Shoulder Impingement: What Occupational Therapists Need to Know

Brian Comly
2 days ago
4 min read

Shoulder impingement is one of the most common problems I see in the clinic. It doesn't just affect athletes who throw or lift weights; it shows up in people folding laundry, reaching into cabinets, or simply rolling over in bed. When the rotator cuff tendons and surrounding structures get pinched, pain becomes a barrier to everyday life.

As occupational therapists, our role is to look beyond the anatomy. We connect the dots between movement patterns, posture, environment and function.

With the right strategies, we can help clients not only reduce pain, but also restore independence and confidence in their daily routines.

What Is Shoulder Impingement?

Shoulder impingement happens when the space between the humeral head and the acromion narrows, compressing the rotator cuff tendons and bursa. Over time, this creates irritation and inflammation.

Poor posture, repetitive overhead reaching, muscular imbalances and sometimes structural differences in the acromion all play a role. Clients often report pain with overhead movements, weakness, or difficulty sleeping on the affected side.

Diagnosis

While occupational therapists (OTs) don't formally diagnose, we are often the first to catch functional red flags. Things I look for include:

-Painful arc- Pain between 60-120 degrees of shoulder abduction.
-Functional difficulties- Reaching overhead, dressing, grooming, or lifting.
-Observation- Rounded shoulders, forward head posture, scapular winging or poor control.
-Client report- Sharp pain with reach, night pain, or fatigue with overhead tasks.
-Provocative tests- Commonly used to identify impingement patterns:
- Neer Test (pain with passive forward flexion)
- Hawkins-Kennedy Test (pain with internal rotation in 90° flexion)
- Empty Can Test (pain or weakness in resisted abduction)

Treatment

-Exercises-

1) Scapular Retraction

Strengthens rhomboids and middle trapezius, to stabilise the shoulder blade and protect the subacromial space.

Sit or stand tall. Pull shoulder blades back and down, avoiding shrugging.
Hold 5-10 seconds, 2-3 sets of 10-15 reps.
Upgrade: Add bands or cables, then progress to one-sided work.

2) Rows

Builds the posterior chain (rhomboids, traps, lats) for scapular stability.

Use a band, dumbbells, or cable. Pull toward your torso while keeping your elbows close and your spine neutral.
3 sets of 10-12 reps.
Upgrade: Remove chest support or perform single-arm rows for core activation.

3) Horizontal Abduction (T raises)

Targets the posterior deltoid, infraspinatus, and teres minor.

From a prone or bent-forward position, raise arms straight out into a 'T'.
2-3 sets of 10-12 reps.
Upgrade: Add light dumbbells or bands.

4) Open Book (Half Kneel)

Improves thoracic mobility and scapular control.

In a half-kneel, 'open' arms apart like a book, rotating through the thoracic spine.
2-3 sets of 10 per side.
Upgrade: Add a resistance band or do it from quadruped.

5) External Rotation with Band

Strengthens infraspinatus and teres minor for joint stability.

Keep elbow at side, rotate forearm outward against the band.
3 sets of 12-15 reps.
Upgrade: Progress to side-lying dumbbell external rotation, then side plank version.

6) Prone Y-T-W-L

Activates the lower traps, serratus anterior, and scapular stabilisers.

Lie prone, move arms through Y, T, W, L positions.
2-3 sets of 8-10 per letter.
Upgrade: Add light weights (3–5 lbs).

7) Serratus Anterior Punch

Essential for scapular protraction and upward rotation.

Supine, punch a dumbbell toward the ceiling by protracting the shoulder blade.
2-3 sets of 10-15 reps.
Upgrade: Progress to plank or bear plank punches.

8) Scaption

Works the supraspinatus in a safe plane of motion.

Raise your arms in a 'V' (30° forward of abduction) with dumbbells, stopping just below the nipple line.
2-3 sets of 12-15 reps.
Upgrade: Use an incline bench or slightly lean forward with weights.

-Stretches-

Subscapularis Release
Manual release (with thumb, broomstick corner, or tool) to reduce anterior shoulder tightness.
Pectoralis Minor Stretch
Doorway or wall stretch, to open the chest and reduce scapular anterior tilt.
Cross-Body Stretch
Pull the arm gently across the chest to lengthen the posterior capsule and deltoid.
Thoracic Spine Extensions
Use a foam roller for repeated extensions to improve posture and overhead mechanics.

-Therapeutic Approach-

Professional guidance

Early assessment and form correction by an OT, PT, or trainer is critical.

Manual therapy

Scapular mobilisations, soft tissue release, or IASTM (Instrument Assisted Soft Tissue Mobilisation) can restore mobility.

Technique cues

'Elbows in your pockets' helps avoid shoulder hiking; slow, controlled motion prevents compensation.

Programming

Start by limiting pushing and overhead exercises for 2-4 weeks. Reintroduce gradually with a pull-to-push ratio of 3:1 or 4:1.

Lifestyle changes

Address the habits that created the imbalance, such as posture at work, lifting form, or repetitive overhead tasks.

Pacing and patience

Shoulder impingement improves with consistency, not force. Clients who commit to daily corrective work usually make steady progress without setbacks.

Conclusion

In my experience, shoulder impingement responds really well to a combination of strengthening, stretching and small daily habit changes. The clients who get better fastest are the ones who stay consistent with their exercises and adjust their environment so they are not constantly aggravating the shoulder. I've seen people go from not being able to wash their hair without pain, to lifting, swimming, or playing catch with their kids again.

The earlier we catch it, the easier it is to treat.

About the author:

Brian Comly, M.S., OTR/L

Brian is a husband, father of two, full-time occupational therapist, certified nutrition coach - and the founder of MindBodyDad and The Growth Kit.

Shoulder Impingement: What Occupational Therapists Need to Know (Mind Body Dad on The Occupational Therapy Hub)

Since 2009, he has worked in Philadelphia with patients recovering from spinal cord injuries, traumatic brain injuries, strokes, orthopaedic injuries and progressive neurological disorders. Brian blends his clinical experience with his passion for performance, health and parenting to provide evidence-based strategies that help people live stronger, healthier and more intentional lives.