Shoulder impingement: Symptoms, diagnosis, and stretches

Quick note: This article is for education, not a diagnosis. If you had a major fall, can’t lift your arm, have numbness/weakness down the arm, fever, or a hot/red swollen shoulder, get medical care urgently.

What “shoulder impingement” actually means

“Shoulder impingement” is a catch-all term people use when shoulder tissues get irritated and “pinched” during certain movementsespecially reaching overhead.
Clinicians may also call it subacromial impingement or rotator cuff tendinitis/tendinopathy. The usual suspects are the
rotator cuff tendons and the subacromial bursa (a small, slippery cushion).

The shoulder is basically a high-performance joint with a “tiny socket, big range of motion” design. That’s great for grabbing a suitcase from the overhead bin…
but it also means small changes in posture, strength, or tendon health can create big feelings (your shoulder’s drama is legendary).

Primary vs. secondary impingement (the “why” behind the pain)

• Primary (structural) factors: the space above the rotator cuff may be tighter due to anatomy or bony changes over time.
• Secondary (functional) factors: the space narrows during movement because the rotator cuff and shoulder blade (scapula) muscles
  aren’t coordinating welloften from weakness, fatigue, or poor mechanics.

In real life, many people have a little of both: normal aging + repeated overhead motion + “I sit like a shrimp at my laptop” posture.

Common symptoms of shoulder impingement

Symptoms can come on gradually or after a jump in activity (new workout, weekend painting marathon, sudden return to tennis, etc.). Common patterns include:

• Pain with overhead reaching (putting dishes away, washing hair, throwing, swimming, painting ceilingsaka “shoulder crimes”).
• Pain when lowering the arm from overhead.
• Night pain, especially when lying on the affected side.
• Weakness or fatigue when lifting, reaching, or carrying.
• Stiffness or a feeling that the shoulder is “catching.”
• Painful arc: discomfort that peaks in a mid-range (often roughly when the arm is partway up), and eases a bit at the start or end.

Where does it hurt?

Many people feel it at the front or outer side of the shoulder, sometimes radiating down the upper arm. That’s a classic rotator cuff/subacromial pattern.
Pain that shoots past the elbow with tingling or numbness can point to nerve involvement (neck or arm), which is a different problem and needs a proper exam.

Impingement vs. “I tore something” vs. “frozen shoulder”

• Possible rotator cuff tear: marked weakness, trouble lifting the arm, or a sudden injury with a pop may suggest more than irritation.
• Frozen shoulder (adhesive capsulitis): stiffness becomes the headlineboth active and passive range of motion shrink.
• Arthritis/AC joint issues: pain at the very top of the shoulder or with cross-body movements can be a clue.

You don’t need to self-diagnose with a mirror and a dream. But noticing the pattern helps you (and your clinician or physical therapist) pick the right plan.

How shoulder impingement is diagnosed

Diagnosis is usually based on your story + a physical exam. Imaging can help in certain cases, but many people improve without ever needing an MRI.

1) The history (your shoulder’s autobiography)

Expect questions like:

• When did the pain startgradual or sudden?
• What makes it worse (overhead work, sleep, certain exercises)?
• Any injury, fall, or new sport/job task?
• Where exactly is the pain, and does it travel?
• Any weakness, numbness, neck pain, or systemic symptoms?

2) The physical exam (yes, the “weird arm tests”)

Clinicians test range of motion, strength, tenderness, and specific provocation tests. Common impingement-related tests include:

• Hawkins-Kennedy test: the arm is positioned at shoulder height and gently rotated inward; pain can suggest subacromial irritation.
• Neer test: the arm is lifted overhead in a controlled way; pain can indicate subacromial structures are irritated.
• Painful arc: pain that shows up in a mid-range during arm elevation can support a subacromial pain pattern.
• Rotator cuff strength tests: checking external rotation and elevation strength can help identify tendon involvement.

Important nuance: these tests are helpful clues, not magical truth wands. A good exam looks at the whole pictureshoulder blade motion, posture, neck screen,
and which movements recreate your pain.

3) Imaging (when it helps and what it can/can’t do)

• X-ray: can rule out arthritis, certain bony changes, or calcific issuesbut it doesn’t directly show tendon irritation.
• Ultrasound: can evaluate rotator cuff tendons and bursitis in real time (often cheaper and quicker than MRI).
• MRI: shows soft tissues in detail and may be used when symptoms persist, strength is clearly reduced, or surgery is being considered.

Translation: imaging is a tool, not a verdict. Many people have “abnormal” findings that never hurt, and many people hurt with minimal imaging changes.
The best plan is based on symptoms, function, and progressnot just a radiology sentence that reads like a gothic novel.

Treatment basics before we talk stretches

Calm it down, then build it up

• Activity modification: temporarily reduce painful overhead work and swap aggravating exercises (more on that below).
• Ice/heat: some people prefer ice after activity; gentle heat before movement can help stiffness.
• Pain relief options: some use over-the-counter anti-inflammatory medication if safe for themask a clinician if you’re unsure.
• Physical therapy: often a cornerstone: mobility work + rotator cuff and scapular strengthening + technique coaching.

A common mistake is stretching aggressively while the tendon is already cranky. If your shoulder feels like it’s auditioning for a horror movie,
start with gentler motions and controlled strengthening.

Stretches for shoulder impingement

These stretches are commonly used in rehab programs to improve shoulder mobility and posture mechanics. Aim for a gentle stretch sensation,
not sharp pain. Most people do well with 20–30 seconds per stretch, 2–4 rounds, once or twice dailyadjust based on symptoms.

1) Cross-body posterior shoulder stretch

Why it helps: tightness in the back of the shoulder can change mechanics and contribute to painful elevation.

1. Bring the sore arm across your chest at shoulder height.
2. Use the other arm to gently pull it closer (no twisting your torso like you’re wringing out a towel).
3. Hold 20–30 seconds, breathe, repeat.

Common mistake: hiking the shoulder up toward your ear. Keep the shoulder blade “down and back.”

2) Doorway pec stretch (chest opener)

Why it helps: rounded-shoulder posture can reduce comfortable overhead motion and overload the front of the shoulder.

1. Place your forearm on a doorframe with the elbow around shoulder height.
2. Step through slowly until you feel a stretch in the chest/front shoulder.
3. Hold 20–30 seconds; repeat on both sides if needed.

Make it nicer: keep your ribs down (avoid arching your low back like you’re posing for an action figure box).

3) Gentle posterior capsule “sleeper-style” stretch (only if tolerated)

Why it helps: can improve internal rotation in some people, but it’s not for everyone.
If it causes sharp pain, numbness/tingling, or makes you sorer for hours, skip it.

1. Lie on your side with the sore shoulder down, arm in front of you, elbow bent.
2. Use the other hand to gently guide the forearm toward the bed/floor until you feel a mild stretch.
3. Hold briefly, then release. Keep it light.

Pro tip: this should feel like a stretch, not a shoulder press from your worst enemy.

4) Thoracic spine extension (upper-back mobility)

Why it helps: overhead reach needs the upper back to extend. If it won’t move, your shoulder tries to do everythingand complains.

1. Sit tall in a chair and clasp your hands behind your head.
2. Gently lean your upper back over the chair back (or a foam roller) while keeping your neck neutral.
3. Do 6–10 slow reps.

5) Pendulum / “arm dangle” (pain-calming movement)

Why it helps: keeps motion going without loading the shoulder heavily.

1. Lean forward with one hand supported on a table or chair.
2. Let the sore arm hang and gently swing it in small circles.
3. 30–60 seconds, then switch directions.

Stretching is goodstrength is the plot twist

Many cases improve fastest when you pair mobility work with strengthening for the rotator cuff and shoulder blade muscles.
If stretching alone hasn’t helped, it’s not because you “did it wrong”
it’s often because the shoulder needs better control and capacity, not just more length.

Shoulder-friendly starter exercises (often used in PT)

• Scapular retractions: gently squeeze shoulder blades down/back (no shrugging), 2–3 sets of 10–15.
• External rotation with a band (elbow at side): rotate the forearm outward slowly, 2–3 sets of 8–12.
• Wall slides: forearms on the wall, slide up while keeping shoulder blades controlled and ribs down.
• Scaption (light weight): lift the arm slightly out to the side in a “V” angle, slow and controlled.

If any exercise causes sharp pain or makes symptoms noticeably worse the next day, scale it back (less range, less load, slower tempo) or switch it out.
Rehab should feel like training, not punishment.

Practical tips that make rehab work in real life

Sleep without angering your shoulder

• Try sleeping on your back or the non-painful side.
• Hug a pillow to support the sore arm so it doesn’t collapse forward.
• Avoid long periods with your arm overhead while sleeping if that triggers pain.

Desk posture (because your laptop doesn’t care about your rotator cuff)

• Bring the keyboard/mouse closer so you’re not constantly reaching forward.
• Take micro-breaks: 30 seconds every 30–60 minutes to roll shoulders and sit tall.
• Do 1–2 sets of scapular retractions during the day as a “posture reset.”

Gym swaps when overhead moves hurt

• Swap overhead press for landmine press or incline press (often better tolerated).
• Focus on rows, external rotation, and controlled scaption first.
• Skip painful upright rows or behind-the-neck presses if they flare symptoms.

When to see a clinician or physical therapist

Consider getting evaluated if:

• Pain lasts more than 2–4 weeks despite smart modifications.
• You notice true weakness (can’t lift the arm well) or sudden loss of function.
• Night pain is severe or worsening.
• You have numbness/tingling, neck pain with arm symptoms, or pain shooting below the elbow.
• You had trauma (fall, collision) or heard a pop and now can’t use the arm normally.

Conclusion

Shoulder impingement is common, annoying, andfortunatelyoften manageable without surgery. The key is matching the plan to the pattern:
reduce aggravating overhead load, restore comfortable mobility (especially chest, upper back, and posterior shoulder), and rebuild strength and control in the rotator cuff and scapular muscles.
If symptoms linger or function drops, a targeted exam (and sometimes imaging) can clarify what’s going on and speed up recovery.

Real-world experiences: what shoulder impingement feels like (and what actually helps)

People often describe shoulder impingement as “not bad…until I do one specific thing.” That’s the classic trap.
Day-to-day life feels mostly fine, and then you reach up to grab a mug from the top shelf and your shoulder sends a strongly worded complaint to your brain.
The weird part is how inconsistent it can feel: you can lift a grocery bag with no problem, but putting on a jacket or fastening a bra strap suddenly becomes an Olympic event.

One common experience is the night pain spiral. You fall asleep on your side, wake up an hour later with that deep ache, roll over, repeat.
After a few nights, everything feels worse because you’re tired and your shoulder is irritated. Many people notice that simply supporting the arm with a pillow
(so it doesn’t drift forward) can make sleep dramatically bettersometimes more than any stretch.

Another theme is the “I kept stretching and it kept getting crankier” story. It’s not that stretching is bad.
It’s that when the tendon/bursa is already irritated, aggressive stretching can feel like picking a scab because you’re “just trying to help it heal faster.”
People often do better when they switch to gentler mobility (like pendulums and easy chest opening) and add controlled strengtheningespecially external rotation
and scapular work. That’s usually when they start saying things like, “It still hurts, but it’s less dramatic and I feel stronger.”

A lot of desk workers also report that symptoms improve when they stop living in “reaching mode.”
If your mouse is far away and your shoulder is subtly forward all day, that low-grade strain adds up.
The win is often boring but real: move the mouse closer, sit taller, do a few scapular retractions between tasks, and suddenly your shoulder isn’t simmering constantly.
Small changes don’t feel heroic, but shoulders love boring consistency.

Athletes and gym-goers often experience a mental hurdle: overhead work is part of their identity.
The people who recover best usually aren’t the ones who “push through” pain; they’re the ones who train around it.
They swap painful overhead presses for variations they can tolerate, keep pulling movements strong, and rebuild overhead capacity gradually.
It’s surprisingly common to hear, “Once I stopped testing it every day, it actually started improving.”

Finally, many people find that getting a clear explanationwhy it hurts, what movements provoke it, and what the rehab plan isreduces fear and improves follow-through.
Shoulder impingement can feel mysterious because it’s triggered by everyday actions, but it usually responds to a straightforward strategy:
calm the tissue down, restore comfortable motion, strengthen the right muscles, and return to overhead activity step by step.
If that process stalls, a physical therapist can often spot the missing piece (too much load too soon, scapular control, limited thoracic mobility, or a different diagnosis entirely).