Shoulder Impingement: The 8 steps to completely fix it!

shoulder impingementImage courtesy of stockimages at FreeDigitalPhotos.net



What is Shoulder Impingement?

Shoulder Impingement is a condition where there is compression of certain structures in the shoulder (… namely the Subacromial bursa and Supraspinatus tendon).

As a result – these structures become irritated and painful.


The 3 main issues associated with Shoulder Impingement are:

  1. Subacromial bursitis
  2. Supraspinatus tendinopathy
  3. Supraspinatus tear

1. Subacromial bursitis:

subacromial-bursitis

Let’s break it down into simpler terms:

  • Subacromial = “underneath the acromion”.
    • (The acromion is a bony protrusion 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!

2. Supraspinatus tendinopathy:

supraspinatusimpingement

The Supraspinatus is part of a group of shoulder muscles called the rotator cuff.

It has the important role of stabilising and moving the shoulder joint.

As the supraspinatus tendon sits directly underneath the acromion (see above), it is susceptible to getting compressed.

This can lead issues in the tendon such as:

  • Inflammation (“Rotator cuff Tendinitis”)
  • Degeneration (“Rotator cuff Tendinosis”)
  • Strain
  • Calcification

3. Supraspinatus tear

Repeated impingement of the supraspinatus tendon in the subacromial space can eventuate into a tear.

Rotator cuff surgery may be required to fix the torn tendon, however, I would always try the conservative route of rehabilitation first!

What causes a Shoulder Impingement?


Video from Smart PT Pro.

Other factors to consider:

  • Improper shoulder mechanics
  • Poor postural factors (eg. Uneven shoulders)
  • Acromial spurs
  • Repetitive use of shoulder (lifting/throwing/pushing/pulling etc)

Symptoms

supraspinatus-2

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)

Pain is often aggravated in certain positions of shoulder such as over head movements.

Tests for Shoulder Impingement

“Mark! How do you know if you have shoulder impingement?”

Here are 3 shoulder impingement tests that you can quickly perform:


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.


a) Painful arc

painful-arc

Instructions:

  • Raise your arm out to the side and over your head.
    • (Also known as Shoulder abduction)

You may have Shoulder Impingement if you have:

  • Unable to lift arm into full range.
  • Pain between 60-120 degrees of abduction.
  • Nil or reduced pain at early (0-60 degrees) and late (120-180 degrees) shoulder abduction.

b) Hawkins Kennedy test

crank-test

Instructions:

  • Bring your bent arm to 90 degrees of shoulder flexion in front of you. (see above)
  • Crank your hand down with the help of your other hand. (Shoulder Internal rotation)
    • Do not let your shoulder hitch upwards.

You may have Shoulder Impingement if this movement reproduces your symptoms.


c) Neer’s test

neer-test

Instructions:

  • Raise your arm in front of you with your thumb pointing downwards.

You may have Shoulder Impingement if this movement reproduces your symptoms.


Shoulder Impingement exercises

shoulder-hurtsImage courtesy of stockimages at FreeDigitalPhotos.net


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?

stop

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!
If feels fine, keep at it!”

Avoid aggravating positions such as over head movements, lifting and sleeping on the painful shoulder!

reachingover-head-liftingside-sleeping-no


Quick tip: When you do use your shoulder, try to keep your elbows pointing towards the ground AND close to the side of your body.


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

voltaren

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

coldpack

Apply an ice pack to your shoulder for at least 10-15 minutes.

Do this 3-5 times per day.

d) Shoulder sling

shoulder-sling

If all else fails, you can temporarily immobilize your shoulder for a short period of time.

(… do NOT wear it for longer than 2 days!)

e) Try natural products

Taking turmeric and/or fish oil capsules are natural ways to help reduce the inflammation.

Step 3: Reduce pressure on painful structures

a) Shoulder traction (with a resistance band)

traction-shoulder

Instructions:

  • 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.
  • 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.

Note: Do NOT pull into sharp pain. (… especially if you have a tear!)

Step 4: Release tight muscles:

If you have a slouched posture, then your shoulder will likely be in an sub-optimal position.

This may lead to a higher risk of developing Shoulder Impingement!

Let’s release those tight muscles that are pulling your shoulder girdle out of the ideal alignment.


Instructions:

  • Place target area on top of a massage ball (or foam roller).
  • Apply an appropriate amount of your body weight on to the ball
  • Continue for 1 minute on each area.Make sure that you cover the whole muscle.

Images from TriggerPoint.

a) Pec minor

pec-minor-trp

b) Upper trapezius

upper-trap-trp

c) Latissimus Dorsi

lats-trp

d) Serratus anterior

serratus-trp

f) Posterior capsule

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

posterior-capsule-trp


Note: If you would like to know how to completely fix your Rounded shoulders, check out this post.


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’t…

Overprotecting your shoulder may predispose you developing frozen shoulder. (… and that’s way worse than Shoulder Impingement!)

a) Pendulum

pendulum

Instructions:

  • Lean over a chair and allow your arm to hang 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.
  • Alternative:
    • Roll a ball on a table top in a circular motion.
  • Progression: Generate more tension throughout the whole arm as you move the arm.

b) Forward leans

shoulder-flexion

Instructions:

  • 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.
  • Alternative:
    • Roll a ball forwards/backwards on a table top.
    • Roll a ball up/down the wall.

c) Rotations

extrotn-movement

Instructions:

  • 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.
  • Progression: Generate more tension throughout the whole arm as you move the arm.

Step 6: Ideal scapula position

By optimizing the scapula position, this will help reduce impingement in the subacromial space.


How to get your scapula into a better position:

  1. Gently retract the shoulder blades BACKWARDS.
  2. Tilt your shoulder blades DOWNWARDS.
    • Imagine the inferior angle (“the pointy part of lower scapula”) is digging into your back.
  3. Pull your shoulder blades DOWN.
    • Imagine tucking your shoulder blades into your back pockets of your pants.
  4. Gently wrap your scapula AROUND the ribs.
  5. Keep your shoulders long/wide.
  6. Relax. Don’t force it!

Now that you know how your scapula should ideally sit, have a look at how it should MOVE as you use your arm.


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
    • This will promote more space where compression occurs in the subacromial region.
  • Over head arm movement is highly reliant on optimal scapula positioning.
  • It can help if you visualize how the scapula should be moving as you use your arm.
  • The scapula should sit flat on the rib cage throughout movement.

This is achieved by learning how to…

Step 7: Activate your Serratus anterior

This muscle is responsible for moving your shoulder blade more effectively as you use your arm.

It is important that you can feel the serratus anterior muscle contracting as you perform the following strengthening exercises.

Activating the Serratus anterior:

Instructions:

  • Assume the wall plank position.
  • Assume the Ideal scapula position.
    • (See step 6)
  • Activate the Serratus anterior:
    • Pull your shoulder blades DOWN and AROUND the ribs.
    • Keep your shoulders long/wide.
    • Push your forearms into the wall.
  • Aim to feel the contraction in the lower and side region of the scapula.
    • (… This is where the Serratus anterior muscle is!)
  • There should be a balance between the muscles that are pulling backwards and the muscles that are pulling down/around.
  • Hold for 30 seconds.
  • Repeat 5 times.
  • Progression: Whilst maintaining the activation of the Serratus anterior, slide your forearms up/down the wall.

Check out this post for more serratus anterior strengthening exercises.

Step 8: Strengthening


Maintain the Ideal scapula positioning throughout all of these exercises.

Remember:

  • Tilt the shoulder blades BACKWARDS.
  • Pull your shoulder blades DOWN and AROUND the ribs.
  • Keep your shoulders long/wide.

… 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 symptoms in your shoulder.

External rotation (with flexion)

Instructions:

  • Keep your elbows tucked to the side of your body.
  • Gently pull your shoulders back.
  • Hold a resistance band between your hands.
  • Pull the resistance band away from each other.
    • (External rotation)
  • Whilst maintaining the tension on the band, lift your arms up as high as you can with nil pain.
    • (Flexion)
  • Hold this position for 30-45 seconds.
  • Repeat 3 times.

Note: Only push yourself as far as you are comfortable!


2. Anti-impingement training:

rotatorcuffstability

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 AND 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:

extension

Instructions:

  • 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:

adduction

Instructions

  • 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:

ir

Instructions:

  • 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.
  • Maintaining optimal scapula position.
  • Engaging the serratus anterior.

a) Flexion:

flexion

Instructions

  • Stand on the end of a resistance band.
  • Pull the resistance band as high as you can comfortable go without 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:

abduction

Instructions:

  • Stand on the end of a resistance band.
  • Pull the resistance band towards the side as high as you can comfortably go without 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:

ext-rotn

Instructions:

  • 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. Strengthening in functional positions

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.

(If you are not sure what to do, feel free to leave me a comment down below and we can brainstorm together!)


For example:

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

meaningful-task

Instructions

  • Stand on the end of a resistance band.
  • Gently pull your shoulders back and down.
    • This is to prevent you starting from a slouched shoulder position.
  • Aim to pull the resistance band as high as you can go without causing any pain.
    • (Experiencing a small amount of discomfort is fine!)
  • 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.

Step 8: Fix your posture!

Sub-optimal postures will place your shoulder in an ineffective position to function.

This can predispose the bursa and tendon to being impinged.

Bad posture may be the root cause of your pain!

Common questions:

a) How long does it take to recover from Shoulder Impingement?

It really depends!

There are many factors that will influence the time it will take for a full recovery.

Try to focus on consistent improvements.

b) Does the Cortisone injection help?

cortisone-needle

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?

Yes, it does…

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?”

My recommendation:

  • Persist with these 7 steps for about 4-6 weeks.
  • If there is absolutely no improvement (… or if it’s getting worse), then it might be the next step to take.
  • It should NEVER be the first thing that you do.

c) Do I need surgery?

My immediate answer is going to be NO.

The reason behind this is that I have a strong belief in healing the body via conservative means.

Please give these exercises a try before even considering surgical intervention.

(Keep in mind – not all surgeries are successful!)


What to do next:

1. Any questions?… Leave me a comment down below.

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises for your Shoulder Impingement!

About

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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196 thoughts on “Shoulder Impingement: The 8 steps to completely fix it!

  1. HI there. First of all your info on here is fabulous! very practical and well laid out.
    Last year (Feb 2019) I was downhill skiing and crashed on my right shoulder. IT was fine immediately after the accident but started to be painful and immobilized after about 4 hours. I have never had a shoulder injury and I cannot believe how LONG it is taking to heal. I stopped doing wts on advice of Dr. and have been paddling, running and doing other sports but nothing extreme. I have been diagnosed through various radiological workups and also from my GP/Physiotherapy/RMT etc that I have a right shoulder impingement. Radiology said ”
    Good thickness and congruency is maintained of the infraspinatus tendon. Focal
    hypoechoic 4 mm lesion is noted within the supraspinatus tendon approximately
    1.7 cm from biceps tendon.” but said no fluid in bursa, no calcification etc. Suggested impingement and “Underlying labral tear, arthropathy or rotator cuff tendinitis/tendinopathy are not excluded.”
    I am an older (60’s) high performance athlete and have played many different sports my entire life… some like paddling at an international competition level. It is now 6 months from the accident and it still flares (keeps me up at night etc) once in a while. Usually it is around overdoing it (planks for instance). I am not sure where to go with this … wondering if after 6 months it should be stabilizing and not flaring. Any suggestions?

    1. Hey Bee,

      Thanks for you question.

      If there is nothing structurally wrong with your shoulder, I would be searching for ways to increase the strength in the shoulder ranges where you are experiencing pain.

      Once you identify what movement is impaired, you can start to tailor exercises specifically for that.

      Resting is good in the short term, but it is best to progressive load the weakened/injured tendons/muscles.

      Mark

  2. Hello Mark,
    Thanks a lot for the article, really appreciate it. I have been experiencing shoulder pain for about 4 weeks now, being a nurse, my job does include work excessive use of the shoulder, but controlling as much as possible. I do believe i have a slouched posture too, for which I have recently started wearing posture correction brace, do you think that would help with the above exercises. Along with that, I do weight training too, so what muscle groups should I avoid and for long? I would appreciate your response.
    Thank you.

    1. Hi Tijo,

      Posture braces are okay in the short term. Try not to get reliant on it!

      You can continue with any gym exercise (… even if your chest is tight). Just try to keep a good posture!

      Mark

  3. Hi Mark!
    Thanks for this useful article. My right shoulder began to be painful 4 months ago when I was playing badminton (especially when I do smash). I went to 3 doctors and every doctor have different diagnosis.

    1st doctor (physical rehabilitation doctor): my supraspinatus was torn around 4 mm (checked by USG), the doctor ask me to rest and do physical therapy (heat and electric), and wait the tear recover itself. I did the therapy for one month but no improvement, then I went to other doctor.

    2nd doctor (orthopedic doctor): he checked my supraspinatus by USG, but found no tear. He said by problem is shoulder impingement, coz my bad posture (hunchback) asked me to train my back muscle, and do physical therapy (heat and electric).

    Coz I’m confused with different diagnose, I went to 3rd doctor (orthopedic specialize in sport injury).
    3rd doctor: he diagnosed I have SLAP tear, asked me do MRI. The result show no slap tear. He also checked by USG my supraspinatus and found no tear. Then he said my problem is shoulder impingement, he asked me meet physical therapist to ask some therapy. The therapist said that my scapula and back muscle are too weak, and because I did overhead activity (badminton), my right shoulder tended into front direction. He asked me to do scapula stabilization exercise with tennis ball and elastic bend. I also do several exercise that you mentioned in the article.

    Mark, how long should I take this exercise? I already stop playing badminton and go to gym for 4 months, and it make me depressed since I always do sport 1 week at least 3 times before this injury. I want to go back to play badminton and gym as soon as possible. Actually the pain degree is only 3/10. I still can go to gym and play badminton, but I’m afraid some tendon will torn if I overuse.

    Can you give me some suggestion?

    Thank you very much

    1. Hi Ricky,

      It sounds like you need to strengthen the tendon that is involved. The exercises mentioned in the blog post will be a good place to start.

      Prioritize getting full range of motion. Follow that up with strengthening of the tendons involved. Then progress functional movements. (in your case, you need to do exercises that mimic the shoulder positions that you adopt whilst playing badminton)

      Mark

      Ps. Physical therapy should be more than just heat and electrical stimulation (in my opinion!)

  4. Hi Mark! Thanks for this valuable info! I have been dealing with shoulder impingement for over 5 years after trying physio, PRP,etc. I finally was not feeling any pain for about two months but it just came back.

    I’m not sure what do to since I have tried everything before and nothing really seems to work.

    Thanks,
    Gianna

    1. Hello Gianna,

      I would start with the protocol as mentioned in the blog post.

      It’s all about strengthening the range of motion that is currently available.

      Mark

  5. Hi Mark.

    I’m Dinesh. I am 32 years old. I have been in martial arts training for 5 years, kickboxing for 3 years and gymming for 10 years. I was trying to increase my lean muscle mass last year. While doing bench press I got a pain in my left shoulder. I couldn’t find out what it is. I tried to find info from many websites. My pain is in the front and deep inside the lateral delts. I can do normal works. But when I try to do bench press and overhead press I feel the pain in the shoulder. I stopped the workouts for almost five months. By seeing your article it seems like I have got shoulder impingement. Will I be able to do workouts again? I have a slight pain now. I would rate 2 out of 10. I don’t like my present life style. I want to hit the weights again. How to get back to workouts?

    1. Hey Dinesh,

      I wouldn’t stop the gym if that is what is important to you.

      You will need to stick with exercises that you are very comfortable with.

      If your pain is shoulder impingement, I would trial the mentioned exercises first. From here – you might need to do more specific exercises, however, it;s hard to say without assessing you in person.

      Mark

  6. Hi Mark,

    This article is absolutely amazing, thanks so much.
    everyone elses info on the internet is so incomplete and barely skims the surface

    my left shoulder has always been the issue

    I have a weak / inactive Serratus Anterior, and I also have a huge knot in my back on the left side around the supraspinatus and infraspinatus. Scapula Retraction / Protraction is knotted and painful.

    I have a heavy gym background, too much chest day.
    I find releasing the pecs and lats help free everything up so much!

    during my chest movements I also keep internally rotating too much, so will have to learn not to. and start doing them with a flat scapula

    Lateral Raises have always been the lift that hurts, I get a huge pinch where the 3 deltoids meet together (below the lateral deltoid). once I release everything and do some light lateral raises / serratus anterior strengthening / External rotator strengthening everything feels amazing like its gliding and getting stronger

    but then I wake up the next day and its very tight / knotted and painful again?
    and there I am thinking what went wrong?

    any tips?
    cheers legend

  7. Hello Mark. I’m not sure if I do have a shoulder impingement but after years of suffering with a neck/shoulder problem I’m trying anything to try to fix the problem. I suffered a concussion in 2006 and I’ve been dealing with problems since. I’ve seen just about every so called professional, from chiropractors, neurologist, doctor, physiotherapist and no one seems to know how to fix me.
    There doesn’t seem to be anything seriously physically wrong with me since the chiropractor straightened out my pelvis but I do have uneven shoulders on my injured/dominant side. An MRI also showed there’s nothing wrong neurologically.

    My head pulls to the same side as my injury (the right side) in a tilted fashion and anytime I try to straighten up it causes my head to shake due to the muscular tension. I’m basically having to fight what my body wants to do and what I want to do. I can move my neck around in full motion and when I support it with my hand it doesn’t shake but when my neck is doing all the work it keeps wanting to pull to the injured side, using the muscles on the uninjured side.

    I’ve tried and I’m trying lots of neck/shoulder exercises but nothing really seems to be helping that much.

    I do sleep on the right side with my arm under pillow and wake up with pain on that side which I try to stretch out. I think I might have to change my sleeping habit.

    I feel pain in the right shoulder and I think my mind is connecting to the pain and pulling away from it by tilting my head causing lots of neck tension. It’s worse when I’m standing or sitting still because that is when I feel the pain.

    If you could advise me when nobody else has an answer for me I would be in your debt!

    Matt

  8. Hello,

    Ive been doing most of this for about a month. My posture has gotten a lot better, but my arms and shoulders have become very weak and i can feel a tingling/numbness through my arms/hands and the thumb and two fingers closest to. Do you know why this has happened, or how to fix it?

    Kind regards
    Rasmus

    1. Hey Rasmus,

      Tingling in the first 3 digits could be related to:
      – carpal tunnel syndrome
      – C6/7 nerve issue
      – Tight forearm pronators

      Is there someone you can get an assessment from to rule these out?

      Mark

      1. Hi Mark,

        Thanks for this article. I’ve been weight lifting since Febuary of last year and noticed weak shoulders from the beginning, which was perhaps a lack of good form in pushing exercises. However my impingement has probably been there since the start (particularly on the right) and I only went to see a physio at the start of this year who put me on a bit of a rehab programme (which included a lot of the exercises above, with resistance bands). However my impingement keeps coming back after a week or so of little to no pain. I constantly get the clicking when I rotate both shoulders and my shoulder press is non existent because of this issue. Is there anything in particular you’d recommend without having to abandon gym/pushing exercises completely. Would also like to start building muscle in my shoulders which I haven’t really been able to do.

        Many thanks.

  9. Hi Mark!
    Thanks so much for always posting free and quality content. I’ve had postural issues for several years, and because of your website, I finally have hope of curing my issues.

    I wanted to ask, I saw you answering another commentor before but I have a similar issue. So when I press this spot on my neck, I also get like a sore pain radiating through my left arm:
    https://i.ytimg.com/vi/yDDX9ayrcbg/hqdefault.jpg

    Is this from shoulder impingement?

    I don’t have shoulder pain, but I do have shoulder weakness radiating through my left arm. When I do the three tests you have shown, I feel like a soreness/ache through my whole arm. It’s not pain but it’s not pleasant. When I massage the areas near my clavicle bone and really near the shoulder bone (it feels like a tendon), that’s when I get that ache. What do you think this may be? I have postural issues as well – do you think it might come from things like rounded shoulders, winged scapula forward head and so forth?

    I’m trying to find a physio as well (the physios I’ve tried so far didn’t really diagonse me and only gave me band exercises and head nodding exercises to fix my muscle weaknesses) – do you know any physios outside NSW that you can recommend me?

    Thanks so much!
    Jess

    1. Hi Jess,

      That spot you are referring to is the scalene muscles. It is usually associated with neck issues and not specifically shoulder impingement.

      Can you locate the painful spot you are referring to. The one near the collar bone/shoulder bone.

      Posture may be influencing your symptoms, but can’t say for sure if it is the only factor.

      Mark

  10. Hi Mark,
    Great article. I am now following you on fb 🙂 In terms of strengthening for functional movements, I was wondering what exercises/movements you would suggest to get back into surfing/freestyle swimming/front crawl. I have the dreaded “swimmers shoulder”/shoulder impingement. I’ve been doing physio for months and months, but my shoulder continues to flare up likely because of poor posture at my desk (Trying to break that habit) . I just want to surf again! :’(

    1. Hey SurfChaser,

      If you have already addressed the inflammation, here are some other things you might want to consider looking at:

      1. I would invest a lot of time doing “shoulder CARS“.

      Try to do as big of a circle as you can without causing any pain.

      2. Make sure to address any Rounded shoulders issues to create more room for the shoulder joint to move.

      3. Address any thoracic kyphosis that may be pushing your shoulders forward.

      4. Make sure you have full shoulder internal and external rotation.

      Mark

  11. Hi!

    I have an impingement in my supraspinatus (got diagnosed 5 weeks ago) and my neck is starting to get more and more stiff. Is this normal? Also, how often should you perform the various steps? Should you go through all the mobility/tension releasing excerices everyday, or even multiple times a day? Additional info: It feels like my neck loosens up a bit when excercising, even if I don’t workout my upper body – as if moving around makes it better.

    Looking forward to hearing from you!

    Sincerely,
    Carla

    1. Hey Carla,

      It is quite common to get neck issues when you have a shoulder problem. This is due to the fact that the neck muscles will start to compensate for the shoulder.

      You can perform these exercises every day… but it depends on how far you are pushing yourself with the exercises.

      If you are every tight, perhaps you may benefit more from the mobility and releases for now.

      Mark

  12. Hi Mark,

    I`ve been struggling with a shoulder impingement for a few years now. I dont get any pain when completing this menu which is great, but what aggravates my shoulder is when i bench press and/or chest fly; Ive stopped doing these exercises because so. It doesnt hurt immediately, but a day or two after im in agony. This leads me to think that my shoulders are rounded due to tight pectorals and weaknesses in my back. what are your thoughts on this?

    And also, in step 4 of your menu, it says to mimic the exercise that cannot perform due to impingement with resistance band, why is it good to do that? would strengthening my chest not bring my shoulders forward even more?

    Thanks for your help, your website and information is brilliant.

    Stacey Banks

    1. Hi Stacey,

      You would have to have a look at how your shoulder is specifically moving as you perform the bench press.

      Look at the shoulder position when you have the bar at its lowest position. It is common to let the shoulder tilt forwards which can then stress out some of your structures in the shoulder.

      If you feel your rounded shoulders are the main factors, check out this post: How to fix Rounded shoulders.

      In regards to step 4: This relates to your goal. Why do you want to get your shoulder better? It is to get back into pain-free bench pressing. If it still hurts, you perhaps will need to focus on other exercises for now, change your bench technique, adjust how low your drop the bar etc. so that you can perform the exercise.

      Thanks for your comment.

      Mark

      Mark

  13. Hi Mark! I love your blog. I have been using a bunch of your suggested exercises to correct impingement in my left shoulder and they’ve been very helpful.

    I keep irritating my shoulder by sleeping on it, though. I try to sleep on my back but always end up rolling onto my left side during the night. Then I wake up with a sore shoulder. Do you have any tips I could use to train myself to sleep on my back?

    1. Hey Johnathan,

      I’m not going to lie to you… changing sleeping habits are not easy!

      You can block the left side of your body with a pillow wall so that essentially stops you from rolling onto that side.

      You could even lie slightly more so onto the right shoulder with the left half of your body propped up and supported by the pillow wall.

      Mark

  14. Dear Mark,

    being a therapist myself, I am also an easy victim to impingement and I am constantly fighting it after 17 years in business. Thank you for your website and for all the tips, tricks and exercises. I started applying them today and will be happy to teach them to my patients, too. I will direct some to your homepage, but as I am situated in Germany, most of my patients will not understand the English instructions.

    Best regards
    Georgia

    1. Hey Georgia,

      Thank you so much for your comment.

      So happy that you have found the blog helpful 🙂

      Keep up the great work with your patients.

      Mark

      Ps. I might have to get the website translated in german one day!

  15. Hi Mark!

    I’m really sorry to add to the long list of people asking for advice but I really enjoyed reading your article. I get an uncomfortable but not painful sensation when I go from arms outstretched over my head and then rotating the shoulder to reach behind my back. I’m a skydiver and this is how you throw the chute (so it opens) the click happens at the top of the shoulder during the transition. Any advice on what that might be would be REALLY awesome. Done lots of research but can’t find an answer 😢

    1. Hello Joe,

      Don’t be sorry for asking for advice. I’m here to help!

      To perform the motion you mentioned, you need a good amount of Shoulder External rotation. (SEE IMAGE)

      Having tight lats, pecs, anterior capsule and/or triceps might cause issues in this position as well.

      What exact structure you have implicated is hard to say! I would have to see the specific area where you experience the symptoms.

      Mark

      1. That’s perfect Mark thanks for helping isolate the issue. I’ll look into what might be right and make it right 👍👍👍

  16. Hello Mark,

    I have been dealing with subacromial impingement for nearly 9 months. My condition has not improved. I feel I am exasperating my shoulders by continuing to do the wrong exercises for rehab. Would you be able to advise me if any of the following exercises I am currently doing will aggravate my subacromial impingement?

    – One armed rows (35 lbs)
    – Face Pulls with resistance band
    – Face down Y’s , I’s and T’s
    – Horizontal Pulling Rows with Gymnast Rings

    1. Hey Kody!

      That’s a hard question to answer without seeing you.

      If you have the pre-requisite movement and strength in your shoulder to do the exercises, then it should be fine.

      Best way to determine for yourself is to go by how you feel. Does it hurt during or after doing the exercises?

      If so – consider modifying the exercise to an intensity/range/speed/depth that you can control comfortably.

      Mark

      1. Hi Mark,

        It definitely hurt doing the Abduction and Flexion exercises against gravity (even at the lowest point). However, I could do external rotations no problem. I also tried Serratus punches (lying down) with 15 lbs weights. I felt discomfort doing these as well.
        I even tried passive hanging on my pullup bar (~5 min). I don’t know if hanging is aggravating my shoulders.

        Right now, I’ve taken 2 Naproxen and still feel pain just by standing with arms down at my side. I have pain all day every day for the past few months and I don’t know what exercises to do because during exercise it might feel okay but then a couple hours later the pain hits me.

        Kody

  17. Thank you so much for this wonderful article!! Every single post of yours has been extremely enlightening, uplifting and very helpful! I’ve been suffering for months with shoulder pain and have been so frustrated!! I’m seeing a physical therapist who is trained in PRI techniques and am working on my posture but the pain is overpowering on many days..your posts help me understand what is going on and give me some hope that I may be pain-free one day and be able to lead an active lifestyle.

      1. Thank you Mark! All of the PRI concepts are finally starting to make sense, but the pain cycle is definitely tiring. I work a desk job with computers and realized after seeing my current PT,that, my posture has been wrong for many years . I was told I have APT and laterally tilted to my right as well. I’m still in a lot of pain and not leading an active lifestyle like i want to because even basic things like walking for 15 mins or standing hurt so much! Lingering question in my mind is how much stretching vs strengthening vs activation should be incorporated daily? Some days I feel I cant move my pelvis to the correct position for sitting, standing or walking as the pain is stopping me and other days i can do it. I have ups and downs where I do great with exercises taught by the PT and sometimes cant do them at all. For Example, I started doing planks and in 2 weeks or so my left shoulder was hurting really bad, my nerve was tingling in my upper arm, tricep swollen so much I had to back off. That small set back threw my posture off again as my left shoulder was hiking up from tightness and pain. What’s the right balance and how much should we do at a time with posture correction?

        Sorry for the lengthy comment and Thank you for taking the time to read it!

        Thanks!

  18. Hi Mark,

    Thank you so much for posting such a simple to understand yet detailed shoulder impingement recovery. Also, I’m sure everyone one here appreciates the time you take to respond to our questions.

    I was diagnosed with shoulder impingement in November 2018. It basically put a complete halt to the powerlifting style workout regimen that I usually follow (apart from Deadlifts).I have quite a stressful job and going through a tough time in general, so the strenuous training was fundamental in keeping me mentally happy and physically in shape.

    I wanted to ask the following questions:

    1. I’ve been following a physio routine (not yours – I did start yours last week) for nearly 5 months now and while the pain has subsided, I still can’t even do a pushup or bench press an empty bar without setting off the inflammation again. Do you have any advice for how to get back into being able to do Bench Press, Overhead Press and Pullups?

    2. The inflammation for the most part has subsided and my left shoulder has started feeling much more strong and stable. I honestly can sometimes forget I have the injury but as soon as I do specific movements like the cable internal rotations (in your program)/ bench press/push-up, it hurts quite bit. Would you know the reason for this?

    3. I have had this injury for 5 months despite being very committed to my rehab protocol (and will incorporate your protocol too now). In your experience, can this injury be permanent? I really hope not has weightlifting is something that genuinely makes me happy and keeps me from getting overweight and the mental health impact of the injury has been far worse than the physical!

    Thanks in advance for taking the time to answer my questions. I’m definitely going to be a regular visitor on your website!

    1. Hey Cameron,

      1. My advice would be to focus on partial repetitions. Over time, slowly go lower in depth. Try to utilize isometric pauses at this deep level.

      2. Sounds like a Subscapularis tendon issue to me. Issues with this tendon can explain pain with shoulder internal rotation, deep bench,press ups and push ups. Have a quick google on the location of the subscapularis tendon and let me know if that is where you feel your pain. (you might have shoulder impingement AND subscapularis tendon issue)

      3. In the vast majority of people, this injury is not permanent. You just need to find the right strategy and exercise to help fix it.

      Best of luck mate.

      Mark

  19. Mark,
    Having had impingement issues my adult life, this has been the most helpful site I’ve seen. Clear, good information and well designed, the tri-fecta of usefulness!
    Thank you. I will certainly pass your site on to others!
    Steve

  20. Hi Mark!
    I wish I looked for your article before!!
    Started backcountry skiing last winter so suddenly lots of shoulder repetitive movement with a heavy backpack. And soon I could not lift my arm especially fwd (like trying to grab the steering wheel in my car)…
    I waited, thinking it will pass, but not and it’s been over a year and doctor suggested we tried the cortisone injection. Just happened so not sure of results yet.
    But oh! I feel I’ve done things wrong ready your great article.

    Just had an Echographie and diagnosed with a ‘tiny’ tendinitis in the supraspinatus. Pain is not tiny but I waited so long…
    I feel doctors been misled because I keep insisting all the pain was in the acromio-scapular joint.
    Now I realize maybe it is the supraspinatus that caused this pain there… could it be right?
    Ill guess now the plan is to let the cortisone settle Nessie’s now it’s just worst. Then start slowly your program. When should I start?
    Thank you so much for making this info available:)

    1. Hey Aimee,

      You can start straight away.

      If there is a lot of pain/inflammation, it is very important to listen to how your body responds to the different exercises.

      Small amounts of pain is acceptable (<3/10 pain) whilst doing the exercise, but ideally try to keep in pain free.

      Mark

  21. Hi Mark,

    Do you have a Youtube channel? If, say, each page of your website were a video, there are a few “pages” I would add to my physical therapy youtube playlist. Each morning I could just press play and follow along. Your images are very good, but for some reason I get overwhelmed trying to reproduce movements from images. Thanks for all this wonderful information.

  22. Hi Mark,
    Can shoulder impingement cause a catching sensation in the clavicle area?
    I get this occasionally when i turn my head or use my arm?
    Your exercises really helped my shoulders, but sadly still I’m having this issue alongside right shoulder pain which goes into upper arm and inside posterior arm. It weakens much quicker than the left arm as well.
    Any ideas?

      1. It’s weird Mark, but it feels like it’s catching kind of half way along the clavicle? Similar catching feeling on left side clavicle as well.
        Although it’s intermittent with both.
        It’s weird, almost feels like it’s out of position, or moved up?

        I do have intermittent rubbing/grating sensation on outside of right shoulder. But it comes and goes.

        Many thanks again.

          1. Thanks so much for responding!
            Yes, it does Mark, all those areas,
            as well as a tender serratus anterior.
            Is this impingement?

            Thanks again!

          2. It may be referred pain that you are experiencing.

            You can try gently pressing into the muscle (Scalenes) where it is marked ‘X’ on the picture of the last comment I sent to you.

            (If you are not sure, it might be better to get someone trained to do it on you)

            This might help release some tension off the muscle and reduce the symptoms that you have mentioned.

            Mark

  23. Hi mark ,

    Firstly thank you so much for providing such a great in depth article . Through using your exercises I can now do all abduction excersies and rotations without pain or discomfort.

    The one thing that seems to still be bothering me is front raises and the exercise involving standing on the band and going up . I have strength now in abduction but anything with my arm straight in front seems to cause pain (irritation ),any advice on how to get through this last hurdle ?

    Thank you so much again

    1. Hey Cameron,

      Great to hear of your progress!

      In regards to pain with shoulder flexion, you might need to reduce to a load where you can comfortably handle.

      From here, start to increase the number of repetitions. Once you get can 20-30, start increase the load.

      Best of luck!

      Mark

  24. Hello,
    I have a shoulder (+neck+elbow+wrist) pain whenever I am working at my desk/on a computer.
    The shoulder is the worst and then the pain shifts the neck, elbow, wrist etc area and keeps worsening.
    I see this tendency of my head tilting forward and someone told me the weight of the head stresses the neck, shoulder and hence the pain. Whenever I realize this I try to pull my head back. Also m so confused about desk height, position of elbows etc. Also what exercises can I do to alleviate this and what is the best posture when sitting at a desk?
    Also what medicine/ointment can I use to reduce the existing inflammation as the pain keeps piling on as its my job to work on a computer.

  25. Hey Mark!

    Thanks for all the fantastic content on this site!

    I’m a 36 year old male who, ever since college had been out of shape. That was until about 14 months ago I decided to change that.

    I started working out 4 days a week. Mostly lifting weights under the guidance of a personal trainer and HIT Cardio twice a week along with a complete change in eating habits. Glad to say it paid off!

    In those 14 months I dropped over 50lbs, dropped several suit sizes and have muscles definition I didn’t think I’d ever have. I went from only squatting 95lbs to now able to do over 300.

    I was feeling great until a week ago when I was hit with severe shoulder pain in my right arm.

    I’ve been well aware of the potential problems with shoulder impingement and rotator cuff tears so I’m sure to do almost all of the exercises you list above specifically to try and prevent this from ever happening.

    Well my GP diagnosed it as shoulder impingement and is sending me to PT.

    My question and concern is this: will I be able to return to my workout routine? Obviously I can’t damage my shoulders or live the rest of my life in pain. But on the other hand, it’s the bench press, pull ups and military press (and the like) that basically “saved me” and got me back to a healthy weight and in good physical condition. So the thought of having to give that up breaks my heart and makes me fearful of returning to my old body only 14 months after gaining my new one, and all at an age that feels too young to HAVE to give up lifting. There’s guys in the gym 15 years old than me that are still lifting and in better shape than me haha!

    Is there any hope for me??

    Sincerely,
    Mark V

    1. Hey Mark!

      By the sound of it, the drive and motivation you have will definitely get you back into your normal work out routine.

      Try to keep the shoulder as active as possible! You might just need to modify some exercises at the gym so that you can perform it safely.

      Let me know how it goes.

      Mark

  26. Hey Mark.

    I started getting pain in right shoulder after starting to bring barbell lower to my chest during bench press and doing heavy chest flys.

    I can recreate most pain when I press my hands together in front, in the positon you’d use to prey.

    Lifting my arm higher creates pain, as well as reaching out to get the baby from his cot or returning him.

    I went to gym and did exercises that don’t involve overhead movements such as deadlift and rows and I have no pain during the exercises but not sure if I should rest from doing any resistance exercise.

    Are these other exercises fine if I don’t have any pain while doing them?

    I do have a faint tingling in my right arm so not sure if there is some nerve damage? Impingement seems like the most likely issue I have.

    Also would you recommend doing these reehab exercises for a few weeks and then gradually reintroduce chest and shoulder workouts?

    Many thanks in advance.

    1. Hey Robin,

      All exercises are fine to do if they are pain-free. Just be careful when you are near fatigue as your technique may give out.

      Tingling is a sign of nerve irritation somewhere along its pathway. Based on your mechanism of injury, if it’s anything, you might have just strained the nerve. (should self heal with time)

      Have a quick google of “Subscapularis tendon”. Is that where your pain is?

      Mark

      1. Hey Mark

        It looks like it is the subscapularis. Just looked at one of the tests with arm behind the back and I can move my left arm away but the injured one I can’t.

        Tingling isn’t there anymore. Which of these rehab exercises (if any) are best suited for helping with this?

        I’ve taken a couple of weeks off the gym altogether as not aggrivate anything for now.

        1. Hey Robin,

          I would focus on internal rotation exercises. (heaps of them on youtube).

          Make sure to feel the contracting of the muscle where the pain is located.

          See how you go with that for the next couple of weeks. If the pain is still there, you will likely need to address other aspect of your technique/posture to help it heal 100%

          Mark

  27. Hi Mark,
    Normally I’m very fit and healthy, but since a Ceilidh dance 5 days ago I’ve had a sore shoulder, which has been getting progressively worse, until almost unbearable no matter what position I’m in. I’m struggling to dress, and can’t drive. I visited. My GP today, who has diagnosed shoulder impingement. I have 3 days to wait until I see an orthopaedic consultant, and my question would be what you would advise in the immediate short term to get me through the next few days. Even sitting still is very painful, and no position in bed seems comfortable. I’d love to try your recommended exercises, but for now, pretty much anything is too sore. I’m taking ibuprofen and trying not to move my arm in any way the hurts it, but that’s proving v difficult. Are there any positions that you could recommend to minimise the pain? Not sure what consultant will recommend but I really feel that if I get offered a cortisone injection I would take it, so I can get temporary relieve to allow me to start to build up my shoulder strength. Does this seem a reasonable approach?
    Thanks,
    Kim

    1. Hi Kim,

      Sounds like your shoulder is very sensitive/irritable at the moment. This may be due to an increase in inflammation to the area.

      Here are some things that might help:
      – Get some ice on to it
      – Try to move the shoulder as much as you comfortably can without making symptoms worse. (Even if you have to do very gentle “shoulder pendulum” or “shoulder cradle” exercises.)
      – Get stronger anti-inflam (over the counter may no be strong enough)
      – Wear a shoulder sling, but no more than 1-2 days MAX.
      – Apply anti inflam cream to the area.
      – You will need to use trial and error to find the best position for your shoulder. If there is a significant amount of inflammation, all positions may be uncomfortable for now.

      Good luck!

      Mark

  28. Hello Mark,

    Thank you for this page. It really contains valuable information.

    For the past 6 months or more, I had pain in my arm; specifically on the biceps tendon. I took anti-inflamatory pills and 2 cortison injections. But the pain remained.
    My doctor informed me that I need a surgery Biceps Tenodesis.

    I am doubtful about the surgery and keen on finding other solution to releive the pain.
    Do you think the exercices are enough or I need additional or different ones?

    Waiting your reply.

    Thank you again for your time.

    Karim

    1. Hi Karim,

      Is the Long head biceps completely torn or severely frayed on scan? These are the main reasons one would even consider getting a biceps tenodesis.

      In regards to which are the best exercises for you… It really depends on what exactly is causing your pain. Is it the impingement of the biceps tendon? Or is it hurting with certain positions. Or even with use? Weakness of other muscles?

      Based on that, you will need to do specific exercises to address the specific problem.

      I would also opt to avoid surgery… even if there are tears! (Some people get worse after surgery!)

      Mark

  29. Hey Mark,
    Thanks for previous reply, I really Do appreciate it.
    A couple more questions for your advice/opinion please. (Thank you).

    Both my shoulders have a catching sensation in certain positions is this typical?
    Also I have deltoid tenderness, my serratus anterior are tender, my scalenes and upper traps feel tight. If I raise my left arm for a short duration I get tingling in my hand.
    Are these all shoulder impingement symptoms?

    MANY THANKS in advance that you give your time, help and expertise freely.
    You help thousands, God bless you.
    Angela

    1. Hi Angela,

      Is it possible that you may have Thoracic Outlet syndrome? This may explain all the symptoms that you have mentioned.

      Pure shoulder impingement (subacromial) should not generally give you tingling in the hand.

      Mark

      1. Thanks for responding again!
        I have extremely tight scalenes, trapezius and shoulders. Possible fibromyalgia diagnosis. Is it possible that extremely tight muscles can cause thoracic outlet syndrome or shoulder impingement Mark?

        1. Yep! That can be all part of Thoracic outlet syndrome and impingement.

          However – I do find that doctors tend to diagnose people with Fibromyalgia when they have no idea what exactly is going on. Usually – if you have multiple areas that hurt, they automatically classify you as having Fibro.

          Mark

          1. Thanks again Mark, you’re such a good man, helping so many 😊
            I wholeheartedly agree, Dr’s tend to diagnose fibromyalgia when they just don’t know or have given up. (As gas my physio) 😔
            I KNOW I have forward head posture, rounded shoulders and a tight thoracic area. And know suffering from shoulder pain (both sides).
            Do you have ANY suggestions which area to start addressing first?

            Thank you so very much Mark.

          2. Hey there Angela,

            You can address any region first!

            But since your shoulders are specifically giving you issues, you can start by addressing your rounded shoulders and see how you respond to that.

            If nil improvements, you might need to have a look at the nerves via a scan.

            Mark

  30. Hi Mark!

    This is by far the best resource on the web right now. Thanks for all the detail. It has been a huge help. If you don’t mind, I have two questions.

    1. How do we know when to progress from stretching to strengthening? I typically start as soon as the inflammation has gone down and I have full range of motion but the last two times I’ve done that, the inflammation flares up again the day after. Maybe I’m doing too much resistance?

    2. Have you heard of Dr. John M. Kirsch and his fix for impingement? He stopped doing shoulder surgery and just asks his patients to do dead hangs from a pull-up bar. He claims this pushes the acromion upwards and creates space in the shoulder.

    Again, thanks for everything, Mark. Your work has changed the way I heal my shoulder and I’ve seen huge improvements. It has been a life changer!

    Austin

    1. Hi Austin,

      You can start strengthening any time really. But you need to make sure that it is not making things worse in the process! Go a bit more gentler and see how you respond to it.

      Match the exercise intensity with your shoulder’s capacity.

      I have not heard of Dr Kirsch, but yes, the sub acromial space will be decompressed in a hanging position. However that being said- a lot of people with impingement may not be able to even get into that position in the first place.

      Mark

  31. Without having visited a doctor, I am self-diagnosing shoulder impingement (right), after pushing a heavy box on a roller conveyor belt and having some pain afterward, but no loss of strength.
    This injury occurred approximately 3 months ago, and I have been able to lift heavy items to chest level, do half push-ups without much aggravation, and do basic yoga stretches (I am NOT advanced in any way with yoga).
    In trying the three tests you provide, each recreates the pain for me. I find I cannot reach upper cabinets without at least some twinge of pain, and if I find myself sleeping with my arm above my head, lowering the arm can be from mild to excruciating pain.
    I have been using Ibuprofen to reduce possible inflammation, and use peppermint essential oil for any inflammation reduction it might provide.

    I would like to begin the shoulder traction stretch, work on resolving any tight muscles, and beginning the initial exercises you suggest here. Does this sound like a proper plan? I had a similar situation with the left should several years ago and performed basic, pain-free stretches (arm circles and raises) and was pain-free without recurrence within a month. This time, those same stretches seem only to aggravate the issue, which seems logical, based on the information you have provided here. Due to the difference in pain, I have self-diagnosed the impingement.

    Thank you for any clarity you may be able to provide. I truly appreciate the clear and detailed information you offer for those interested in self-help without exacerbating the issues.

    1. Hi Amy,

      Sounds like a plan!

      Focus on gradually progressing your movements and the intensity of your exercises.

      As your shoulder gets stronger, function should increase and pain should decrease.

      All the best.

      Mark

  32. Hi Mark,
    I had to stop doing yoga about 5 years ago due to a terrible shoulder pain that lasted years on and off. I took antinflamatory, did a lot of physiotherapy and exercises to heal my shoulder.
    I’ve started doing yoga again 3 months ago and the pain is back. The worst position for me is facing dog. I think my shoulders are week. Any suggestion?
    Thanks, Chicca

    1. Hey Chicca,

      In the Facing dog pose, the shoulder is in end range flexion. This can be a stressful position for the shoulder if there is some sort of underlying issue.

      Do you have Rounded shoulders as well? If you have shoulders that roll forward PLUS you force your shoulder into end range flexion, this could cause some impingement of some structures in the shoulder.

      Check it out: How to fix Rounded shoulders.

      Mark

  33. Hello,
    I’ve had a problem with right shoulder for nearly two years now, have had ultra sound, MRI and taken NSAID (Naproxen) and seen Physio’s who have given me some of your exercises mentioned but I will be adding new ones from you, so thank you for that.

    The scans have shown Inpingement and Bursitus and my consultant is now suggesting a Cortisone injection. My question is firstly after this amount of time do you think this is for the best? Also afterwards how long should I leave it before starting to do the exercises again?

    Also my shoulder makes very loud clicking, crunching noises. Dr’s have told me this is nothing to worry about but it is quite concerning.
    Thanks again for all the information.
    Dave

    1. Hello Dave,

      … After this amount of time (2 years), do you think this is for the best?

      The cortisone injection might help temporarily reduce any inflammation in your shoulder. However, since it has been 2 years, I would think that there would be minimal (if at any) inflammation present now. (unless you have acutely aggravated it?) . I am not the biggest fan of the injections, but in some cases, it might give you a bit of momentum in the beginning as you start your rehab.

      My opinion: If you can, try to persist with the exercises. Gradually progress the resistance. Remember small amount of pain during exercise is fine. If you are finding it hard to progress, then you can give the cortisone a try.

      How long should I leave it before starting to do the exercises again?

      The doctor will usually say rest for 5-10 days before commencing the exercises again. (But keep in mind, this is to purely see the result of the injection alone without the interference of other interventions)

      I usually find crunching/clicking noises is as a result of poor shoulder stability (which is common in people with impingement).

      Mark

    1. Hey John,

      General rule that I personally follow is:

      – Use ice if the pain is acute. Usually 24-48 hours following the aggravation.

      – Use heat all other times.

      Mark

  34. Hi Mark, your article is extremely helpful and thoroughly explains what many doctors either can’t or won’t. I have had shoulder impingement on and off for 3/4 months although has been consistently painful the past month. I wonder if you have any suggestions that may help me? Im not sure if it’s how I sleep but I can’t pinpoint any other activity that would cause the pain, it’s always worse when I wake up, it can go from 0 pain to 10 overnight. I definitely don’t sleep on it. Although I do sometimes wake up with it laying above my head? Could this cause impingement and how do I stop doing this in my sleep???? Any suggestions welcome. Thanks

    1. Hi Lynsey,

      It sounds like there is something flaring up the inflammation in the shoulder. This can make the pain shoot up from 0 to 10 over night.

      If the pain is worse after sleeping, the shoulder position would be the first thing to look at.

      With the position of the arm above your head… this is a potential source of aggravation. As the shoulder goes into flexion/internal rotation, there is a higher chance that the structures in the shoulder can get squashed.

      You can’t really control how you move around once you are asleep. Best thing you can do is make sure you are as comfortable as possible in a safe position (on your back, with pillows supporting the back of the arm/shoulder) so that there is no need for the body to move when you’re fast asleep.

      Mark

  35. Hi Mark,
    Great information. Would a posture correction brace paired with your exercises help or hinder the recovery process? In your experience do the posture correction braces even work?

    1. Hi Justin,

      They are fine to use in the short term when you starting to address your posture.

      I would not recommend on using them for the long term as you risk becoming reliant on it.

      Mark

  36. Hi Mark and thanks so much for all your pages for self help.
    Regarding shoulder impingement, I believe I do have it. Both my shoulders are sore and make creaking noises and the left does seem more unstable and it hurts to lie on. Also discomfort reaching behind.
    I’ve been trying to improve my rounded shoulders and mild kyphosis, thanks to you. However, I’ve been doing these exercises a few times now, and my biceps (upper outer arms) are really really sore (to palpate as well). Is this normal?
    Many thanks in advance.

    1. Hi Angela,

      The exercises should not make your pain worse.

      If it has – you will need match the intensity of the exercises with your tolerance and capabilities.

      The pain may also be Delayed Onset of Muscle Soreness. (which is basically the normal pain you will feel after doing exercises that you aren’t used to be doing)

      Mark

      1. Thanks so much for getting back to me Mark, I actually meant deltoid pain, not biceps.
        Generally shoulder/upper back and neck tightness and aching.

        Thanks so much again 😊

  37. Hey Mark! Thanks for all of the great tips and exercises. I’ve been struggling with my impingement for about three months. You mentioned to work on the positions that give you pain. So, what if the pain is significant doing that specific movement? Work through it or…?
    All the best! Thanks for your time.

    1. Hey Joshua,

      You will need to get to the stage where you can start to do the specific movement.

      If you are unable to do the complete movement, you can start by doing part of the movement.

      Do not push past pain. A small amount of pain is fine.

      Mark

  38. Hey Mark, thanks for the great write up.
    My right shoulder has been bothering me for quite some time now.I have seen 2 different doctors and both of them decided to use cortisone to treat the issues. The last doctor also ordered an MRA to diagnose the issue. The results showed High grade partial interstitial tearing at the mid to posterior supraspinatus, mild subscapularis and infraspinatus tendinosis and mild fibrillation of the supior labrum. Do you think i would benefit from those exercises and stretches?

    Thank you

    1. HI Flo,

      Yes – these exercises will likely be a great place to start.

      Push your shoulder as far as you can comfortably tolerate without flaring it up.

      Mark

  39. Hi Mark! Thanks for the great article!

    I recently started to experience shoulder pain, which seems to be an impingement stemming from weight lifting and bad posture.

    What order would you suggest to address these concerns? 1st- Shoulder impingement. 2nd- Forward neck. 3rd- Hunch back. 4th- Rounded shoulders?

    Thanks for your time!

    1. Hi Scott,

      Addressing your shoulder impingement first is a great place to start.

      In terms of where to go next, it really depends which area is affecting your shoulder the most.

      All of the areas you mentioned could be addressed next 🙂

      Mark

  40. Thanks for the article, Mark! Quick question:

    I’m pretty sure I have an impingement. Everything you say in this article and both the Hawkins and Painful Arc test recreate the pain. However, the Neer’s test does not. Could my pain be signs of something else or is it normal to pass that test?

    Thanks!

    Austin

  41. Hey Mark,

    Great stuff, man!

    I’ve been dealing with impingement (guessing it started 4-5 weeks ago) from what I believe was mostly due to lifting weights pretty consistently for the past 7 years or so (with less than perfect form I’ve learned since scouring the net to learn about this problem), failing to strengthen the rotator muscles and likely not so great posture. Maybe a little due to aging as well as I turned 50 last May.

    Unfortunately, as you mentioned, my small town doctor recommended (and I accepted) the cortisone shot and anti-inflammatories as well as rest for a month. Before I went to him I’d been doing the stretches and was doing the rehab exercises consistently – before trying just rest. It seemed to get better for a few days but then got worse. That’s when I broke down to go see him.

    It’s been two weeks and I’ve been doing some of the stretching but only have done the rehab exercises a few times since he recommended rest only initially. The pain is pretty much gone and I plan on getting more consistent with the rehab/strengthening exercises now.

    My two questions are 1) how often do you recommend the exercises? Three or four times a week? And 2) how long do you recommend staying away from lifting before I begin getting back into it, starting with lighter weights to “test it” and ease into it?

    Thanks in advance!
    Don

    1. Hi Don,

      Thanks for your questions.

      1) how often do you recommend the exercises?

      Depending on how you are feeling and how much you are pushing yourself, you can try every second/third day with the exercises and adjust accordingly.

      2) how long do you recommend staying away from lifting

      As soon as you feel confident with the exercises mentioned in the post, start to include the exercises you were previously doing at a much lesser intensity (partial reps, less weight/more reps, more rest etc). From here, you can start to get back to the level you were before.

      Keep in mind that it is a good idea to address any underlying issues that have predisposed you to impingement (ie. posture, technique, etc)

      Mark

  42. Hi Mak,
    Thank you for posting helpfull information!! Its very well explain, but there are 2 types of impingement, and I have pain in the back of my right shoulder, so I think I have internal impingement and it hurts during bench press not in the front but in the back of my shoulder. So what muscle should i strengthen for internal impingement?
    Thank you

  43. Hi! My shoulder makes a popping noise when I do the the third exersize. Does this mean I need to get inflammation down more in order for it to be beneficial? Thanks!

    1. Hey Caitlin,

      I am not sure which exercise you are referring to. But you don’t want to have any noises coming from your shoulder when you are doing the exercises. (especially if it is painful)

      You might just need to adjust your technique, intensity, resistance and/or range of motion.

      Mark

  44. I have a shoulder impengment on right side. Pain is on outside of upper arm and shoulder. I been doing the bands for external and internal rotation. I been doing this for 6 months and i have only gotten to where im not in constant mild pain. I still have much discomfort if I do squats, bench press or curls. I have had a MRI arthrogram and it came back clear so i am wondering what is recovery time for this. I also have type 2 acormion.

  45. Hi Mark, I’m a side sleeper which causes me to place my entire arm under my pillow in the last 2 years I have been waking up with tremendous arm / hand tingling which has recently progressed to painful arm / shoulder / neck during the day.

    Can you suggest methods to strenghten these areas and also is there any pillow that I can purchase that would put less pressure on my arm.

    Thanks

    1. Hi Michel,

      If sleeping on the painful shoulder is the only cause of your symptoms, I would recommend to sleep on the other side (or your back) for the time being.

      Tingling in the arm/hand is suggestive of nerve involvement.

      Try to make sure that you ensure that your neck remains in a neutral alignment (ie. don’t let it tilt to one side as this can pinch a nerve).

      If you have right sided issues, you can start to stretch your neck towards the LEFT before and after you sleep to see if it makes any difference.

      Mark

  46. 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).

      Mark

  47. 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.

      Mark

  48. 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

  49. 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.

    Thanks!

    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.

      Mark

  50. 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.

      Mark

  51. 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.

  52. 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.
    Cordially

    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.

      Mark

      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)

          Mark

          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)

            Mark

  53. 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.

  54. 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…

    Corey.

    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?

      Mark

  55. 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!

      Mark

  56. 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.

      Mark

  57. 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.

      Mark

  58. 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.

  59. 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
    Ian

  60. 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.

  61. 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!

    Anita

      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?
        thanks

        Anita

  62. 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)
      (See image)

      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.

      Mark

      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.

  63. 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!

      Mark

  64. 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
    Farhan

  65. 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?
    Thanks
    Carole

  66. 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 .

      Mark

  67. 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.

      Mark

  68. 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.

      Mark

    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.

      Mark

  69. 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.

      Mark

  70. 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.

      Mark

      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

  71. 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. 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.

          Mark

          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.

            Mark

  72. 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).

      Mark

      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?

          Mark

          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

  73. 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 !

      Mark

  74. 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

  75. 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.

  76. 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
    Peter

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