Neck & Shoulder

What It Is

Line drawing of the shoulder blade from behind, shown bare on one side and with the rotator cuff muscles on the other, with the supraspinatus running along the top of the blade and under the bony shelf of the acromion to the upper arm. — The supraspinatus slides under that bony shelf at the top of the shoulder every time the arm lifts — that's where the pinch happens.

Shoulder impingement syndrome is a very common shoulder problem where one of the tendons inside the shoulder swells and rubs against tissue or bone, causing pain as you lift your arm (NHS, 2024). NHS physiotherapy services now often call it "rotator cuff-related shoulder pain", and you may also hear terms such as subacromial pain or bursitis (Leicestershire Partnership NHS Trust, 2026). It can affect young athletes as well as older people (AAOS, n.d.).

When the rotator cuff tendons are irritated or injured, the tendon can respond by swelling, similar to the way ankles do when they are sprained. As you lift your arm, the space between the top of the shoulder (the acromion) and the rotator cuff tendons becomes smaller, so the acromion can rub against (impinge on) the tendon and the bursa below it, causing irritation and pain (AAOS, n.d.). Irritation can lead to more swelling, and the more the tendon swells, the less space there is for it to move, which can become a vicious circle. The good news is that shoulder impingement usually gets better in a few weeks or months (NHS, 2024).

Shoulder Anatomy With Relevance to Impingement

The main shoulder joint is a ball and socket joint called the glenohumeral joint. Impingement happens just above this joint, in the space underneath the acromion, which is the bony tip at the top of the shoulder blade (AAOS, n.d.). If you look at your shoulder, you will notice a small tip or protrusion at the top… this is the acromion (Greek akron = tip/hill). The acromion joins the collar bone at a small joint called the acromioclavicular joint, or ACJ for short. Wear and tear in the ACJ can sometimes add to the problem (Garving et al., 2017), but the pinching itself happens in the space under the acromion.

There are four rotator cuff tendons, but the most commonly affected is called the supraspinatus tendon (Garving et al., 2017). The supraspinatus is a muscle that stabilizes the shoulder joint. It also helps to lift your arm to the side. As you lift your arm, the tendon slides under the acromion. This is where the problems occur, as the tendon can become pinched (or impinged) under the acromion.

There is also a small fluid-filled sac between the rotator cuff and the acromion, known as the subacromial bursa, which helps the tendons glide smoothly (AAOS, n.d.). This can become inflamed and swollen, which is known as bursitis. This reduces the space even more and adds to the impingement.

What Causes Shoulder Impingement?

There are a number of things that can contribute to shoulder impingement:

1. Arthritis of the ACJ

Wear and tear on the ACJ can cause thickening of the joint and bone spurs (small bony lumps). These can reduce the space under the acromion and contribute to impingement of the rotator cuff tendon (Garving et al., 2017).

2. Low-lying or Hooked Acromion

The shape of the acromion varies from person to person, and doctors often describe it in three types, I, II and III (Garving et al., 2017). A hooked acromion, or a bone spur on the front edge of the acromion, can decrease the space underneath it and contribute to impingement (Garving et al., 2017; AAOS, n.d.).

3. Bursitis

Subacromial bursitis is a swelling of the fluid-filled sac under the acromion. If this becomes inflamed, there is less space for the rotator cuff tendon, causing impingement (AAOS, n.d.).

4. Poor Posture

Poor posture puts the shoulders forwards and changes the position of the shoulder blade, which may contribute to impingement (Garving et al., 2017).

5. Repetitive Strain to the Tendon

Repeated overhead use, for example in swimming, tennis or volleyball, or in jobs such as painting, construction or paper hanging, can irritate the rotator cuff tendon (AAOS, n.d.). A sudden increase in activity, such as lots of gardening in the spring after a winter break, can also overload the tendon (Leicestershire Partnership NHS Trust, 2026).

6. Rotator Cuff Tear

Some people with rotator cuff pain have a tear in one of the rotator cuff tendons, which can sometimes be seen on an MRI scan (AAOS, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Impingement Syndrome

Research shows that the best treatment for rotator cuff-related shoulder pain is exercise that gradually builds up the strength of the rotator cuff (Leicestershire Partnership NHS Trust, 2026), and stretching exercises to improve movement can be very helpful (AAOS, n.d.). I can guide you through a graded strengthening and stretching programme, with hands-on work for your shoulder and upper back. See the My Approach tab for how I work.

1. Exercise

Follow any exercises from your family doctor, nurse practitioner or physiotherapist as early as you can, and do not stop moving your shoulder completely, as this can stop it getting better (NHS, 2024). Some pain while exercising is normal, but it should be tolerable and settle soon after you finish (Leicestershire Partnership NHS Trust, 2026).

2. Ice or Heat

Hold an ice pack (or a bag of frozen peas) wrapped in a tea towel on your shoulder for up to 20 minutes, 2 to 3 times a day (NHS, 2024). If ice doesn't help, try heat, which can also be an effective way of helping to manage pain (Leicestershire Partnership NHS Trust, 2026).

3. Painkillers

The NHS suggests taking painkillers such as paracetamol or ibuprofen, or using ibuprofen gel, for shoulder impingement (NHS, 2024). (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

4. Avoid Aggravating Activities

While your shoulder settles, try not to carry on with activities that caused your shoulder pain or that involve repeatedly lifting your arm above your head, such as swimming or playing tennis (NHS, 2024).

5. Therapy

I can help with hands-on work and exercises for your shoulder, and a physiotherapist, osteopath or chiropractor can also help. A physiotherapist can suggest exercises to help your range of movement and reduce pain (NHS, 2024). Be patient: it can take at least 12 weeks for symptoms to improve, but most people do recover (Leicestershire Partnership NHS Trust, 2026).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Stronger painkillers: a family doctor or nurse practitioner can prescribe a stronger painkiller if you need one (NHS, 2024).
Steroid injection: an injection of a steroid (a strong anti-inflammatory medicine), usually with a local anaesthetic, into the bursa under the acromion, which may relieve pain if rest and exercises have not helped on their own (NHS, 2024; AAOS, n.d.).
Surgery: an operation to widen the space around the tendon so that it no longer rubs on the tissue or bone (NHS, 2024).

How I can help (see the My Approach tab)

A graded strengthening programme for the rotator cuff and shoulder blade
Hands-on work and stretching for the shoulder, chest and upper back
Advice on posture, sleeping position and your work or sport set-up

Tips

Impingement often results from sports that place repeated overhead stress on the shoulder (AAOS, n.d.).
People who do repetitive lifting or overhead work, such as painters and construction workers, and athletes in overhead sports are at increased risk (AAOS, n.d.).
Bone spurs and wear and tear in the ACJ can leave you more susceptible to the condition (Garving et al., 2017).
Avoid sleeping with your arm raised above your head at night, or on the affected side. Resting your arm on a pillow, or putting a rolled pillow behind your back so you don't roll onto the painful arm, may help (Leicestershire Partnership NHS Trust, 2026).
Break larger tasks into smaller, more manageable chunks to reduce the risk of flare-ups (Leicestershire Partnership NHS Trust, 2026).

Treatment

My Approach

Line drawing of the upper back from behind with the arm raised out to the side and then overhead, showing the trapezius, shoulder and shoulder-blade muscles, with arcs marking the range of movement. — As the arm goes up, the shoulder blade has to rotate and tilt with it — the lower trap work is about getting that part right.

Impingement pain usually responds best to the right amount of load: not complete rest, and not pushing through pain. My aim is to settle the shoulder, then build strength in the rotator cuff and shoulder blade muscles so it copes with reaching, lifting, work and sport again.

I start by assessing how your shoulder, shoulder blade, neck and upper back move, testing your rotator cuff strength, and asking about your work, sport and what brings the pain on. I also try simple changes, like supporting your shoulder blade with my hands or tape, to see what eases the pain.

When It's Sore

Cutting back what provokes it, such as reaching overhead and heavy carrying, rather than stopping everything
Gentle holds, like pressing your hand out against a wall, which often ease pain
Hands-on work for tight chest, neck, upper back and shoulder blade muscles; chest wall work needs your informed consent and a written consent form
Warm or cool applications in the clinic, and I'll show you how to use ice or heat safely at home
Taping to support your shoulder blade in the short term, and I'll show you how to tape it yourself

As It Settles

Stretching to restore normal shoulder movement, with gentle, low-velocity mobilisation if your shoulder or upper back is stiff
Cross-fibre work on the tendon once it's past the early irritable stage (never on a calcified or acutely painful tendon)
Shoulder blade control, wall push-ups and rows, then turning-out work to strengthen the rotator cuff
Building to overhead, work- or sport-specific movements, including gym-based progressions if you lift
Some discomfort during exercise is fine if it settles soon after; if pain rises at night or the next day, we ease back
A home programme, and a look at your posture, sleeping position and work or sport set-up

If your pain isn't easing after a few weeks, or it stops your usual activities, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Early on, most people come once or twice a week, then weekly, with a reassessment at about 4 to 6 weeks, then less often as you manage more on your own. Impingement usually gets better over a few weeks or months, and it can take 12 weeks or more of regular exercise for symptoms to improve.

What I Focus On

Load Management

Isometric Holds

Shoulder Blade Control

Progressive Cuff Strength

Posture & Set-Up Review

Please read

When to See a Doctor First

When to Get Help

See your family doctor or nurse practitioner if your shoulder pain does not go away after a few weeks, or if it is stopping you from doing your usual activities (NHS, 2024).

Sources

References

NHS (2024) Shoulder impingement. Available at: https://www.nhs.uk/conditions/shoulder-impingement-syndrome/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Shoulder impingement/rotator cuff tendinitis. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/ (Accessed: 7 October 2026).
Garving, C., Jakob, S., Bauer, I. et al. (2017) 'Impingement syndrome of the shoulder', Deutsches Ärzteblatt International, 114(45), pp. 765–776. doi: 10.3238/arztebl.2017.0765. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5729225/ (Accessed: 7 October 2026).
Leicestershire Partnership NHS Trust (2026) Rotator cuff-related shoulder pain. Patient information leaflet, MSK Physiotherapy Service. Available at: https://www.leicspart.nhs.uk/wp-content/uploads/2026/04/LPT-CHSMSK16-Rotator-Cuff-Related-Shoulder-Pain.pdf (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooShoulder Impingement Syndrome

What It Is

Shoulder Anatomy With Relevance to Impingement

What Causes Shoulder Impingement?

1. Arthritis of the ACJ

2. Low-lying or Hooked Acromion

3. Bursitis

4. Poor Posture

5. Repetitive Strain to the Tendon

6. Rotator Cuff Tear

Self-Care & Treatment

How to Treat Impingement Syndrome

1. Exercise

2. Ice or Heat

3. Painkillers

4. Avoid Aggravating Activities

5. Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooShoulder Impingement Syndrome

What It Is

Shoulder Anatomy With Relevance to Impingement

What Causes Shoulder Impingement?

1. Arthritis of the ACJ

2. Low-lying or Hooked Acromion

3. Bursitis

4. Poor Posture

5. Repetitive Strain to the Tendon

6. Rotator Cuff Tear

Self-Care & Treatment

How to Treat Impingement Syndrome

1. Exercise

2. Ice or Heat

3. Painkillers

4. Avoid Aggravating Activities

5. Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to Get Help

References

Related Conditions

Hyperkyphosis

Rotator Cuff Tendinopathy

Frozen Shoulder

Subacromial Bursitis

Book a session