Shoulder Impingement
Next to hand injuries, shoulder injuries are the second most common climbing injury among climbers, increasing dramatically over the last 20 years. Shoulder impingement is the second most common shoulder injury, following SLAP tears. When discussing shoulder impingement syndrome, it is important to distinguish between primary and secondary forms of the injury.
Primary impingement is caused by a mechanical narrowing of the subacromial space. Think of the top of the subacromial space, the acromion, as a roof, and when you lift your shoulder to a certain point, the bones and muscles of your shoulder bump up against the roof, creating pain and discomfort.
Secondary impingement is due to a disturbance in the functional aspect of the humeral head, which is the part of the humerus that articulates with the shoulder socket. This is often caused by the head of the humerus not being centred, which can be triggered by muscle imbalances and tight pectoral muscles.
Anatomy
The shoulder is a pretty complex joint, but when it comes to shoulder impingement, the key parts are fairly simple. The main joint is where the top of your upper arm bone (the humeral head) fits into a shallow socket on your shoulder blade (called the glenoid).
Around this joint are a few other important structures that help your shoulder move smoothly and stay stable, like the acromion, the collarbone, and a little fluid-filled sac called the subacromial bursa.
This bursa acts like a cushion to reduce friction, especially between the top of the shoulder and the rotator cuff tendons, mainly the supraspinatus, which is the one that often gets irritated with impingement. While other muscles like the infraspinatus are nearby and part of the rotator cuff too, the supraspinatus is usually the one getting squeezed.
There are a few things that can contribute to shoulder impingement, like changes in bone shape, poor posture, muscle imbalances, or shoulder overuse. These issues can lead to
Inflammation of the bursa and irritation of the rotator cuff tendons.
Simply put, shoulder impingement occurs when the space under the acromion, the subacromial space, gets too tight. The reduced space can lead to pinching of the supraspinatus tendon and the subacromial bursa, especially during overhead movements (Figure 1), creating pain during elevation of the shoulder.
Figure 1. Property of College Park Chiropractors
Method Of Injury
Shoulder impingement is primarily an overuse injury, where repeated aggravating movements gradually narrow the subacromial space, the area beneath the acromion and above the rotator cuff tendons. In general, activities involving repetitive overhead motions, like swinging a hammer or lifting heavy objects above head height, are common culprits.
In climbing, however, shoulder impingement often develops from specific movement patterns that place the shoulder in compromised positions. Movements such as climbing with "chicken wing" elbows, mantling over the lip of a boulder, or performing repeated overhead jams with the thumb rotated downward can all contribute. These positions often challenge the rotator cuff and scapular stabilizers, especially when there’s an underlying imbalance or lack of control. Over time, this can lead to irritation and “pinching” in the subacromial space, resulting in pain and limited range of motion.
Property of Climbing Magazine
Assessment
Shoulder impingement syndrome can often present very similar to damage or injury to the rotator cuff muscles, and although these injuries are in a very similar location they are not both considered to be shoulder impingement. In order to test to see if you possibly have rotator cuff injury perform this external rotation test.
Signs or Symptoms
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Dull ache in the front or side of the shoulder
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Painful while lying on the shoulder
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Discomfort lifting the arm, reaching across the body and behind the body
Testing
External Rotation Test
With your arm placed in a 90 degree bend with your hand straight out in front of you performs resisted external rotation. (you can do this against a wall or a friends hands)
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If this causes pain but does show any weakness it is likely shoulder impingement, however, if you feel weak in this position it is likely a rotator cuff injury.
Step 2: External Lag Sign
From the same position, 90 degrees bend at the elbow and hand straight out in front of you, have a friend bring your arm into external rotation and let go.
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If you are unable to hold the position, and your arm rotates back towards your body (Lags) you likely have a rotator cuff injury.
Painful Arc Test
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Stands or sits upright.
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Slowly raises their arm sideways (abduction) from 0° to 180°
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Observe where pain begins and ends.
Positive Test:
Pain is present between 60° and 120° of abduction (painful arc range).
Pain that goes away past 120° is classic for subacromial impingement.
External Rotation Test
Lag Sign 1:30
Painful Arc Test
Drop Arm Test
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Stands or sits upright.
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Have a friend passively lift your arm to 90° of abduction (out to the side).
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Have them release the arm, you will then slowly lower it back down to their side under control.
Positive Test:
Inability to lower the arm slowly and smoothly, or
The arm drops suddenly or jerks down, or
Experiences sharp pain or weakness.
Drop Arm Test
Hawkins Test
NOTE this test can be uncomftablke in healthly shoulders, compare to your other side for best results
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Bring your arm to 90° forward flexion with the elbow bent.
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Have a friend support the elbow and internally rotates the shoulder by pushing down on the forearm/wrist.
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This compresses the structures in the subacromial space.
Positive Test: Pain in the front or top of the shoulder, likely impingement of supraspinatus or bursa.
Hawkins Test
Recovery
PLEASE READ
When it comes to recovery from this injury things get a little complex. This injury can be caused by several factors, based on whether it is primary or secondary shoulder impingement. This makes the recovery process rather challenging as there are an array of possible issue areas, from muscle stability, imbalance, improper posture, atrophy or hypertrophy and so on… therefore this section is going to focus on the low-hanging fruit and provide some exercises that might help alleviate symptoms. However, it is highly recommended that you seek a professional diagnosis and treatment plan. As always if there is any pain above a 2/10 in these movements do not use them and seek advice from a professional
Mobility
Pectoralis Muscle Massage
In order to massage our pec, we can do one of two things: hands, fingers or knuckles to apply pressure to the tight muscle, or we can use an old, but still smooth carabiner. For both options use lotion to reduce the friction on your skin.
Can be completed for 5-10 minutes a up to 1-3 times day
Pectoralis Stretch
The main goal here is to stretch out the pectoralis muscles to help reduce the tension that might be pulling on your shoulder. Tight pecs can mess with your shoulder positioning and contribute to impingement, so loosening them up is a solid step in the right direction.
Start by lying on your back with your arm out to the side at shoulder height, palm facing up and resting flat on the ground. To add a bit more stretch, you can gently hold a light weight (1–3 lbs) in that hand—just enough to increase the pull slightly, not to strain.
Next, move the arm up to about a 140-degree angle (just above shoulder height) and repeat the same stretch in that position.
If it feels better, you can also try doing these on your stomach instead of your back—some people find that more comfortable. It’s worth trying both to see what works best for your body.
Perform for 30 seconds per position, for 3 sets, 2-3 times a day
Wall Angels
This exercise is all about strengthening the shoulder blade stabilizers, which play a huge role in keeping your shoulder joint happy and moving well. It’s recommended to perform this both with bent elbows and straight arms to target different parts of the shoulder complex.
If this movement causes pain or discomfort, don’t force it—skip it and consult a professional.
To do it:
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Stand with your back flat against a wall, feet a few inches away if needed.
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Bring your elbows up to shoulder height, bent at 90 degrees, like a goalpost.
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Press your elbows and the backs of your hands into the wall.
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Slowly slide your arms upward as far as you can while keeping everything in contact with the wall—especially your lower back and shoulder blades.
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Then return to the starting position with control.
Can be completed for 8 reps, 3 sets once a day
Strenghtening
Because this injury can be pretty complex, this section won’t go too deep into specific exercises. Instead, it's just a starting point with a few general resources that might help you start building some strength back.
It’s usually a good idea to work on overall shoulder stability
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Scap retraction exercises
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External rotation strength
If any of these cause pain or feel off, don’t do them.
If you are still feeling symptoms after a few weeks of self-guided rehab, it’s probably time to check in with a professional who can dial in a program that’s specific to your injury.
External Rotation Exercise
More about this Injury
References
Schöffl, V., Schöffl, I., Lutter, C., & Hochholzer, T. (2022). Climbing medicine: A practical guide. Springer International Publishing Springer.
Vagy, J. (2018). Climb injury-free: A proven injury prevention and rehabilitation system. The Climbing Doctor.
Phillips N. Tests for diagnosing subacromial impingement syndrome and rotator cuff disease. Shoulder Elbow. 2014 Jul;6(3):215-21. doi: 10.1177/1758573214535368. Epub 2014 Jun 17. PMID: 27582939; PMCID: PMC4935057.