Shoulder Impingement

Shoulder impingement comes from the supraspinatus tendon becoming entrapped between the acromion and greater tuberosity during elevation and internal rotation of the arm. Repetitive impingement is often the beginning of a variety of shoulder issues such as supraspinatus tendon disruption, subacromial bursitis, biceps tendonitis, and rotator cuff rupture. Shoulder impingement results from repetitive overuse combined with functional issues like upper cross syndrome and scapular dyskinesis. (1)


Symptoms are often related to a period of overuse. It may start as a sharp pain with overhead activity or while reaching behind the back to fasten a bra. As it progresses, pain can become constant and even be present at rest. Pain can be present at night time and disrupt sleep. Sleeping on the affected side often makes symptoms worse. The pain is typically felt over the front and outside portions of the shoulder. 


Treatment for shoulder impingement focuses on restoring strength and range of motion while avoiding aggravating movements. Manual therapy is used to address tight muscles. Manipulation of the cervical and thoracic spine has been shown to decrease pain and disability in shoulder impingement patients while increasing mobility and function. (2-6) Mobilization can be done to the shoulder itself to increase range of motion. Return to activity begins when range of motion is full and pain free and strength is restored. Rehabilitation exercises focus on restoring muscle coordination around the shoulder joint. 


If you have an issue that you would like some guidance with, give us a call at (616) 301-1702.

  1. Warner J.J.P, Micheli L.J, Arslanian L.E, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. Clin Orthop Rel Res. 1992;285:191–199.

  2. Boyles RE et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. 2009 Aug;14(4):375-80

  3. Crosbie J, Kilbreathe SL, Hooman L, York S. Scapulohumeral rhythm and associated spinal motion. Clin Biomechan. 2008; 23: 184-192.

  4. Strunce JB, et al. The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain J Man Manip Ther. 2009; 17(4): 230–236.

  5. Walser RF, Meseve BB, Boucher TR. The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematice Review and Meta-Analysis of Randomized Controlled Trials. J Man Manip Ther. 2009; 17(4): 237-246.

  6.  Muth S et al. The Effects of Thoracic Spine Manipulation in Subjects With Signs of Rotator Cuff Tendinopathy Journal of Orthopaedic & Sports Physical Therapy, 2012, Volume: 42 Issue: 12 Pages: 1005-1016