Shoulder impingement syndrome is one of the most common causes of shoulder pain, particularly pain felt when reaching up or out. It happens when the tendons of the rotator cuff are compressed or irritated as they pass through a narrow space in the shoulder. Although it can be persistent and frustrating, it usually responds well to the right combination of hands-on care and exercise. At Back in Action in Penwortham, we care for people across Preston and Lancashire with impingement-related shoulder pain.
Understanding shoulder impingement
The shoulder is controlled by the rotator cuff, a group of four muscles and their tendons that hold the ball of the joint securely in its socket and allow the huge range of movement the shoulder is capable of. These tendons pass through a narrow space beneath a bony arch at the top of the shoulder. When this space is reduced, or the tendons become irritated and swollen, they can be pinched or compressed as you lift the arm — this is impingement, sometimes also called subacromial pain.
The result is a characteristic pain on reaching overhead or out to the side, often in a particular arc of movement. It is a mechanical problem — relating to how the shoulder moves and how the tendons are loaded — rather than a sign of anything serious, and it frequently involves the way the shoulder blade and surrounding muscles are working, which is why effective care looks at the whole shoulder rather than just the painful spot.
The shoulder blade is a key player that is easy to overlook. It provides the moving platform on which the arm operates, and if the muscles that control it are weak or working poorly, the space available for the tendons can be reduced and the rotator cuff put under more strain. Improving the control and strength of the shoulder blade is therefore often as important as addressing the shoulder itself.
What impingement can feel like
Symptoms usually relate clearly to shoulder movement and include:
- Pain when reaching overhead, out to the side, or behind the back, such as fastening a seatbelt
- A painful arc of movement, often in the middle range of lifting the arm
- Pain when lying on the affected shoulder at night, which can disturb sleep
- Aching at the front or side of the shoulder, sometimes spreading partway down the arm
- Weakness or reluctance to lift the arm fully
- Pain that has usually built up gradually rather than appearing after a single injury
The link between the pain and reaching or overhead activities is one of the most recognisable features of impingement.
Common causes and risk factors
Impingement usually develops from a combination of factors rather than a single injury, and often builds gradually as the demands on the shoulder outpace what it is prepared for. Common contributors include:
- Repetitive overhead activities, in work, sport or hobbies
- A sudden increase in overhead, lifting or training activity
- Returning to a sport or task after a break without building back up gradually
- Weakness or imbalance in the rotator cuff and the shoulder-blade muscles
- Posture that reduces the space available for the tendons
- Age-related changes in the tendons of the rotator cuff
Part of our assessment is understanding what is contributing to the impingement, since addressing that is key to lasting improvement.
When to seek help
Impingement is not dangerous, but it can be slow to settle and is worth addressing rather than pushing through, since persistent irritation of the tendons tends to prolong the problem. Please seek prompt medical attention if your shoulder pain follows a significant injury, if you cannot lift the arm at all, or if the shoulder is hot, swollen and red with a fever. Otherwise, it is worth seeking advice if the pain is persistent, limiting, or disturbing your sleep.
How long does it take to settle?
It helps to be realistic: impingement often takes a number of weeks to settle, and sometimes longer, particularly where the rotator cuff and shoulder-blade muscles need strengthening. This is not a sign that anything is seriously wrong; it reflects the time the shoulder needs to adapt and rebuild. The encouraging news is that the great majority of people improve well with a consistent, progressive approach, and that strengthening exercises — done patiently over time — tend to be far more effective than rest alone.
How chiropractic care can help
Chiropractors care for many people with shoulder pain of this kind. The aim of our care is to settle the symptoms, restore comfortable overhead movement, and rebuild the strength and control of the rotator cuff and shoulder blade that protect the shoulder going forward. Following a thorough assessment, our hands-on, drug-free care may include soft-tissue work to ease tension around the shoulder, mobilisation of the shoulder, shoulder blade and upper back where movement is restricted, and — central to recovery — a graded rehabilitation programme to strengthen the rotator cuff and the muscles that control the shoulder blade. Because we are a multi-practitioner clinic, we can also draw on physiotherapy. We will always be honest about what care can realistically offer and refer you on where appropriate.
What to expect at Back in Action
Your first visit is mostly about understanding your shoulder pain. We will take a careful history and carry out a physical examination of the shoulder, shoulder blade, neck and upper back, including tests of movement and strength. We will explain what we have found in plain language and discuss whether chiropractic care is appropriate.
You can read more on our new patients page, with current charges on the fees page. Because impingement responds best to a progressive approach over time, we will set out a realistic plan, explain your part in it, and review your progress as we go. We will be clear that consistency with the strengthening work, rather than any single treatment, is usually what turns the corner.
Helping yourself: self-care and recovery
Your own role is central in recovering from impingement:
- Reduce, rather than completely stop, the overhead activities that aggravate it
- Keep the shoulder gently moving within comfortable limits
- Follow a graded strengthening programme for the rotator cuff and shoulder blade consistently
- Pay attention to posture, since a rounded, slumped posture reduces the space available for the tendons
- Be patient and consistent, as the shoulder rewards steady effort over weeks rather than days
If you would like guidance tailored to you, we can build a safe, progressive exercise and self-care plan around your recovery.
Related conditions and treatments
Impingement syndrome is closely linked to shoulder pain, shoulder and arm pain, AC joint pain and other recurrent overuse injuries. The care we provide draws on approaches such as exercise and rehabilitation and chiropractic manipulation, and may form part of a wider plan alongside our chiropractic and physiotherapy services.
Take the first step
If shoulder pain on reaching or lifting is getting in the way of your life, you do not have to simply put up with it. We are happy to talk it through and help you understand your options. You can get in touch to book an appointment, or to ask any questions before your first visit.