Shoulder impingement is one of the most common causes of shoulder pain in active adults, and one of the most commonly mismanaged. The term describes a mechanism rather than a single diagnosis: a pinching or compression of the soft tissues (particularly the supraspinatus tendon and subacromial bursa) in the narrow space beneath the acromion during shoulder elevation. Understanding what is causing the impingement determines how it should be treated.
Our team has particular experience managing shoulder presentations, including complex rotator cuff cases and shoulder impingement in both desk workers and overhead athletes.
What Causes Shoulder Impingement?
- Rotator cuff weakness: the four rotator cuff muscles normally work to depress the humeral head and maintain it centred in the socket during arm elevation. When they are weak or inhibited, the humeral head rides up into the subacromial space.
- Poor scapular control: the scapula needs to rotate upwardly and tip posteriorly as the arm elevates. Weakness in the serratus anterior and lower trapezius impairs this mechanics and reduces the subacromial space.
- Thoracic kyphosis: excessive rounding of the upper back tilts the scapula forward and downward. This is related to the posture patterns discussed on our neck pain page.
- Tight posterior shoulder capsule: stiffness in the posterior capsule can bias the humerus anterosuperiorly during elevation.
- Acromial morphology: a curved or hooked acromion provides less subacromial space and predisposes to impingement.
Symptoms
- Anterior or lateral shoulder pain during arm elevation, particularly between 60 and 120 degrees (the painful arc).
- Pain with activities above shoulder height, reaching overhead, behind the back, or across the body.
- Night pain, particularly lying on the affected side.
- Weakness in the shoulder, especially with external rotation and abduction.
- A clicking or catching sensation in the shoulder during movement.
Treatment at Waterloo Chiropractic
- Thoracic spine mobilisation: reducing thoracic kyphosis directly improves scapular position and subacromial space.
- Glenohumeral joint mobilisation: restoring internal rotation and posterior capsule mobility.
- Rotator cuff and scapular stabiliser rehabilitation: the evidence consistently supports progressive loading of the rotator cuff over passive treatment alone.
- Soft tissue therapy and dry needling for the posterior capsule, infraspinatus, subscapularis, and pectoralis minor.
- Postural correction addressing the thoracic and shoulder posture patterns that perpetuate impingement.
- Activity modification and sport-specific load management, particularly for overhead athletes and those with occupational exposure.
How Waterloo Chiropractic Can Help
At Waterloo Chiropractic, we assess shoulder impingement with a focus on understanding the cause, not just treating the symptom. Our assessment examines scapular mechanics, rotator cuff strength and activation, thoracic spine mobility, glenohumeral range of motion, and the cervical spine for referred pain or neural contributions. This comprehensive picture is what allows us to direct treatment at the right targets.
Treatment combines thoracic and glenohumeral joint mobilisation to restore movement, soft tissue therapy and dry needling for the posterior capsule and rotator cuff musculature, and a progressive rotator cuff and scapular stabiliser loading programme. The exercise component is essential: without it, the mechanical factors driving impingement will persist regardless of how good the hands-on treatment is.
We work with patients across the full spectrum of shoulder presentations, from desk workers with early-stage impingement to overhead athletes and those with more complex rotator cuff involvement. If you have had a shoulder ultrasound or MRI, please bring the report or images to your first appointment. Find out what to expect.
Shoulder pain that limits your range of motion or disturbs your sleep should be assessed. Book online or call (02) 9690 0911. Shop 265, 8 Lachlan St, Waterloo NSW 2017.