Shoulder impingement syndrome is one of the most frequent shoulder complaints we see at Burwood Physio. It causes pain with overhead activities, reaching across the body, and lying on the affected side at night. With the right physiotherapy approach, most people recover fully without surgery.
What Is Shoulder Impingement Syndrome?
Shoulder impingement occurs when the soft tissue structures in the subacromial space — primarily the supraspinatus tendon and the subacromial bursa — are compressed or pinched between the humeral head (ball of the shoulder) and the acromion (the bony roof above). This compression causes pain, inflammation, and over time can lead to tendon damage if left untreated.
The condition was historically described as a purely structural problem (bone compressing soft tissue), but current understanding recognises that muscle weakness, poor posture, and movement dysfunction play a larger role than anatomy alone.
Types of Shoulder Impingement
- Primary impingement — mechanical compression from a hooked or curved acromion shape
- Secondary impingement — compression resulting from rotator cuff weakness, poor scapular control, or capsular tightness (most common type)
- Internal impingement — compression of the posterior rotator cuff against the glenoid rim, seen in overhead athletes
Causes and Risk Factors
- Repetitive overhead activities (swimming, throwing, racquet sports, painting, construction work)
- Weak rotator cuff muscles — particularly supraspinatus and infraspinatus
- Poor scapular control (the shoulder blade doesn’t rotate properly to clear the acromion)
- Rounded shoulder posture and thoracic kyphosis
- Tight posterior shoulder capsule
- Sudden increase in training load or activity
Symptoms of Shoulder Impingement
- Pain at the front or side of the shoulder, often radiating into the upper arm
- A painful arc — pain when raising the arm between 60° and 120° (the range where impingement occurs)
- Pain when reaching overhead, behind the back, or across the body
- Night pain, particularly when lying on the affected shoulder
- Weakness with lifting or rotating the arm
How Is Shoulder Impingement Diagnosed?
Your physiotherapist will perform a thorough shoulder assessment including range of motion testing, strength testing of the rotator cuff and scapular stabilisers, and specific impingement tests (Neer, Hawkins-Kennedy, and Jobe’s). If imaging is needed, ultrasound or MRI can assess the tendons and bursa for structural damage.
Physiotherapy Treatment for Shoulder Impingement
Physiotherapy is the first-line treatment for shoulder impingement and is effective in the vast majority of cases. At Burwood Physio, our approach targets the underlying causes rather than just managing symptoms.
Exercise Rehabilitation
Strengthening the rotator cuff and scapular stabilisers is the cornerstone of impingement treatment. The goal is to restore the normal position of the humeral head during movement, reducing compression in the subacromial space. Your programme will progress from basic isometric and low-load exercises through to sport- or work-specific training.
Scapular control exercises — targeting the serratus anterior, lower and middle trapezius — are particularly important. A well-functioning shoulder blade creates space under the acromion and allows the arm to elevate without impingement.
Posture Correction
Rounded shoulders and a forward head posture reduce the subacromial space and predispose to impingement. Your physiotherapist will address thoracic mobility, pectoral flexibility, and postural awareness as part of your programme.
Manual Therapy
Shoulder joint mobilisation, thoracic spine manipulation, and soft tissue release of the posterior capsule and rotator cuff muscles can rapidly reduce pain and improve range of motion, allowing you to engage in exercise rehabilitation more effectively.
Shockwave Therapy
For impingement presentations with concurrent supraspinatus tendinopathy or calcific tendinitis, shockwave therapy is highly effective. It promotes tendon healing and can dissolve calcium deposits that contribute to mechanical impingement.
Dry Needling
Dry needling to the rotator cuff muscles, posterior capsule, and periscapular musculature can relieve muscle tightness and reduce referred pain patterns around the shoulder.
How Long Until Recovery?
With consistent physiotherapy, most patients with shoulder impingement see significant improvement within 6–12 weeks. Those who commit to the home exercise programme and modify aggravating activities during treatment recover fastest. Chronic or severe cases with associated rotator cuff tendinopathy may take 3–4 months.
When Is Surgery Considered?
Surgical decompression (arthroscopic acromioplasty) was previously common for shoulder impingement. However, high-quality research (including a 2018 landmark trial published in the Lancet) found that surgery offers no benefit over well-supervised physiotherapy for most impingement presentations. Surgery is now reserved for cases with confirmed structural lesions that fail to respond to 3–6 months of quality physiotherapy.
Book a Shoulder Assessment at Burwood Physio
Shoulder pain doesn’t have to limit your swimming, gym, work, or daily life. Get an accurate diagnosis and an evidence-based treatment plan from our experienced physiotherapy team.
Burwood Physio is at Shop 2, 36-38 Victoria St E, Burwood NSW 2134, serving patients from Strathfield, Concord, Croydon, Ashfield, and across the inner west. Same-week appointments available, HICAPS on-site, all health funds accepted.
Call 02 8322 9022 or book online.
Reviewed by the Burwood Physio Clinical Team
BPhty (Hons) | AHPRA Registered Physiotherapists | Member, Australian Physiotherapy Association
Our clinical team has over 20 years of combined experience in musculoskeletal physiotherapy, sports rehabilitation, and pain management. All content is reviewed for clinical accuracy and updated in line with current evidence-based practice guidelines. Meet our team →
