Shoulder pain that limits movement and interferes with daily life is often caused by shoulder impingement. This occurs when soft tissues, such as tendons and the bursa, become compressed within the shoulder joint. The resulting friction causes irritation and inflammation, leading to pain and restricted motion.
Understanding Shoulder Impingement
Shoulder impingement, often called subacromial impingement, is characterized by a narrowing of the space beneath the acromion, the bony arch at the top of the shoulder blade. This reduced space causes underlying structures, particularly the rotator cuff tendons, to be pinched when the arm is lifted. It frequently affects individuals who perform repetitive overhead movements.
Common symptoms include a dull ache in the shoulder and upper arm, particularly on the side and front of the joint. Pain often worsens when attempting to lift the arm overhead, reach behind the back, or perform activities like throwing. Discomfort at night is also common, especially if lying on the affected side, which can disrupt sleep.
Immediate Relief and Activity Modification
The immediate goal is to manage pain and reduce inflammation using passive self-care strategies. Cold therapy, such as an ice pack wrapped in a thin towel, is recommended for acute pain or flare-ups to reduce swelling. Apply ice for 15 to 20 minutes at a time, several times a day.
Heat therapy, like a heating pad or warm shower, is appropriate for chronic stiffness and dull aches, as it increases blood flow and relaxes tight muscles. If experiencing both acute pain and stiffness, use heat before gentle exercises and ice afterward. Always protect the skin by placing a cloth barrier between the heat or cold source and your shoulder.
Activity modification focuses on avoiding movements that provoke pain. Temporarily refrain from reaching for high shelves, carrying heavy bags, or engaging in overhead sports like swimming or tennis. Adjusting your sleeping posture by avoiding lying directly on the painful shoulder can prevent nighttime flare-ups. This provides the irritated tendons and bursa with relative rest without stopping all shoulder movement, which prevents stiffness.
Targeted Stretches and Strengthening Exercises
The long-term release of shoulder impingement relies on a structured program of specific stretching and strengthening movements. These exercises are designed to improve the joint’s range of motion and enhance the stability of the shoulder blade, thereby increasing the space within the joint. All movements should be performed slowly and gently, stopping immediately if a sharp pain is felt.
Gentle Range of Motion and Stretches
Pendulum stretches are an excellent starting point for gentle mobilization, promoting blood flow without engaging the rotator cuff muscles. To perform this, lean over a table and let the affected arm hang straight down. Use your body’s momentum to swing the arm in small, controlled circles about ten times in each direction. This movement should be completely passive.
The cross-body arm stretch targets the posterior capsule of the shoulder, an area often tight with impingement. Gently pull the affected arm across your chest toward the opposite shoulder, using your other hand to apply light pressure above the elbow. Hold this stretch for 20 to 30 seconds, repeating two or three times, and avoid sharp pain.
A doorway stretch helps lengthen tight chest muscles, which can pull the shoulders forward and contribute to poor posture. Stand in a doorway with your forearm resting against the frame and your elbow bent at a 90-degree angle. Step forward slowly until a gentle stretch is felt across the front of the shoulder. Hold this position for about 30 seconds, and repeat three times.
Rotator Cuff Strengthening
Strengthening the muscles that stabilize the shoulder joint, especially the rotator cuff, is fundamental for sustained relief. Scapular squeezes, or shoulder blade squeezes, are a simple exercise that improves posture and activates the muscles that control the shoulder blade. While sitting or standing tall, gently pinch your shoulder blades together as if you are trying to hold a pencil between them, holding the contraction for five seconds and repeating ten times.
External rotation exercises are particularly important for strengthening the muscles that keep the upper arm bone centered in the socket. To perform this, stand with your elbow bent at 90 degrees and tucked close to your side, holding a light resistance band anchored to a fixed point. Pull the band away from your body, rotating your forearm outward, before slowly returning to the start position for a set of 10 to 15 repetitions. Beginning with very light resistance is necessary to avoid re-irritating the tendons.
Wall slides, or wall angels, work to improve the coordinated movement between the shoulder blade and the upper arm, known as scapulohumeral rhythm. Stand with your back flat against a wall, pressing your elbows and forearms against the surface with your arms forming a “W” shape. Slowly slide your arms upward while keeping your elbows and wrists in contact with the wall, then slowly slide them back down for 10 repetitions. This movement helps to retrain the stabilizing muscles in the upper back.
Knowing When to Seek Professional Help
While self-management is effective for many cases of shoulder impingement, recognizing signs that require professional intervention is important. If your shoulder pain persists for several weeks despite consistent rest, activity modification, and home exercises, consult a physical therapist or orthopedic specialist. Persistent pain may indicate a more significant underlying issue, such as a partial tear of the rotator cuff tendon.
Immediate medical attention is warranted if you experience:
- Sudden and complete weakness in the arm, or the inability to lift the arm at all.
- New symptoms of numbness or tingling that extend down the arm or into the hand, signaling nerve involvement.
- Visible swelling or excessive warmth.
- A fever, which may suggest an infection or inflammatory condition.
A healthcare professional can provide a tailored treatment plan, which may include physical therapy, corticosteroid injections, or, in rare cases, surgical intervention.