26 Jun, 2025 0 Comments

FEELING THE PINCH?

WHAT YOU NEED TO KNOW

Do you get a sharp, debilitating pain in your shoulder when brushing your hair, putting on clothes, or raising your arm? Does it feel like your shoulder “catches” with intense pain mid-movement, then eases as you continue? If this sounds familiar, you might be dealing with Shoulder Impingement Syndrome (SIS).

SIS is a common shoulder condition that occurs when the tendons of your rotator cuff—those crucial muscles that stabilise your shoulder—get trapped in a narrow space within the shoulder joint, called the sub-acromial space. This pinching can cause inflammation, pain, and even more severe damage over time if not treated properly. While the discomfort may seem manageable at first, ignoring it could lead to long-term damage and a frustrating, prolonged recovery process.

WHAT CAUSES SHOULDER IMPINGEMENT?

The root cause of SIS often lies in repetitive overhead movements. Activities like swimming, tennis, golf, or weightlifting all involve raising the arm above shoulder level, which increases the risk of pinching the rotator cuff tendons. Even daily tasks, such as hanging laundry or reaching up to a high shelf, can contribute to shoulder impingement over time.

Poor posture can also play a significant role. If your shoulders are hunched forward, it changes the alignment of your shoulder blades and narrows the space where your tendons glide, increasing the likelihood of impingement. Muscle imbalances, where certain muscles are stronger or tighter than others, can further disrupt your shoulder mechanics, causing instability and repeated trauma to the tendons.

In some cases, SIS can result from trauma, such as a fall or accident, or due to structural issues like bone spurs. These bony outgrowths can form over time, narrowing the space within the joint and leading to more frequent pinching and irritation of the tendons.

Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury.

You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time.

The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.

SYMPTOMS OF SHOULDER IMPINGEMENT

Shoulder Impingement Syndrome presents with a variety of symptoms, which can range from mild discomfort to debilitating pain:

Pain when lifting your arm: You may experience a sharp, catching pain, especially when your arm is raised to shoulder height or overhead.
Weakness or discomfort when reaching behind your back or head: Everyday movements like tucking in a shirt, brushing your hair, or fastening a bra may become painful.
Pain radiating down your arm: The discomfort might not stay localised to the shoulder; it can spread down the arm towards the elbow or even the wrist.
Difficulty sleeping: Lying on the affected shoulder can exacerbate pain, often leading to disturbed sleep or the inability to sleep on that side.
Loss of strength: You might notice weakness in the shoulder, making it harder to lift objects or carry out routine tasks without discomfort.

These symptoms are often aggravated by physical activity, particularly those that involve repeated overhead movements, and they tend to worsen over time if left untreated.

DIAGNOSIS AND TREATMENT: A ROADMAP TO RECOVERY

Early diagnosis is crucial to preventing further injury and achieving a full recovery. A qualified physical therapist can diagnose SIS using manual tests to assess your range of motion, strength, and the specific location of your pain. Imaging, such as ultrasound scans or x-rays, can help confirm the diagnosis and reveal any additional complications, such as tendon tears or bone spurs.

Once diagnosed, the focus shifts to effective treatment. Shoulder impingement treatment often involves working through specific stages with a therapist to rehabilitate the shoulder and prevent recurrence.

1. PAIN RELIEF AND INFLAMMATION CONTROL

In the early stages, reducing pain and inflammation is critical. This may involve anti-inflammatory medications, laser therapy, ultrasound therapy, or corticosteroid injections in more severe cases. Manual therapy techniques like massage can help to release tight muscles and alleviate discomfort. Strapping or taping the shoulder may provide additional support, reducing strain on the injured tendons and helping to ease movement.

2. REGAINING RANGE OF MOTION

Once the pain is manageable, your therapist will guide you through exercises designed to restore your shoulder’s full range of motion. This step is essential to prevent stiffness and improve flexibility in the joint. Gentle stretches and mobilisation techniques can help, along with specific exercises targeting the rotator cuff and shoulder muscles.

3. STRENGTHENING THE SHOULDER MUSCLES

As your range of motion improves, the next step involves building strength in the muscles around the shoulder joint, particularly the rotator cuff and muscles that support the shoulder blade. This stage is crucial for stabilising the shoulder and preventing future impingement. Your therapist will prescribe tailored exercises that focus on both strengthening and restoring proper shoulder mechanics.

4. ADVANCED REHABILITATION: POWER AND AGILITY

For individuals involved in sports or physically demanding work, the final stage of rehabilitation involves more advanced exercises that enhance shoulder power, speed, and agility. These activities help prepare your shoulder for a return to high-intensity or overhead movements. At this point, proprioception exercises are introduced to help retrain your body’s awareness of joint positioning, improving coordination and balance in the shoulder joint.

WHY RECOVERY TAKES TIME

Shoulder impingement can be stubborn. While some cases respond quickly to treatment, many people require 3-6 months of consistent therapy before fully recovering. Each stage of recovery must be completed before moving to the next; rushing through the process can result in setbacks and re-injury.

Patience is essential during recovery. It’s important to monitor your progress closely with your therapist and gradually build up the intensity of exercises to ensure you regain full function without causing further damage.