Shoulder Archives - Vitality Physiotherapy

Subacromial Impingement: Symptoms, Causes & Treatment

Subacromial impingement is one of the most common causes of shoulder pain, accounting for up to 65% of all shoulder complaints seen in clinical practice. If you’ve noticed pain when reaching overhead, lying on your shoulder at night, or performing a serve or golf swing, subacromial impingement could be the reason.

The good news is that the vast majority of people recover well with the right physiotherapy, without needing surgery. At Vitality Physiotherapy in Southwark, London SE1, we assess and treat subacromial impingement every week, helping active people get back to the sport and daily life they love.

What Is Subacromial Impingement?

The shoulder is a remarkably mobile joint — but that mobility comes at a cost. A small space called the subacromial space runs between the top of the upper arm bone (humerus) and a bony arch formed by the shoulder blade (the acromion). Running through this space are the tendons of the rotator cuff and a small fluid-filled cushion called the subacromial bursa.

Subacromial impingement occurs when these soft tissue structures become compressed or irritated within this narrow space, typically during arm movements — especially lifting the arm to the side or overhead. Over time, repeated impingement can cause inflammation, pain, and in some cases, partial or full rotator cuff tears.

A note on terminology: You may come across clinicians and researchers who argue that “impingement” is an imprecise — or even misleading — label. Their point is a fair one: a degree of subacromial compression is a normal part of shoulder movement, and it is only when the structures within that space become pathological that pain arises. For this reason, terms such as subacromial pain syndrome or rotator cuff-related shoulder pain are increasingly preferred in clinical literature. We use the term “subacromial impingement” here because it remains the most widely recognised by patients, but the most important thing — whatever the label — is identifying and addressing what is actually driving your pain.

Symptoms of Subacromial Impingement

Symptoms vary between individuals, but the most common complaints include:

Pain on the top and outer side of the shoulder, which may radiate down the upper arm
A “painful arc” — pain that occurs when raising the arm between roughly 60° and 120° of elevation
Night pain, particularly when lying on the affected shoulder
Pain with overhead activities such as reaching to a shelf or dressing
Reduced shoulder strength or difficulty sustaining overhead movements
Pain during sport — for example, the forward swing when serving in tennis, or the backswing in golf

In some cases, you may also notice a catching or clicking sensation as the arm moves. If weakness is significant, or if pain came on after a fall or direct impact, a rotator cuff tear should be ruled out.

What Causes Subacromial Impingement?

Impingement can develop gradually through wear and overuse, or more suddenly following a change in training load or a specific injury. Common contributing factors include:

Structural factors

Bony spurs (osteophytes) on the underside of the acromion, which narrow the subacromial space
An hooked or curved acromion shape (Type II or III), which is associated with higher impingement rates
Calcific tendinitis — calcium deposits within the rotator cuff tendon

Functional and movement factors

Rotator cuff weakness or muscle imbalance, particularly of the external rotators
Poor scapular control — the shoulder blade fails to rotate or tilt correctly during arm elevation
Postural habits that contribute to a rounded upper back and forward head position
Sudden increases in training load, repetitive overhead activity, or technique errors in sport

It is worth noting that structural findings on imaging do not always correlate with pain. Many people have bony spurs or an hooked acromion and no symptoms at all, which is why treatment focuses on what’s driving your pain rather than what a scan shows

How Is Subacromial Impingement Diagnosed?

Diagnosis is primarily clinical, meaning a thorough physical assessment by a physiotherapist or clinician is the most important step. Your physiotherapist will carry out:

A detailed history of your symptoms, activity levels, and aggravating factors
Range of motion testing to identify painful arcs and movement restrictions
Strength and rotator cuff testing to assess the integrity of the cuff muscles
Specific orthopaedic tests, such as Hawkins-Kennedy and Neer’s tests, to reproduce impingement signs
Scapular and postural assessment to identify contributing movement dysfunction

Imaging such as ultrasound or MRI may be requested if a rotator cuff tear is suspected, or if symptoms are not progressing as expected with treatment. X-ray can identify bony spurs or calcification but does not show soft tissue structures.

Treatment for Subacromial Impingement

Most specialist guidelines — including those from NICE and the British Elbow and Shoulder Society — recommend physiotherapy as the first-line treatment for subacromial impingement. Surgery is generally only considered if conservative management over three to six months has not produced sufficient improvement.

What physiotherapy involves

At Vitality Physiotherapy, we take a whole-body approach. We don’t just treat the painful shoulder in isolation — we assess the entire kinematic chain, including the thoracic spine, scapula, and hip and core stability, all of which can contribute to shoulder dysfunction.

Your treatment plan may include:

A targeted rotator cuff strengthening programme, progressed according to your goals and tolerance
Scapular stabilisation exercises to restore efficient shoulder blade movement
Thoracic mobility work to improve upper back extension and rotation
Manual therapy — joint mobilisation or soft tissue work — to reduce pain and improve movement
Postural re-education and workstation or technique advice where relevant
Kinesiology taping as an adjunct to support the shoulder and reduce pain during activity
Sports-specific rehabilitation, working in collaboration with your coach or personal trainer where appropriate

How long does recovery take?

Recovery time varies depending on the severity of the impingement and any underlying structural changes. Most people with subacromial impingement see significant improvement within 6–12 weeks of consistent physiotherapy. Those with a concurrent partial rotator cuff tear, significant structural changes, or a longer history of symptoms may take longer.

The key to a good outcome is early assessment, a well-structured rehabilitation programme, and addressing the root cause — not just the pain.

Will I need surgery?

The majority of people do not need surgery. A large body of evidence, including the influential CSAW trial, has shown that for most patients, subacromial decompression surgery provides no significant advantage over a well-delivered physiotherapy programme. This reinforces why early, expert physiotherapy is so important.

If surgery is recommended by your consultant after conservative treatment, your physiotherapist will work closely with your surgeon to optimise your pre-operative strength and your post-operative rehabilitation.

Struggling with shoulder pain? Book an appointment at our Southwark (SE1) clinic and get a thorough assessment today.

What Can You Do in the Meantime?

While you are awaiting assessment or in the early stages of treatment, the following can help manage symptoms:

Modify — don’t stop — activity. Avoid positions that reproduce sharp pain, but keep moving within a comfortable range.
Sleep position: try sleeping on your unaffected side with a pillow supporting the painful arm in front of you.
Ice or heat: short-term use of ice packs (10–15 minutes) can help in acute flare-ups; some people prefer warmth for ongoing stiffness.
Anti-inflammatory medication: over-the-counter NSAIDs such as ibuprofen can provide short-term pain relief if appropriate for you — always check with your pharmacist or GP.

Please avoid self-diagnosing and attempting to self-treat without professional guidance. Many shoulder conditions share similar symptoms, and an accurate diagnosis will ensure you follow the right programme for your specific presentation.

Frequently Asked Questions

Is subacromial impingement the same as a rotator cuff tear?

Not exactly. Subacromial impingement refers to compression of the rotator cuff tendons (and bursa) within the subacromial space. A rotator cuff tear is a structural injury to the tendon fibres themselves, which can occur as a result of prolonged impingement or from a sudden traumatic event. The two conditions can co-exist, which is why a thorough assessment is important.

Can I still exercise with subacromial impingement?

Yes — in most cases, staying active is beneficial. The key is modifying your exercise to avoid pain-provocative movements while you work on the underlying cause. Your physiotherapist will guide you through what is safe to continue and what to temporarily adjust.

Do I need a GP referral to see a physiotherapist?

No. In the UK you can self-refer directly to a physiotherapist. At Vitality Physiotherapy in London SE1, you can book an initial assessment online without a GP referral. If imaging or onward referral is needed, we will advise you accordingly.

Ready to get your shoulder assessed?

Our experienced physiotherapists at Vitality Physiotherapy, Southwark SE1 are specialists in sports and musculoskeletal physiotherapy. We offer same-week appointments and a thorough, personalised assessment to get you on the right path.

→ Book your appointment online | Call us: 0207 193 9928

Last reviewed: February 2026 | Vitality Physiotherapy Ltd

SLAP Tears

Did you know that small changes in the position of the clavicle, scapula, and spine all help move the shoulder? The shoulder is able to perform all these brilliant movements mostly because of its shape, but also because it’s supported by those other joints too. The accessory joints (between the clavicle, scapula, and spine ) allow us to create these complex movements. They also make these movements more stable and more powerful too! There are 7 movements that occur in the shoulder: abduction (away from the body), adduction (across the body), internal rotation, external rotation, flexion (upwards), extension (backward), and circumduction (a combination of all the above).

Taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury. Many athletes endure micro-traumatic stresses on the shoulder which can be both unpleasant and painful too! Significant damage happens these injuries are left without being treated.

Is a SLAP tear similar to a rotator cuff tear?

A SLAP tear is not to be confused with a rotator cuff tear. A rotator cuff tear involves a tear to a rotator cuff muscle/tendon. A SLAP tear refers to a tear of the labrum – which is a thick piece of cartilage that lines the shoulder joint. In most cases, there is also damage to the bicep tendon that attaches to the labrum. Sometimes SLAP tears are confused with AC Joint problems. One of the key differences is that in SLAP tears, you’ll have pain when your bicep muscle works eccentrically (like going down on a bench press).

What is a SLAP tear?

This is a tear to the ring of cartilage (labrum) that surrounds your shoulder’s socket. A SLAP tear tends to develop over time from repetitive, overhead motions, such as throwing a baseball, playing tennis or volleyball, or swimming. Usually, you’ll have pain at the top of the shoulder, clicking, and pain with those overhead activities. If you’ve had a SLAP tear your:

Athletic performance decreases. You have less power in your shoulder, and your shoulder feels like it could “pop out.

Range of motion decreases. You may not feel able to throw or lift an object overhead like you used to, as your range of motion decreases.

Shoulder hurts and you can’t pinpoint the pain. You have a deep, achy pain in your shoulder, but you can’t pinpoint the exact location.

There are 4 types of SLAP tears:

Type I SLAP lesions have been described as isolated fraying of the superior labrum with a firm attachment of the labrum to the glenoid. These types of SLAP tears are typically due to degenerative changes. It has been suggested that the majority of the population has some variation of a Type 1 SLAP lesion. These often present with no symptoms and are no cause for concern.

Type II SLAP lesions are defined by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps brachii from the glenoid cavity. This can often cause instability in the shoulder. This is the most common type of SLAP tear and often needs surgery for repair.

Type III SLAP lesions are tears in the shape of a bucket-handle. The labrum peels back, with no damage to the long head of bicep tendon.

Type IV SLAP lesions are a combination of Type II and Type III tears. This involves a bucket handle tear to the labrum, which extends into the bicep tendon. This type of tear often causes instability in the shoulder and the long head of the bicep.

Do all SLAP tears heal on their own?

Unfortunately, SLAP tears do not heal on their own. Sometimes surgery is the best option, depending largely on the type of SLAP tear. If a SLAP tear is left untreated, the shoulder can become unstable, leading to dislocation. Reduced range of motion, chronic pain, and adhesive capsulitis (frozen shoulder) are also common. Discuss this with your trusted healthcare provider after a thorough assessment of the injury, and what the best option is for you. A good clinician will always be able to advise about the advantages and disadvantages of the treatment options.

What does conservative management look like?

Exercises that develop strong control of the rotation in the shoulder are very important. They help ultimately to manage the load placed on the upper labrum (superior labrum), relieve pain, and help overhead athletes move their arms more efficiently. Watch me show you my favourite SLAP tear exercises!

Rotator cuff tears

How do you tear your rotator cuff?

Rotator cuff tears are common. They tend to occur more often amongst people over the age of 50 than younger people in their 30s and 40s. Older people tend to get tears due to age-related changes. In fact, it’s so common almost 50% of people over 60 get them. One study showed that asymptomatic tears were twice as common as symptomatic ones! Younger and middle-aged people tend to get them due to trauma, trying to lift a very heavy object or catch something heavy. Tears can also happen from a fall onto the shoulder or arm. It can also occur from a boom-bust cycle too much too soon type of exercise such as trying a new sport and overtraining without sufficient strength and conditioning to support the shoulder. In older people, it tends to happen because of age-related changes from decreased blood supply to the tendons connecting muscles to bones.

Do I have a rotator cuff tear or a sore shoulder?

There are many conditions that can give you pain in the shoulder. Pain can be referred from the neck as well as other organs like the gall bladder, lungs, and even your heart. It’s important to know that your shoulder pain is not a symptom of any other condition. A good Physio (like all of us at Vitality Physio) will ask all the relevant questions to keep you safe.

Some of the most noteworthy features of rotator cuff tears are:

The affected shoulder hurts when lying on it while resting.
Pain when lifting or lowering the arm during simple activities such as reaching for a shelf.
A feeling that the shoulder is weak. It’s particularly noticeable when lifting your arm to shoulder level or when rotating your shoulder.

Does the rotator cuff always need surgery if it is torn?

Let’s take a closer look at the anatomy:

The rotator cuff tendons are special. They are all connected via the rotator cable. Therefore, they all work together to make the rotator cuff a continuous structure, working harmoniously together. The cable functions as a stress shield. It acts in the same way that a suspension bridge transmits loads across to its supporting towers.

Here’s the good news- this means that even when you have a large tear of a rotator cuff tendon, you can sometimes neither have pain nor a loss of function!

However, tears that affect the function of the rotator cable are likely to need surgery. Therefore, the location, more than the size of the tear is more relevant in deciding whether surgery is needed.

How can Physiotherapy help?

It is important to address all factors that may have contributed to tendon injury or tear when treating rotator cuff injuries when surgery is not needed.

With physiotherapy, you will improve neck, scapular, and thoracic spine function. All of the body parts are integral to good shoulder function. If your neck is stiff or weak, your shoulder joint can often have to work harder. By targeting these supporting areas, you will improve the way your body is set up before you move your shoulder. This means that you give your shoulder the best chance to move both easily and powerfully.

As movement experts, Physios are great at distinguishing whether your joints have the stability to move efficiently too. So, we can help you get your shoulder working to its best potential.

We can help you find interim solutions to find more comfortable positions to sleep, and ways to modify your technique for activities, while you are recovering or getting stronger.

Now, generic exercises – off the internet will help to a certain extent; however, they cannot be replaced by robust, goal-orientated, and bespoke training plans. They are often not targetted to your individual needs, and it’s difficult to guess without an expert to guide you how often, how many repetitions, and how heavy to load your muscles.

To make improvements rehab should always be:

Specific- meaning is it for endurance, strength, balance, flexibility, or a combination of these?
Measurable- it needs to be scored.
Prescribed- so that you know the:

Intensity: How many repetitions?
Sets: How many times should you repeat a particular number of repetitions of a given exercise?
Dose: How many sessions per week?

By working with a well-planned specific rehab program- you’ll make the best gains and use your time efficiently too!

The Shoulder: an overview

The shoulder is a ball and socket joint. Its structure and form mean that it allows for many different movements, making it the most mobile joint in the body! The socket is pretty shallow but this allows us not only to complete day-to-day activities like washing our hair but also allows us to participate in overhead sports like tennis and cricket. Here at Vitality Physio, shoulder injuries are one of the most common injuries that we see. But first, some anatomy:

Shoulder anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder joint is actually where the ball of the humerus meets the rounded shallow socket of the scapula, called the glenoid. The muscles of the rotator cuff keep the large head of the humerus, positioned and centered in the glenoid. Doing so, helps to keep the most mobile joint in the body moving optimally!

So, what are the common causes of Shoulder Pain?

The shoulder is a complex joint, but fear not, with the right approach rehab needn’t be overwhelming! Overusing or underusing muscles and tendons can cause pain. Too much too soon, boom and bust are often the biggest culprits! Irritation to the bursae (the fluid-filled sac under bones or tendons) is very common and can be painful, even disturbing your sleep at night. Age-related injuries such as frozen shoulder or rotator cuff tears can cause pain too. They can rob you of movement and limit your function! Sometimes impact injuries and dislocations cause immense pain and damage to ligaments. Occasionally, shoulder pain may be referred from a nearby structure like an irritated nerve in the neck.

Every body is different and therefore every injury can present and have an impact on life in many different ways. A tendon injury for example may prevent someone from participating in sport, whereas a frozen shoulder can prevent someone from getting dressed in the morning. No matter the cause of injury, it is important to establish the cause. It helps prevent further injury, and will limit further longer-term issues too. Why leave it to chance?

What should I do if I have shoulder pain?

Distinguishing what is causing the pain, will impact your rehab. Sometimes, shoulder pain can be a result of an underlying illness such as diabetes or cardiac issues. Your Physio will flag the symptoms associated with causes other than the structures of the shoulder, and refer you to the right medical professional as needed.

If you have sudden crushing pain in your shoulder, call 999 straight away! If the pain runs from your chest to the left jaw, arm, or neck, or occurs with shortness of breath, dizziness, or sweating.

Do I need a scan of my shoulder? Why?

A thorough examination of the shoulder, alongside a detailed history of the injury, will often provide the most information required for our Physios to make a diagnosis. MRI scans are not always needed. In fact, a study in 2014 showed that MRI scans showed changes and pathology in both symptomatic and asymptomatic shoulders. It also demonstrated that symptoms may not match the MRI findings. The notable financial burden of ordering MRI scans and the pertinency of the findings are therefore sometimes questionable. This does not mean that you will never need a scan, however, this should be done to either confirm a diagnosis, rule out dangerous pathology, or if you have failed conservative therapies for a reasonable amount of time.

What can you expect from Physiotherapy?

Your Physio will offer you a tailor-made plan, based on the problems you have and the goals you’d like to achieve. Maybe you’d like to play tennis again, go bouldering or even the simple everyday activities such as getting your arm into a coat or reaching a high shelf. We are all different, so why should your treatment be exactly the same? The primary principles of our problem-solving treatments however, will all resonate with any shoulder condition that you may have. They are the mainstays of quality Physiotherapy, including education about injury, modified training, adequate strength work, restoring function, and returning safely to sport.

It’s really important to load and train the shoulder, even when pain and dysfunction are resolved. This should include a combination of strength and mobility work. Train the shoulder muscles from the famous rotator cuff, deltoids, and traps as well as the scapular and spinal muscles.

What can you do now?

If you are experiencing shoulder pain, come and see us, we will help you understand what exactly is going on. Don’t let the pain hinder you any longer. Let us help you with a tailored rehab program specific to your injury and goal.

Subacromial Impingement

Subacromial impingement is a common condition where pain is felt over the top of the shoulder and upper arm. It can affect golfers, tennis players or non-athletes.

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Shoulder