13/07/2025
Pain lifting your arm overhead or lying on your shoulder? You might’ve been told it’s shoulder impingement — but the term itself is outdated. We now understand this condition as a combination of subacromial tissue overload and motor control deficits, not simply a mechanical “pinching” of tendons. The key structures involved are the supraspinatus tendon, subacromial bursa, and sometimes the long head of biceps. Pain is typically provoked by poor scapular control, reduced upward rotation, or altered glenohumeral kinematics — especially in positions of flexion and internal rotation. While acromial shape and bursal thickening were once blamed, recent research shows that anatomical factors are less predictive of symptoms than previously thought. The real issue is a mismatch between load tolerance and movement control. Rehabilitation focuses on progressive loading of the rotator cuff and scapular stabilisers, restoring optimal shoulder mechanics, and gradually reintroducing overhead activity. Manual therapy may assist short term, but long-term outcomes hinge on improving motor control and tendon capacity. Thinking of a cortisone injection? It may offer short-term pain relief, but without addressing the underlying mechanics, symptoms often return — sometimes worse. For lasting change, strength and movement retraining remain the gold standard.
