Treat The Hidden Cause of Subacromial Impingement
Key insights: 60-second read
- Subacromial impingement is rarely just a shoulder problem – it can stem from hidden restrictions in your upper back, rib cage, and posterior shoulder capsule that rob your shoulder of the slack it needs to move freely.
- Poor posture is a primary driver – slouched, forward-rounded shoulders place constant tension on the back of your shoulder, gradually stiffening tissues and setting the stage for things to jam up and impinge.
- Mobility work should target the "step before" – instead of just treating the painful spot in isolation, address the upper back, rib joints, and shoulder capsule to restore normal mechanics and reduce impingement pressure.
- Test and retest to track progress – use a simple shoulder test before and after each exercise to gauge progress in range and pain, confirming whether you're on the right track or not.
- Movement with pressure is key – using a ball to apply pressure while gently moving your arm helps "shear free" restricted tissue, making releases more effective than static pressure alone.
Are you struggling with shoulder pain at the tip of your shoulder that won't go away? If you are, make sure you're taking a step back to look at the bigger picture. Subacromial impingement syndrome can be a constant battle – partly because it genuinely feels awful, and partly because the treatments you've tried may not have addressed the underlying cause of why that part of your shoulder became sore in the first place.
The good news is that improving pain from subacromial impingement doesn't have to be as difficult. In this guide, I want to walk you through three simple mobility exercises that go after the step before – addressing why your subacromial space is impinging when it shouldn't be.
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1. The Hidden Context: Why Your Shoulder Hurts
The reason for subacromial impingement often has everything to do with how the rest of your shoulder complex moves and functions. When you move your arm, your shoulder blade must slide around your upper back to facilitate this.
If there's a relatively hidden handbrake at the top of your upper back – restrictions in your rib joints, spinal joints, or soft tissues – things can break down. Instead of your shoulder blade moving up as your arm moves up, it can jam up. Your arm still needs to move, so it becomes far easier to impinge your shoulder underneath that subacromial space.
"We ultimately need to look more broadly than where your shoulder pain actually is to understand why it's actually there."
Additionally, muscular tightness – most commonly at the back of the shoulder – again pulls slack out of the system, making the subacromial space more likely to jam up with movement.
Key Concept: The source of your pain (bursa, tendon, or other tissue) isn't the whole story. There has to be a reason why that exact tissue became painful. If you aren't looking at the tissue in your upper back, the posterior shoulder capsule, and the soft tissue at the back of your shoulder, you could be missing the hidden context that caused your pain to be there in the first place.
2. Exercise 1: Upper Back & Rib Joint Release
This is potentially the most common reason behind subacromial impingement. Restrictions in the upper back joints or soft tissue make it harder to express normal, fluent shoulder movement.
Step-by-Step Instructions
- Setup: Take a lacrosse ball or tennis ball. Place it anywhere in your upper back – from the very top down to the bottom of your shoulder blade. Gently recline down onto the ball. You can do this in sitting or standing if lying down is uncomfortable.
- Positioning: Roll off the bony bumps in the middle of your spine so you're targeting the spinal joints and rib joints. Start near the base of your neck, and roll slightly to the side you're working on.
- Release with Movement: Stay on the ball, or if your shoulder allows, gently move your arm into shoulder flexion as far as symptoms allow. Use this movement with pressure to shear free restricted tissue.
- Oscillate: Gently oscillate in and out of your end range. As the tissue starts to give, your arm should go further and further as muscles and rib joints mobilise.
- Systematic Search: Work your way down, staying close to the spine or coming further out toward your shoulder blade. Spend the most time on the spots that feel most restricted.
- Test & Retest: Return to your shoulder flexion test. If restrictions in your upper back were part of the problem, you should feel a smoother, more comfortable movement immediately.
"The benefit of doing this is we're using movement with the pressure from the ball to shear free the restricted tissue as we find it."
3. Exercise 2: Posterior Shoulder Capsule Release
In a perfect world, your shoulder capsule has enough slack to express normal range of motion. If it has become tighter for any reason, your ability to move freely is reduced, increasing the likelihood of jamming and impingement.
Step-by-Step Instructions
- Setup: Get down on all fours (or use a table if the floor is hard for you). Drop down onto your elbows to direct pressure through the back of your shoulder while avoiding subacromial pain - as shown in the video above.
- Position: Pull your shoulders back to take slack out of the system. Shift your body weight to the side you're working on. Imagine your arm bone pushing out the back corner of your shoulder.
- Target: You should feel pressure at the back of your shoulder, toward your armpit. If you feel jamming in the front, adjust your position – come up and over it a bit more, or adjust your shoulder position.
- Hold: Hang out here for 30-60 seconds (or up to 2 minutes) as comfortable.
- Progression (optional): To bias more of the back of the shoulder, rotate your forearm inward (internal rotation). But be cautious – if you lack flexibility, this may expose impingement symptoms. Start with forearms parallel if you're irritated.
- Test & Retest: Reassess your shoulder flexion. You should notice improved range and less pain if the capsule was a contributing factor.
4. Exercise 3: Soft Tissue Release at the Back of the Shoulder
One of the most common reasons for developing tightness in the upper back, shoulder capsule, and tissues at the back of your shoulder is the quality of the postures we get into most throughout the day – sitting at a computer, driving, or relaxing on the couch.
If you slouch and your shoulders drop and roll forward with gravity, the weight of your arm hangs off these structures, asking them to become restricted over time. Improving those postures goes a long way, but in the meantime, this release can help.
Step-by-Step Instructions
- Setup: Use your lacrosse or tennis ball. Place it on the back of your shoulder (the posterior aspect). Lie down onto it, or press against a wall if that's easier.
- Position: Have your elbow out to about 90 degrees if comfortable. If not, having it down lower is fine.
- Release: Once you find a tight spot, stay there and let the ball press in. You can tense the muscle for 5-10 seconds, then relax – this prompts the tissue to give and allows the ball to sink deeper.
- Hunt: Systematically search all around the back of your shoulder for any areas that feel restricted.
- Add Movement: If your symptoms aren't too irritable, gently express internal rotation (rotating your forearm down) while keeping the ball in place. This helps shear free the restricted tissue.
- Test & Retest: Reassess your shoulder flexion test one final time. You should notice cumulative improvements in range and pain.
Your shoulder impingement – that subacromial space and the tissues irritated within it – has to be there for a reason. While it could be a bursa, tendon, or ligament that's the source of pain, there must be a reason why that exact tissue in your body became painful.
If you aren't taking that step back to look at the tissue in your upper back, the posterior shoulder joint capsule, and the soft tissue at the back of your shoulder, you could be missing some of the hidden context that caused that pain to be there in the first place. All the medications, injections, surgeries, and general strength work in the world can be helpful, but they may not be fixing the problem.
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- Grant
Frequently Asked Questions
What is subacromial impingement?
Subacromial impingement occurs when the tendons of the rotator cuff or the bursa become pinched or irritated as they pass through the subacromial space – the gap between the top of your arm bone and the acromion (the bony tip of your shoulder). This can cause pain, weakness, and limited movement.
How do I know if I have a tight posterior capsule?
A common sign is difficulty reaching behind your back or across your body. You may also feel a deep ache at the back of your shoulder. The exercise described in this guide – shifting weight onto your elbow on all fours – can help you identify if this is a restriction for you.
Can I do these exercises if my shoulder is very painful?
Yes, but with caution. Always respect your pain. If an exercise increases your symptoms significantly, ease off or modify it. You can do the upper back release without moving your arm; just let gravity do the work. For the capsule release, adjust your position to avoid any jamming in the front of your shoulder.
How often should I do these exercises?
You can perform these mobility exercises daily. The key is the "test and retest" approach – you should see immediate improvements in your shoulder flexion test after each session, which guides you on which areas need the most work.
One key insight from this video
"Your shoulder impingement has to be there for a reason. If you aren't taking that step back to look at the tissue in your upper back, the posterior shoulder joint capsule, and the soft tissue at the back of your shoulder, you could be missing the hidden context that asked that pain to be there in the first place."
Living With Shoulder Pain?
If you are struggling with shoulder pain, limited movement, or ongoing symptoms, we can help. Learn more about our shoulder pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you would like help making sense of your shoulder pain or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
