Treating Subacromial Impingement: Why Shoulder Pain Keeps Getting “Hit”
Subacromial impingement is one of the most common shoulder diagnoses—and one of the most fixable.
Despite how it’s often explained, this isn’t usually a problem of “damage.”
It’s a space and control problem.
What does “subacromial impingement” actually mean?
It describes pain that occurs when tissues under the acromion (the “roof” of the shoulder) become irritated during arm movement.
What it doesn’t mean:
something is permanently damaged
surgery is inevitable
rest alone will fix it
Most shoulder pain labeled as impingement is modifiable.
Think of the shoulder like a house
Here’s a simple way I like to describe what’s actually happening inside the shoulder.
The acromion is the roof
The humeral head (the ball) is the floor
The space between them is the living space
Three important structures live in that space:
The supraspinatus tendon
The subacromial bursa
The long head of the biceps tendon
They all need enough room to move comfortably.
How that space gets crowded
There are two main ways problems start.
1. The floor comes up
If the rotator cuff isn’t controlling the ball well, the humeral head can ride upward during movement.
When the floor comes up, everything above it gets hit more often.
2. The roof drops down
Poor shoulder blade mechanics, a stiff upper back, or tight tissues like the pecs can cause the acromion to sit lower than it should.
When the roof drops, the living space shrinks.
Often, both are happening at the same time.
Why repeated “hitting” matters
When those structures keep getting hit, they get irritated.
The body responds by:
bringing in fluid
thickening tissue
increasing inflammation
That’s the body’s way of trying to protect and strengthen the area.
But bigger, irritated tissues take up more space, which makes the house even tighter—and the hitting happens more often.
That’s how shoulder pain becomes persistent.
How we approach treatment
At SB Physio, treatment isn’t just about strengthening one muscle.
We focus on:
keeping the ball from riding up
helping the roof stay lifted
making enough room for everything in the house
That means combining:
joint mobilizations to improve motion and reduce early compression
rotator cuff control to keep the ball centered
scapular mechanics so the roof moves correctly
upper-back mobility to support the whole system
Mobilizations alone don’t fix shoulder pain—but they can reduce irritation so real strengthening can happen.
Why physical therapy is the right first step
Subacromial impingement rarely needs injections or surgery right away.
Physical therapy is the best first step because it:
improves movement mechanics
restores strength and load tolerance
reduces pain without masking it
helps determine if more invasive care is actually needed
The bottom line
Subacromial impingement isn’t a life sentence.
When the shoulder has enough room—and enough control—those structures stop getting hit.
That’s how we treat shoulder pain at SB Physio.
This content is for educational purposes only and is not intended as medical advice. Shoulder conditions vary, and treatment should always be individualized based on a comprehensive evaluation by a licensed healthcare professional.
