If your GP or last physio told you that you have "shoulder impingement," they weren't wrong, but they didn't tell you much either. Impingement is a description of what's happening mechanically (something getting squashed when you raise your arm), not the actual cause. Four causes account for most of what we see.
1. Rotator cuff tendinopathy
The most common one. The tendons of the rotator cuff (supraspinatus most often) get irritated from overuse, sudden load increase, or just being asked to do more than they're conditioned for. The pain is usually felt on the side of the shoulder, comes on during arm elevation, and is worst between 70 and 120 degrees.
Treatment: graded loading, manual therapy, posture work for contributing factors. Cortisone injections are sometimes useful but they aren't a long-term fix. Most cases settle in 6-12 weeks with the right loading program.
2. Sub-acromial bursitis
The bursa (a fluid-filled cushion that sits between the rotator cuff and the acromion bone above it) gets inflamed. Usually secondary to one of the other three. Pain is sharper, can wake you up at night when you roll onto that side, and is sensitive to direct pressure.
Treatment: settle the bursitis with rest and anti-inflammatory measures, then treat the underlying driver. Treating the bursa without treating what irritated it leads to it coming back.
3. Scapular dyskinesis
Fancy term for "your shoulder blade isn't moving properly." If the scapula doesn't tilt and rotate correctly when you lift your arm, the space the rotator cuff has to move through gets narrower, and things start getting pinched. Often a postural and muscular control problem, not a structural one.
Treatment: scapular control exercises, postural reset work, and retraining the movement pattern. This is the one that responds best to specific exercise prescription and worst to "rest it for a while."
4. Frozen shoulder (early stage)
Less common but easy to miss. The shoulder capsule starts to tighten and inflame, often without obvious cause. Early-stage frozen shoulder can look like impingement because both restrict movement, but the management is completely different.
Treatment: in the early "freezing" phase, gentle range work and pain management. Aggressive stretching makes it worse. This is also one of the rare cases where a referral to a specialist for injection consideration is genuinely worth it.
Why the right answer matters
The treatment for tendinopathy is graded loading. The treatment for frozen shoulder is the opposite — gentle movement, no loading. If you've been doing tendinopathy exercises for what turns out to be early frozen shoulder, you've been making it worse for weeks.
"Impingement" is a label that covers all four. A useful diagnosis narrows it down. If the answer to "what's actually wrong with my shoulder?" is "impingement," ask the follow-up question.
What a proper assessment looks like
In a first session at Recharge for shoulder pain, we'll run through specific tests for each of the four (and a couple of others). By the end you should know which one it is, what's likely going to fix it, and roughly how long.
Ring us on 07 394 4227, or book directly with whichever of us is the right fit. For shoulder work, Claire is usually the starting point.
