What is Subacromial Impingement?

Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain. It occurs when the soft tissues within the shoulder become compressed beneath the acromion (the top part of the shoulder blade), causing pain and limiting movement.

The shoulder is made up of three bones and several muscles that work together to provide strength and mobility. The space between the ball-and-socket joint and the acromion is known as the subacromial space. When this space becomes narrowed, the tendons and bursa can become irritated or trapped during arm movements.

---

Causes of Subacromial Impingement

There are several factors that can contribute to shoulder impingement, including:

• Shoulder injuries or trauma
• Age-related bony changes
• Poor shoulder muscle control or instability
• Tight muscles and supporting tissues
• Reduced mobility in the upper back (thoracic spine)
• Weakness or poor movement of the shoulder blade
• Poor posture, particularly rounded shoulders
• Swelling or irritation of the shoulder tendons and soft tissues

Often, symptoms develop gradually without any obvious injury.

---

Common Symptoms

Subacromial impingement typically causes pain on the outside of the upper arm, although discomfort may extend towards the elbow.

Common symptoms include:

• Pain when lifting the arm forwards or sideways
• Sharp pain during certain movements
• A constant dull ache at rest
• Pain around the top of the shoulder and neck muscles
• Difficulty reaching overhead
• Reduced shoulder strength or movement

---

Treatment

Most people recover successfully without surgery.

Conservative treatment is highly effective and usually includes:

• Activity modification
• Pain relief medication
• Physiotherapy
• Shoulder strengthening exercises
• Postural correction

If symptoms persist despite rehabilitation, steroid injections or surgery may occasionally be recommended.

---

Managing Your Pain

Rest from Painful Activities

Although complete rest is not recommended, avoiding activities that aggravate your shoulder can help reduce irritation.

You should try to avoid:

• Reaching overhead repeatedly
• Lifting objects at shoulder height
• Heavy lifting with an outstretched arm

If you need to lift something, keep it close to your body and bend your elbow whenever possible.

---

Pain Relief

Over-the-counter medications such as paracetamol and ibuprofen may help reduce pain and inflammation.

Always:

• Follow the dosage instructions
• Check that the medication is suitable for you
• Speak to your pharmacist or healthcare professional if unsure

Your clinician may prescribe alternative pain relief if required.

---

Heat and Cold Therapy

Applying heat or ice may help ease symptoms.

General advice:

• Apply for no longer than 10 minutes
• Use up to five times daily
• Always protect your skin with a towel
• Follow instructions provided with gels or creams

---

Exercises for Subacromial Impingement

Regular exercises help restore movement, improve shoulder stability and reduce pain.

Aim to complete the exercises 2–3 times each day, provided your pain allows.

Pendulum Swings

Lean forwards while supporting yourself with your unaffected arm.

Allow your affected arm to hang relaxed and gently swing it:

• Forwards and backwards
• 10–15 repetitions

---

Isometric Shoulder Press

Stand or sit with your elbow bent to approximately 90 degrees.

Place your forearm against a wall with a pillow supporting your elbow.

• Push gently into the wall
• Hold for 5–10 seconds
• Repeat 10 times

As this becomes easier, gradually move your arm further away from your body.

---

Shoulder Blade Pushes

Stand facing a wall with your hands placed against it and elbows straight.

Without bending your elbows:

• Push your shoulder blades forwards
• Then squeeze them backwards

Repeat 10–15 times.

---

Tennis Ball Release

Stand with your back against a wall and place a tennis ball between your shoulder blade and the wall.

Gently lean onto the ball and roll over tight areas.

• Hold pressure for 30–60 seconds
• Repeat up to 10 times

---

Improving Your Posture

Poor posture can increase pressure within the shoulder.

When sitting:

• Keep your back upright
• Relax your shoulders
• Keep both feet flat on the floor
• Avoid rounded shoulders
• Take regular movement breaks

Try to correct your posture at least once every hour and avoid sitting continuously for longer than 30 minutes.

---

Recovery

Most people notice gradual improvement within 6–12 weeks by following an exercise programme and modifying activities.

Recovery times vary depending on:

• Severity of symptoms
• Shoulder strength
• Posture
• Exercise compliance
• General health

---

When to Seek Further Advice

You should contact your healthcare professional if:

• Pain continues beyond 6–12 weeks
• Symptoms become significantly worse
• You lose shoulder strength or movement
• Your symptoms interfere with everyday activities despite completing your exercises

Further assessment, imaging or additional treatment may be required.

---

Frequently Asked Questions

What causes subacromial impingement?

It is usually caused by irritation or compression of the shoulder tendons beneath the acromion due to poor shoulder mechanics, posture, muscle weakness, injury or age-related changes.

Will I need surgery?

Most people improve with physiotherapy, exercises and activity modification. Surgery is only considered if symptoms persist despite conservative treatment.

How often should I do the exercises?

Aim to complete your rehabilitation exercises 2–3 times each day, provided your pain allows.

How long does recovery take?

Most people experience significant improvement within 6 to 12 weeks, although recovery varies from person to person.

Can posture really affect shoulder pain?

Yes. Poor posture can alter the way your shoulder moves, increasing pressure on the tendons and contributing to impingement symptoms. Improving posture is an important part of treatment.