Understanding rotator cuff & shoulder impingement
The rotator cuff is a group of four muscles that centre and control the shoulder joint through its very large range of movement. When their capacity falls behind demand, pain typically appears with overhead and reaching activities.
Impingement describes the resulting pinching sensation. It is better understood as a symptom of how the shoulder is moving and coping than as a structural problem needing correction.
Signs you might notice
- Pain reaching overhead or out to the side
- Difficulty sleeping on the affected shoulder
- Weakness lifting or carrying
- A painful arc of movement partway up
- Pain reaching behind you, for a seatbelt for example
Common contributing factors
- Increases in overhead work or sport
- Weakness in the cuff and shoulder blade muscles
- Reduced mobility in the upper back
- Previous injury or long standing avoidance
- Age related tendon change
How we assess and treat it
We test the cuff properly with resisted movements rather than by eye, assess shoulder blade control, and check the upper back, since a stiff thoracic spine forces the shoulder to work harder.
Rehabilitation is graded strengthening, done properly and progressed on evidence rather than guesswork. It requires consistency, and we will be direct about that.
- Hands-on treatment for symptom relief
- Progressive rotator cuff and shoulder blade strengthening
- Mobility work for the upper back
- Activity and load modification while you rebuild
- Referral for imaging or specialist opinion if progress stalls
Common questions
Do rotator cuff tears always need surgery?
No. Many partial and even full thickness tears function well with good strengthening, particularly in older adults. Surgery is one option rather than the automatic answer.
Why is it worse at night?
Lying on the shoulder compresses the tendons and reduces blood flow, and there is less distraction from the pain. Position changes usually help while treatment takes effect.
How long until it improves?
Expect meaningful change over six to twelve weeks with consistent work. Shoulders reward patience and punish sporadic effort.