Shoulder Impingement: The 7 steps to fix it!

shoulder impingement
Image courtesy of stockimages at

Here’s what to expect in this post:

// What is Shoulder Impingement?

Shoulder Impingement is a condition where certain structures in the shoulder (… namely the Subacromial bursa and Supraspinatus tendon) get squashed by the surrounding bones.

As a result, shoulder pain can arise from 2 main issues:

  • a) Subacromial bursitis
  • b) Supraspinatus tendonopathy.

a) Subacromial bursitis:


What does this mean?… Let’s break it down into simpler terms:

  • Subacromial = “underneath the acromion”. (The acromion is a bony part of your shoulder blade.)
  • Bursitis “inflammation of the bursa”. (A bursa is a fluid-filled sac within the shoulder complex.)

Translation: It is the inflammation of the fluid-filled sac structure in the area of your shoulder that is underneath the acromion.

… Still confused?… You see that red thing in the above picture? … It’s getting squashed …and it’s causing your pain!

b) Supraspinatus tendonopathy:


The Supraspinatus muscle is part of a group of shoulder muscles which has the important role of stabilising the shoulder joint.

As the tendon of the Supraspinatus is subject to getting squashed in Shoulder impingement, it can lead to inflammation, strains and tears.


// Area of pain


With Shoulder impingement, the area of pain is usually felt deep within the shoulder joint.

In many cases, pain can also refer down the side of your upper arm. (see above)

// What are the causes?

Video from Smart PT Pro.

Since the area where your Subacromial bursa and Suprasinatus tendon is located is already very narrow, it is subject to being squashed and irritated. (see video)

There is further narrowing of the area when you move your shoulder (eg. lifting/throwing/pulling/pushing/carrying). And even more so if the shoulder is not moving properly.

… But here’s the real issue:

Your posture.

If you have bad posture… your shoulder will be in a position which will amplify the impingement of the bursa and tendon!

By fixing your posture, you will be addressing the root cause of your Shoulder impingement issue.


// The posture of someone with Shoulder Impingement


This type of posture is very common in people with Shoulder Impingement. (.. although I must admit I may be exaggerating it just a tad bit).

It places the shoulder in a very ineffective position which predisposes the bursa and tendon to being impinged.

… How does your posture compare?

// Do you have Shoulder Impingement?

Here are 3 quick tests that you can do to find out!

a) Painful arc



  • Raise your arm out to the side and over your head.
    • (Also known as Shoulder abduction)
  • You may have Shoulder Impingement… if you have pain between ~60-120 degrees of abduction, but nil/reduced pain at early and late movements.

b) Hawkins Kennedy test



  • Bring your bent arm bent to 90 degrees of shoulder flexion in front of you. (see above)
  • Crank your hand down with the help of your other hand. (Internal rotation)
  • You may have Shoulder Impingement if this movement reproduces your symptoms.

c) Neer’s test



  • Raise your arm in front of you with your thumb pointing downwards.
  • You may have Shoulder Impingement if this movement reproduces your symptoms.

Note: These tests for Shoulder Impingement 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 7 steps to fix your Shoulder Impingement

Image courtesy of stockimages at

  1. Stop all activities that cause pain
  2. Reduce inflammation
  3. Reduce pressure on squashed structures 
  4. Release tight muscles
  5. Start with these exercises
  6. Scapula position
  7. Strengthening exercises

Note: Each exercise 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!”

Avoid over head movements, lifting and sleeping on the painful shoulder!


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 to do some 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 the 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 4-5/day.


d) Shoulder sling


If all else fails, you can temporarily immobilise your shoulder for a short period of time. (… but I wouldn’t go past 2 days!)

Step 3: Reduce pressure on painful structures

a) Shoulder traction (with a resistance band)



  • 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.
  • It is important that you 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.

Step 4: Release tight muscles:

If your posture is not ideal, then your shoulder will be in an sub-optimal position. This leads to a higher risk of Shoulder Impingement!

Tight muscles are pulling you shoulder girdle out of the ideal alignment. We need to release those muscles first!


  • Place target area on to a massage ball (or foam roller).
  • Apply a firm pressure in a small circular motion.
  • Aim to do 1 minute on each area.
    • (… or as long as you require)

Images from TriggerPoint.

a) Pec minor



b) Upper trapezius



c) Latissimus Dorsi



d) Serratus anterior


f) Posterior capsule

A tight posterior capsule can push the humeral head forward in the shoulder socket. This may increase the chance of shoulder impingement.



Note: Following these releases, I strongly recommend that you also stretch the muscles for best results.


Step 5: Initial exercises

The goal here is to keep the shoulder as mobile as possible.

Do what you can. Don’t do more than you can do…

Depending on the severity of your pain, these exercise may be quite challenging (… or not difficult at all). If there is nil issue, move on to Step 6.

a) Pendulum



  • Lean over to allow your arm to dangle 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.


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.

c) Rotations



  • 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.

Step 6: Scapula position

Many dysfunctional positions of the scapula will increase the chance of Shoulder Impingement from occurring.

By optimising posture (… and with it the scapula position), the subacromial area where it is subject to narrowing will be adequately maintained.

Note: There is no one perfect position of the scapula. The scapula is designed to move and be adaptive to whatever function it needs to perform.

Video from Daily Bandha.

Main points:

  • The scapula should glide smoothly and be well controlled on the rib cage.
  • As the arm is raised, the scapula should laterally rotate so that the inferior angle reaches the side of your ribs.
  • Over head arm movement is highly reliant on optimal scapula positioning.
  • It can help if you visualise how the scapula should be moving as you use your arm.
  • The scapula should sit flat on the rib cage throughout movement.

Step 7: Strengthening

You must ensure optimal scapula positioning throughout all of these exercises. 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 inflammation in  your shoulder.

External rotation



  • Keep you elbows tucked to the side of your body.
  • Pull the resistance band away from each other.
  • Bring your arms forward by 10cm.
  • Hold this position for 30 seconds.
  • Repeat 3 times.



2. Anti-impingement training:


If the shoulder bone (… also known as the humeral head) is not centrated in the shoulder joint, it can often move in an upwards position. This can lead to the impingement of the structures in the subacromial space.

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/inwards direction into the socket whilst you move your arm. (see picture above)

(This may take some time to understand and perform correctly… and that’s fine. Keep at it!)

a) Extension:



  • 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.
  • Progression:
    • Start from a higher position.
    • Apply more tension to the band

b) Adduction:



  • 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.
  • Progression:
    • Start from a higher position.
    • Apply more tension to the band

c) 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
  • Progression:
    • Apply more tension to the band

3. Against gravity

Progress to these exercises only if you are able to conduct the previous Shoulder Extension, Adduction and Internal rotation exercises easily.

Ensure that you are depressing your humeral head throughout movement. (see above exercises)

a) Flexion:



  • Stand on the end of a resistance band.
  • Aim to pull the resistance band upwards to shoulder height.
    • Consider lifting as high as possible with NO 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.

b) Abduction:



  • Stand on the end of a resistance band.
  • Pull the resistance band side ways to shoulder height.
    • Consider lifting as high as possible with NO 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.

c) 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


4. Get strong at your meaningful task

Ask yourself:

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.

For example: If you have difficulty hanging out the clothes on the clothes line… you can do the following exercise:



  • Stand on the end of a resistance band.
  • Aim to pull the resistance band upwards to above shoulder height.
    • Make sure there is NO 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.

(… Have no idea what to do? Send me an email and I will help you out!)


Step 8: Fix your posture!

Remember… if your bad posture is placing your shoulder is an ineffective position, it is going to be susceptible to injury. (… and that includes getting shoulder impingement!)

Oh no… 🙁

… But you’re in luck! I’ve dedicated this WHOLE website to offering the exact strategies to fix your posture.

Bad posture is the root cause of your pain!

Have a look at these posts to get your started:


// What about the Cortisone injection?


If you have already been to your doctor, then the chances are that they have already suggested that you get the cortisone injection.

“Huh? What’s that?…”

This particular injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to:

  • a) reduce the inflammation and
  • b) reduce the pain by numbing the area.

Sounds great in theory… right?


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!).

“Mark! … But what do YOU suggest?”

I say, see how you go with these 7 steps for about 4-6 weeks. If there is absolutely no improvement (… or if it’s getting worse), you then can consider getting one.

It should NEVER be the first thing that you do.

Any questions?…

Leave a comment down below and I will get back to you!


I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

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85 thoughts on “Shoulder Impingement: The 7 steps to fix it!

  1. Hey Mark,

    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?

    1. Hi Brandin,

      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).


  2. 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.

    Thanks again!

    1. Hi Javier,

      Great question.

      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.


  3. 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

  4. 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.


    1. Hi Michael,

      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.


  5. 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?

    1. Hi Jeff,

      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.


  6. Hello Mark,

    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.

  7. Hi Mark,
    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.

    1. Hi Shew,

      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.


      1. Hi Mark,
        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) ?
        Best regards

        1. Hi Shew,

          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)


          1. Hi Mark,
            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
            Best regards

          2. Hey Shew,

            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)


  8. 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.

  9. 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…


    1. Hey Corey,

      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?


  10. 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. Hey Mike,

      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!


  11. 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

    1. Hello Kerry,

      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.


  12. 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

    1. Rehanahmed,

      3. There is obliteration of inferior glenohumeral recess is seen, suggesting an element of adhesive capsulitis.

      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.


  13. 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.

  14. Hi Mark
    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.
    Kind regards

  15. 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.

  16. 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!


      1. hi Mark,
        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?


  17. 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.

    1. Hi Anne,

      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.

      An easy one is a wall push: (see below)

      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.


      1. 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.

  18. Hi Mark,

    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. Hi AJ,

      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!


  19. Hi Mark,
    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.
    Kind Regards

  20. 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?

  21. Hi Mark,

    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.

    Thanks Mark!

    1. Hi Liz,

      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 .


  22. Hi Mark:

    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?

    1. Hey Paul,

      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.


  23. 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?

    1. Hey Jennifer,

      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.


    1. Hey Audrey,

      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.


  24. 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!

    1. Hi Ryan,

      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. (see link)

      You can get a MRI if you would like to double check everything.


  25. 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

    1. Hi Ilene,

      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.


      1. 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

  26. 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

    1. Hey 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.


      1. 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!

      2. Hello,

        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

        1. Hi Raymond,

          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.


          1. Hi Mark,

            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?

          2. Hey Raymond,

            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.


  27. Hi Mark
    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

    1. Hey Chris,

      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).

      You can work on it doing this simple exercise.

      Listen to your body. Do not push into pain (esp. if you have known labral tears).


      1. Hi Mark,

        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.

        1. Hey Raymond,

          I like do start off with controlled shoulder articulations: Here is a video.

          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?


          1. 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

  28. 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.

    1. Hi Ishbel,

      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 !


  29. 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

  30. 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.

  31. 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.

    Thank you

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