Is "Shoulder Impingement" a Myth? Breaking Down Your Pain and Finding the Right Fix

Matthew Barrett
Dec 1, 2025
4 min read

For years, if you came to see a shoulder specialist with pain when lifting your arm, you were almost certainly told you had Shoulder Impingement Syndrome – the idea that a bone or ligament was literally pinching your rotator cuff tendon.

As a Shoulder and Elbow Consultant, my approach, and the approach of the best specialists globally, is constantly evolving. We now have a far more nuanced understanding of this common pain. So, is "impingement" still a useful term, or is it just a painful, outdated myth?

The answer is crucial, because understanding your diagnosis dictates your treatment.

Why the Term "Impingement" is Being Challenged

If you have been diagnosed with impingement, please don't worry; the concept was based on a sincere desire to help patients. The theory was simple: as you lifted your arm, the space beneath the bony arch (the acromion) got smaller, pinching the tendons (the rotator cuff) running through that space.

However, modern research and advanced imaging now show that in many cases, what we see isn't a simple mechanical pinching. Instead, the tendon pain is often related to a cluster of factors.

The pain is more often driven by:

Tendon Health (Tendinopathy): The tendon itself is overloaded, irritable, or showing early signs of wear and tear, often due to repetitive activities or poor mechanics.

Muscle Control Issues: The way your deep stabilising muscles and your shoulder blades (scapulae) work together may be inefficient. Poor control means the tendon works harder and gets irritated.

Overall Loading: The cumulative demand you are putting on the shoulder (e.g., swimming, throwing, painting, or heavy lifting at work).

So, What Should I Call My Pain Instead?

You don't need to get caught up in jargon! If you have pain when raising your arm, the best modern term is usually Rotator Cuff Related Pain (RCRP). This matters because RCRP shifts the focus from fixing a structure (a bone spur) to improving function (a healthy, well-moving tendon).

The Old Approach: Pain = Impingement = Potential Surgery (Decompression/Shaving).

The Modern Approach: Pain = RCRP = A Tailored Treatment Plan focusing on the root cause.

What to Do Now: Your Actionable Guide to RCRP

As someone who loves being active, whether I'm running and needing good arm drive or kitesurfing and needing excellent shoulder function, I know the frustration of having pain stop you from doing what you love.

If you suspect you have RCRP, here is what you should focus on right away, and when you should seek expert help.

Phase 1: Immediate Self-Management (The First 1–2 Weeks)

Your primary goal in this phase is to settle the immediate irritation and maintain mobility without causing further pain.

1. Activity Modification (The Key DON'T)

You should avoid movements that cause the "impingement arc", the classic catching pain when lifting your arm between chest height and fully overhead or reaching across your body. You are resting the irritable movement, not the entire arm.

DON'T try to push through the pain to lift objects or complete high-reach tasks.

DO use the arm for low-level, pain-free tasks (e.g., typing, eating).

2. Gentle Movement (The Key DO)

Stopping movement completely often leads to stiffness, which complicates recovery. Keep the joint mobile with gentle, pain-free exercises like pendulum swings and passive range of motion:

Pendulum Swings: Lean over and let your painful arm dangle, swinging it gently in small circles.
Passive Range of Motion: Use your good arm to gently lift and support the painful arm, moving it through a comfortable range.

3. Pain Relief

Over-the-counter anti-inflammatories (NSAIDs) can be useful for short-term relief to reduce irritation and allow you to perform the gentle movements above. It's important to know that these are a tool to enable rehabilitation, not a cure for the underlying problem.

Phase 2: Seeing a Specialist (When to Call Me)

While RCRP often improves with sensible self-management, you should seek a formal diagnosis if:

The pain is worsening or not improving after 2 weeks of gentle management.
Your sleep is constantly interrupted by shoulder pain.
The pain is limiting basic activities (e.g., getting dressed, driving).

When you see me at my clinics in Dorchester or Poole, the focus is not just confirming RCRP, but determining its root cause. This involves a detailed examination and, sometimes, advanced imaging like an ultrasound or MRI, to rule out other issues like major tears, calcific tendinopathy, or arthritis.

Phase 3: The Modern RCRP Treatment Path

The good news? For the vast majority of people, Rotator Cuff Related Pain responds extremely well to non-operative treatments such as the below:

1. Specialised Physiotherapy (The Cornerstone)

This is the most critical element. Modern physiotherapy for RCRP is not passive. It focuses on:

Strength: Carefully targeted exercises to strengthen the rotator cuff and surrounding muscles.
Retraining: Improving the coordination and movement of the shoulder blade (scapular control).

2. Targeted Injections (The Enabler)

If pain is too severe to start effective physiotherapy, a targeted cortisone injection can be an invaluable tool. It calms down the inflammation, providing a "window of opportunity", usually 6-8 weeks, where you can commit fully to the strengthening and control exercises needed for long-term recovery.

3. Surgery (The Last Resort)

Surgery (known as subacromial decompression) is now reserved for a small minority of patients where non-surgical options have been tried diligently for several months, or if there is a clear and significant structural issue causing the problem.

If your shoulder pain is limiting your life, don't just rely on an old, vague diagnosis like "Impingement." The modern approach is tailored, effective, and focuses on getting you back to doing the things you love, whether it's running, kite surfing, or just enjoying a pain-free life.

Try my Score My Shoulder questionnaire, where I'll review your shoulder pain. If you'd like to make an appointment to see me at one of my private clinics in Dorset, speak to my friendly team. Let's get you back to doing the things you love.