side of your arm against a wall as hard as you can with nil pain.
If you are seeing a specialist, make sure they rule out nerve issues coming from the neck and systemic conditions such as Fibromyalgia.
Thanks so much for this Mark. I am seeing the rheumatologist tomorrow, but before we decide on the steroid injection or not I shall go over again with him my MRI results to remind him. MRI shows I do have in my cervical spine “moderately severe spondylotic change at the C5/6 level” and in shoulders “mild to moderate supraspinatus tendinopathy in both shoulders” and “mild distension of the subacromial subdeltoid bursa which is suggestive of associated bursitis”. Looks to me like I have several things going on. I will try the isometric exercises today, thanks.
The article is very detailed and articulated. I really appreciate you explaining everything.
My case is a little different than the rest of the lot. It started in January’18. I do have a posture problem, shoulders are a little slouched. I had been going to the gym for 4 months and started swimming in January and I think swimming was the tipping point. I have taken PT for 3 weeks which only worsened the situation. I have already had a cortisone injection taken in late March’18. It did exactly what you said. Pain went away for a few days and then came back. I am on NSAIDs right now and the doctor says if this doesn’t work out, which my guess is it won’t, then he’ll go for another cortisone injection. He narrowed down the area of problem to be AC joint. I can’t cook or even do my daily routine like wearing a jacket and stuff. Now, I’ve read a lot and I am sure it’s not a tear. I have too much strength in my arm for it to be a tear. I have a few specific questions and rest I am banking on your advice.
1. My biggest worry is that it doesn’t become a tear going forward. What can I do to prevent?
2. There are some bands in the market to keep the shoulders back. Do you think I should wear nay of those?
3. Rest in general like if PT, cortisone and NSAIDs didn’t work, what else can I do?
Rest if you can guide what can I do going forward because nothing seems to be working. I have gotten second and third opinions also and the doctors say this doctor is going by the right approach. I don’t know what to do.
1. Optimal shoulder movement patterns will reduce the risk of further damage to your shoulder muscles. What you focus on is really dependent on what you are lacking. It needs to be specific.
2. Stay away if you can. Your muscles can do a better job if you work at it.
3. See answer 1. It can be fixed!
I had shoulder pain (Nov’16) and had under gone 10-15 physiotherapy session after which the pain was gone and started my workout again after a break of 3 months in FEB’17.
Its more than a year since i started working out and developed and gained strength gradually by increase my weights lifted.
Yesterday night i started feeling similar pain in the same shoulder as i lifted a heavier weight in my shoulder workout yesterday.
I want to know that why did i got the pain again in the same shoulder and if i need to under go physiotherapy session but really dont want to stop lifting wait as will have to start again and get back in shape again.
Appreciate your help and quick fix.
My advice would be to go get it assessed just to make sure!
Hopefully it is just a small strain though.
Hi Mark, I have just a week ago had shoulder arthroscopy and decompression. I have been given some basic exercises to do, pendulums, pulling shoulder blades together, walking hand up the wall, dumb waiter etc. I do a lot of yoga and Pilates and already feel like I could do more but don’t want to over do things. I had and still have a pain in my shoulder blade that I massage against the wall with a spikey ball but nothing seems to help long term. Is there anything you can recommend please?
Here are some blog posts that might help you out.
Fix your shoulder blade pain
Just be careful not to push your shoulder too far. None of the exercises should cause any pain.
Let me know if that helps!
I have deeply appreciated reading your site & have implemented many of your strategies. I work as a pediatric caregiver for a child who is visually impaired, which causes me to lean over a lot at work. I now have double shoulder impingement. Do you have any tips on how to prevent further injury and to heal while working a job like this. I have been trying to fix my posture as much as I can while I’m at work. Also do you have any suggestions for sleeping with double shoulder impingement? I am finding that I wake up with my shoulders feeling like they’re on fire. I can’t quite find the right pillow mattress/scenario.
With any shoulder injury, you need to:
1. Stop doing things that make it hurt. This is usually quite difficult if the aggravating factor is what you do for work. If you can not completely stop, try to perform the activity so that there is less/nil pain.
A cue I like to tell my shoulder patients is to “keep your elbows close to the sides of your body”. This is a safer position for the shoulder.
2. You will need to strengthen your shoulder muscles in ranges of motion with nil pain first. (Same exercises as in the post)
3. Once you are strong in these ranges, you will need to address the actual impingement (by doing exercises, anti inflams, injection, correcting posture etc etc)
4. Sleeping on your back with the back of the shoulder supported with pillows/rolled up towels will be the best position. Side sleeping will generally squash the shoulder .
I have been in PT since December for my shoulder and pain is gone after my sessions and then come back after my weekends as a bartender. I can not lift or rotate a bottle to pour a drink with my left arm (the affected shoulder) I take advil and tylenol as needed. I see you do not recommend cortisone shots. I am still doing follow up with my physical therapist, but have since made an appointment with orthopedics for a consult. Is it time to accept that surgery might be needed for this impingement?
If the PT helped, I would still persist with the exercises, for sure!
If bartending is making it worse, you will need to modify the way you do things there otherwise you will keep aggravating your shoulder.
Surgery is not warranted is most cases if you do the right things.
I really think this is what I have. I have a very tight chest and therefore my shoulders stay somewhat rolled in. I have been lifting weights and thats when it started. Pain and kind of a popping/grinding sensation. Does this sound like impingement?
It sounds like impingement may be a factor in your injury.
But it also sounds like your rotator cuff may not be centrating the humerus head (arm bone) in the shoulder socket leading to popping and grinding.
If there is locking (which can indicate joint issue), I would get a scan performed asap.
Can all of these exercises be done 5-7 days a week?
You can… but only one way to find out! And that is is to try them out.
Since these exercise aren’t strenuous and only use very light resistance, you should be able to do them everyday providing that your body can tolerate it.
Thanks for the question.
Thank you for the quick response and the information.
With much gratitude,
Can a shoulder impingement cause a winged scapula? What about the reverse?
I had labrum repair on my right shoulder. Once it healed, I realized that I had a severe (3 to 4 inches) winged scapula. I can’t support the weight of my arm when it is above my head. It has been months and the doctor/PT has told me that they think it is LTN damage but that it will regenerate and be ok. We have had no MRIs or any other images taken of this area post surgery.
I have been through two months of physical therapy and I am not seeing any progress. My doctor has suggested a shot but I don’t know if that will really help me.
I have winged scapula, shoulder pain, my trap is overworked so I have a sharp pain going from my trap into my shoulder on top (hurts to touch), pain while lifting my hand over head (and during other shoulder impingement tests). One thing is that I don’t have too much pain in my right shoulder until I start reaching the top of my range (head is almost directly over head). I am lifting my hand with my trap mostly.
I have tried different serratus anterior exercises but I can’t tell if I am working that muscle or if my lat and pec minor are doing all of the work. I can see my pec minor contract when doing all of the serratus anterior exercises.
What should I do? I think I need to get some imaging to help determine what is wrong!
Yes – a Winged scapula can result from impingement of the shoulder. (And conversely, winging can also predispose you to impingement.)
Your winging may be due to the body compensating a) for weak muscles +/- nerve damage, b) tight structures and/or c) to avoid pain.
It sounds like you are shrugging your shoulders to elevate your arm. This may be indicative that you have weak shoulder stabilising muscles (namely the rotator cuff and serratus anterior) and/or tight inferior capsule/lats/triceps.
Ideally with arm elevation – you would like the serratus anterior and trapezius muscle to laterally rotate your shoulder blade so that you do not have to shrug your upper traps.
Do you have full shoulder External and Internal rotation? I would check this first.
You can get a MRI if you would like to double check everything.
I’ve been in physical therapy for 3 months for my impingement. I’ve gained some strength and mobility but I still have pain. I’ve tried 2 weeks of Advil but I can’t keep taking them due to gastritis from the anti inflammatories. Is it time for a cortisone shot? I’m getting frustrated
I am not really a huge fan of the cortisone shot as I feel that most inflammation can settle once you remove the aggravating factor… but if you have tried everything with physical therapy and still not getting anywhere, it may be worth a shot.
I have an inpigement and being having physio which isnt helping im in alot of pain in my collar bone so been trying to do exercises but nothing is helping im 61 and suffer with ra osterporis osteraritis
You may not have been given the correct exercises for your shoulder.
Which ones are you doing?
Thanks Mark best advice I’ve come across for my shoulder. I’ve had impingement and subacromonial bursitis and these exercises made a massive improvement so much so I happily refused the steroid injection. My weakest area is external rotation but it’s much improved. The issue I have still with no resolve is tightness in the infraspinatus. When it’s really tight I can feel the humeral head off centre. If I abduct my arm and push the infraspinatus with a ball against the wall I get clicking and the tightness releases and humerus gets centred. Sometimes doing a chair lean stretch also resolves it. Is there an exercise I should be doing to prevent the tightness or is the tightness caused by weak external rotation? Thanks S
If the infraspinatus is tight, you can do stretches for it:
Also make sure you have full INTERNAL ROTATION:
70 degrees is what you want.
If it is weak, continue with the strengthening exercises.
Brill thanks! I’ve added in the stretch as that one helps a lot. Just checked my internal rotation and very tight there too – probably at 60. It’s much less than it used to be before injury. Will stretch internal rotators as well. Thanks!
I can’t understand what to do to mimic the above as dropping you arm down to 70 degree’s seems easy – What am I missing- to get better internal rotation is my issue as well.
Please elaborate when you can
If you can do 70 degrees easy:
a) You have very good shoulder mobility
b) You compensated your way to 70 degrees.
I am going to assume you are b) as if you are a), then all is good!
If you compensated your way to 70 degrees, you likely did not keep you shoulder back and down in a neutral position. Many people “cheat” this movement by letting their shoulder girdle rise up and forward.
Let me know if that made sense.
I finally got this I do not have close to 70 internal rotation since I had PT check it-more like 40 degrees- no wonder its hard to raise that shoulder
Now i need to focus on the External Stretch’s she said the range can be improved by doing these frequently. You have provide some and are much appreciated i hope this can get back to at least 60? What is the best one i can do daily?
The best stretches for Internal rotation of the shoulder joint
– Sleeper stretch
– Arm across body stretch
Aim to get a specific stretch in the back of your shoulder joint.
49 yr old male . love cricket still but have knocking sound in between 90 and 180 degree
and have zero external rotation. upon acceleration and at point of release my arm goes into extreme pain zone recovery is about 2-3 minutes before the pain goes away.
When i heavily tape shoulder so that i kinda push it inwards the pain is not as bad. My feeling is im pushing over tissue that provides some cushioning to affected area. Mri did show some laberal tears but this seems common pathology with 49 yr old male. Im getting desperate for the inpingement to be fixed. Ive seen 7 different dr or physios and im just paying their holiday house off. Any advice
If you have no external rotation, that would be a good place to start.
Without External rotation in your shoulder joint, there is no way you can safely raise your hand over 90 degrees (let alone throw a ball).
Listen to your body. Do not push into pain (esp. if you have known labral tears).
I was diagnosed with rotator cuff tendenitis and worked with PT and she said things were fine and I could resume my fav sport BB
I find that I still baby that arm do not have pain just stiffness. I would think its important to keep it mobile. I use thera bands daily to do some of your shoulder inpingement stuff , external rotations, releases etc
Any good warm ups for BB you would advise and if moving this daily going to make it worse.
I like do start off with controlled shoulder articulations
From here you should try to do sport specific warm ups. Try to mimic the same positions you will be in during your sport.
Sorry – Is BB basketball or baseball?
Thanks Mark-Basketball sorry about that
I have a ? my right shoulder is stiff but have zero pain-
Is this RC ( cuff)tendinitis?
Can this be from poor posture as well?
Doing a lot of band pull backs to help improve my external rotation.
Don’t want to make it worse but it seems mobiliy is better than not
You are great much appreciated
Hi Mark, great website. I was diagnosed with a frozen shoulder, is that the same? Only got one exercise to practice, but seem to have all the symptoms described here.
Frozen shoulder (also known as adhesive capsulitis) is where the capsule around the shoulder joint becomes very tight +/- painful. It usually can take >12 months to heal !
Whereas Shoulder impingement is where the structures in the shoulder joint get squashed when your lift your arm up.
Although different, shoulder impingement may lead to adhesive capsulitis if not addressed properly !
Hi Mark, I have been diagnosed with a frozen shoulder, is that what we are talking about here? I will try the exercises, and hopefully improve overall posture as well
what do you do for frozen shoulder sames exercises?
You can do these exercises for frozen shoulder as well.
You basically want to strengthen in all different ranges.
Thank you so much for this. Your explanations and the visual aids have helped me get a better “feel” for what’s happening when I move, and how to go about the exercises. I am a violinist, and experience pain in my bowing arm when lifting the bow – it hurts more to hit the lowest string (G), since it is the one farthest away from my hand, than playing the E string which can be reached with my elbow closer to the ribs.
Thanks for the comment!
Make sure that you aren’t rounding your shoulders as well :)
This is an incredibly thorough, yet easy to follow guide. Thank you!
Glad it is easy to follow :)
BEST post on shoulder impingement!
this is by far the best information I’ve seen on shoulder impingement! thanks for sharing your knowledge
Thanks for visiting, Ryan!
Thank you for your the great pictures and explanations it’s extremely helpful for myself and my clients.
It is terrific to have such helpful professionals sharing their knowledge with people like myself.
Thanks for dropping by!