What is shoulder impingement and what causes it?

Shoulder impingement syndrome occurs when the rotator cuff tendons or subacromial bursa become compressed and irritated in the narrow space between the humerus and acromion, often due to repetitive overhead activities, poor posture, or muscle imbalances.

Which exercises should be strictly avoided with shoulder impingement?

Exercises to strictly avoid include overhead presses, upright rows, lateral raises beyond 90 degrees or with internal rotation, behind-the-neck pulldowns/presses, deep dips, and push-ups with poor form or flared elbows. Most importantly, stop any exercise that causes pain.

What are the warning signs of shoulder impingement?

Warning signs include a dull ache at rest, sharp pain when lifting the arm overhead or reaching, difficulty lifting the arm (weakness), clicking or popping sensations, and limited range of motion.

Are there safe exercises or modifications for shoulder impingement?

Safe alternatives include exercises performed within a pain-free range, scapular stability exercises (e.g., face pulls, prone rows), external rotation exercises for rotator cuff strengthening, and horizontal pushing/pulling movements like dumbbell rows and chest presses (with proper form).

When should I seek professional help for shoulder impingement?

It is paramount to consult a healthcare professional like a physical therapist, orthopedic doctor, or sports medicine physician for an accurate diagnosis, to identify underlying causes, and to receive a personalized rehabilitation program.

What exercises should you avoid with shoulder impingement?

To effectively manage shoulder impingement, it is crucial to avoid exercises and movement patterns that narrow the subacromial space, particularly those involving overhead reaching, internal rotation, and certain pressing movements, as these can compress the rotator cuff tendons and bursa, exacerbating pain and inflammation.

Understanding Shoulder Impingement

Shoulder impingement syndrome occurs when the tendons of the rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis) or the subacromial bursa become compressed and irritated as they pass through the subacromial space – the narrow gap between the top of the humerus (arm bone) and the acromion (a bony prominence of the shoulder blade). This compression typically happens during arm elevation, particularly when the arm is raised overhead or rotated internally. Contributing factors often include repetitive overhead activities, poor posture, muscle imbalances, scapular dyskinesis (improper movement of the shoulder blade), or anatomical variations of the acromion.

Why Certain Movements Worsen Impingement

The fundamental issue in shoulder impingement is the reduction of space within the subacromial region. When the arm is elevated, especially in combination with internal rotation (where the thumb points down), the greater tuberosity of the humerus (a bony prominence where rotator cuff tendons attach) can press against the acromion. This pinching mechanism directly irritates the soft tissues, leading to pain, inflammation, and potentially, tendon damage over time. Exercises that force the shoulder into these compromised positions are prime culprits for exacerbating impingement symptoms.

Exercises and Movements to Strictly Avoid

The following exercises and movement patterns should be avoided or heavily modified if you are experiencing shoulder impingement, as they are most likely to compress the subacromial space and irritate the affected tissues:

Overhead Presses (Barbell, Dumbbell, Machine):
- Why avoid: Any exercise that involves pressing weight directly overhead, especially with a wide grip or when the elbows flare out, significantly reduces the subacromial space. This directly impinges the rotator cuff tendons and bursa against the acromion.
- Examples: Military press, overhead dumbbell press, push press, Arnold press.
Upright Rows:
- Why avoid: This exercise involves lifting a barbell or dumbbells straight up towards the chin, with elbows flaring out high. This movement places the shoulder in a position of high internal rotation and abduction, which severely narrows the subacromial space and is one of the most common aggravators of shoulder impingement.
Lateral Raises Beyond 90 Degrees (or with internal rotation):
- Why avoid: While lateral raises to 90 degrees can be performed safely with proper form (thumb pointing up or neutral), continuing the raise beyond horizontal or performing it with the thumb pointing down (internal rotation) significantly increases impingement. The humerus is forced into a position that compresses the rotator cuff.
Behind-the-Neck Pulldowns and Presses:
- Why avoid: These variations force the shoulder into an extreme range of external rotation and abduction, which can place excessive stress on the anterior joint capsule and the rotator cuff. For an impinged shoulder, this often leads to direct compression or exacerbates existing inflammation due to poor scapular positioning.
Dips (Especially Chest Dips with Deep Descent):
- Why avoid: Deep dips can place the shoulder joint in an overly extended and internally rotated position at the bottom of the movement, particularly when the elbows flare out. This can cause the humeral head to migrate anteriorly and superiorly, leading to impingement.
Push-ups (with poor form or flared elbows):
- Why avoid: Similar to presses, if push-ups are performed with elbows excessively flared out (leading to internal rotation of the humerus) and without proper scapular stabilization (e.g., "winging" of the shoulder blades), they can place the shoulder in a compromised position, increasing impingement risk.
Any Exercise Causing Pain:
- Why avoid: This is the most critical rule. If an exercise causes a sharp, pinching, or aching pain in the shoulder, especially during or immediately after the movement, it should be stopped immediately. Pain is your body's clear signal of distress and potential harm.

Recognizing Warning Signs

Beyond avoiding specific exercises, it's crucial to be attuned to your body's signals. Common warning signs of shoulder impingement include:

Pain: A dull ache at rest, but sharp pain when lifting the arm overhead, reaching behind the back, or reaching across the body.
Weakness: Difficulty lifting the arm or performing certain movements.
Clicking or Popping: Sensations within the shoulder joint during movement.
Limited Range of Motion: Inability to move the arm through its full range without pain.

Safe Alternatives and Modifications

While avoiding problematic movements, it's essential to incorporate exercises that promote shoulder health and stability. Focus on:

Controlled Range of Motion: Perform exercises within a pain-free range.
Scapular Stability Exercises: Focus on strengthening the muscles that stabilize the shoulder blade (e.g., face pulls, Y/T raises, prone rows).
Rotator Cuff Strengthening (External Rotation Focus): Exercises like external rotations with light resistance bands can improve rotator cuff strength and balance.
Horizontal Pushing and Pulling: Exercises like dumbbell rows, cable rows, and chest presses (within pain-free range, perhaps with a neutral grip) can be safer alternatives.
Proper Form: Emphasize maintaining a neutral spine, engaged core, and controlled movement throughout all exercises.

The Importance of Professional Guidance

Self-diagnosis and self-treatment of shoulder impingement can be counterproductive and lead to further injury. If you suspect you have shoulder impingement, it is paramount to consult a healthcare professional. A physical therapist, orthopedic doctor, or sports medicine physician can provide an accurate diagnosis, identify underlying causes (e.g., muscle imbalances, posture issues, structural abnormalities), and prescribe a personalized rehabilitation program. They can guide you on specific exercises to avoid, modify, and incorporate for safe and effective recovery.

Conclusion

Navigating exercise with shoulder impingement requires a deep understanding of the mechanics of the shoulder and a disciplined approach to movement selection. By strictly avoiding exercises that narrow the subacromial space – primarily overhead movements, upright rows, and movements performed with poor form or excessive internal rotation – you can significantly reduce irritation and promote healing. Always prioritize pain-free movement and seek professional guidance to ensure a safe and effective path to recovery and long-term shoulder health.

Shoulder impingement involves compression of rotator cuff tendons or the bursa in the subacromial space, often exacerbated by arm elevation and internal rotation.
Strictly avoid exercises that narrow the subacromial space, such as overhead presses, upright rows, lateral raises beyond 90 degrees, and behind-the-neck movements.
Deep dips and push-ups with poor form (flared elbows, poor scapular stabilization) can also worsen impingement symptoms.
The most critical rule is to immediately stop any exercise that causes sharp, pinching, or aching pain in the shoulder.
Prioritize pain-free movements, focus on scapular stability and external rotation, and seek professional guidance for an accurate diagnosis and personalized recovery plan.

Shoulder Impingement: Exercises to Avoid, Safe Alternatives, and Professional Guidance