Shoulder Impingement Is Probably Not Causing Your Shoulder Pain

A common rationale for peoples’ shoulder pain that they’re given when they go see their physician, physical therapist, or orthopedic surgeon is that they have something called “shoulder impingement.”

Basically, the thought is that various soft tissues, such as the rotator cuff tendons, tendon of the long head of the biceps, or sub-deltoid bursa, get pinched between bony surfaces in the shoulder as you raise your arm overhead. These people often present with pain that worsens as they lift overhead, and are told that it is this impingement that is causing their symptoms.

But, is this actually true?

When it comes to shoulder pain and injuries, impingement actually likely isn’t a big contributing factor. Through various studies of how the shoulder joint moves, we now know that this soft tissue compression happens in pretty much everybody’s shoulders whenever they lift their arms overhead, and this compression begins as early as when the arm is in 30 degrees of elevation, and is actually the highest at about 70 degrees of arm elevation, which isn’t the point of most pain for people typically diagnosed with “shoulder impingement.” [1]

Researchers have also looked at the impact of removing part of the bone that is responsible for this “impingement” in people who do have shoulder pain, and have found that actually removing the bone doesn’t provide any further benefits compared to physical therapy and exercise for shoulder pain. [2] [3] 

So, with the knowledge that “impingement” happens in pretty much all shoulders (including pain-free shoulders), that the most impingement happens in the range of motion where people typically don’t have the most pain, and that stopping this impingement by removing portions of bone is no more effective than exercise alone, we now believe that shoulder “impingement” is a pretty normal phenomenon, and is likely something that is supposed to happen.

There is actually a shift in the medical and rehabilitative fields away from the term “shoulder impingement” and to the terms “rotator cuff related shoulder pain” or “subacromial pain syndrome” because we now know that impingement probably isn’t the reason why people are having this type of shoulder pain.

Like most types of aches and pains that people deal with, this type of shoulder pain is likely due to overuse conditions than it is impingement. When pain like this pops up during training, we should focus less on trying to “correct the impingement” and focus more on managing training load and volume appropriately, as well as looking at sleep, nutrition, recovery, other life stressors, and other variables of this nature. 

If you are currently dealing with shoulder pain, and have tried managing it on your own without success, contact a trusted healthcare provider for an evaluation

[1] Brossman J, et al. Shoulder impingement syndrome: influence of shoulder position on rotator cuff impingement- an anatomic study. American Journal of Roetgenology. 1996;167(6):1511-1515.

[2] Ketola S, et al. Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment? Acta Orthop. November, 2015; 86(6): 641–646.

[3] Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet. January, 2018; 391(10118): 329-338.