Subacromial Pain (Shoulder Impingement): Physiotherapy Assessment & Rehabilitation
Shoulder pain with lifting the arm, reaching overhead, or lying on the affected side is commonly labelled as “shoulder impingement.” Modern physiotherapy now uses the term Subacromial Pain Syndrome (SAPS) or Rotator Cuff–Related Shoulder Pain to better reflect current evidence.
At Fit2Function Allied Health, we provide evidence-based physiotherapy for subacromial pain, focusing on restoring shoulder strength, movement capacity, and confidence — rather than outdated ideas of tendons being “pinched.”
This page explains what subacromial pain is, why it occurs, when scans are useful, and how structured rehabilitation supports long-term recovery.
What is subacromial pain?
Subacromial pain refers to pain arising from structures in the space beneath the acromion, most commonly the rotator cuff tendons and surrounding soft tissues.
Rather than a single mechanical problem, subacromial pain is now understood as a load-related shoulder condition, influenced by:
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Rotator cuff strength and endurance
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Shoulder blade (scapular) control
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Capacity to tolerate repeated or sustained overhead activity
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Training, work, or lifestyle demands
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Pain sensitivity and recovery capacity
This broader understanding explains why many people have imaging changes without pain — and why active rehabilitation is the cornerstone of treatment.
Common symptoms
Subacromial pain may present as:
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Pain when lifting the arm, especially between shoulder and head height
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Discomfort with overhead or reaching activities
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Pain when lying on the affected shoulder
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Weakness or fatigue with repeated arm use
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Reduced confidence using the shoulder
Symptoms often develop gradually and may fluctuate with activity levels.
Early physiotherapy assessment and management
Accurate assessment is essential to differentiate subacromial pain from other shoulder conditions such as frozen shoulder, instability, or cervical referral.
Our physiotherapists assess:
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Shoulder and scapular movement patterns
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Rotator cuff and upper limb strength
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Symptom behaviour with load and activity
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Work, sport, and daily activity demands
Early management focuses on maintaining safe movement, adjusting load rather than complete rest, and introducing targeted exercises to improve shoulder capacity.
Do I need imaging?
Imaging is not routinely required for subacromial pain, particularly in gradual-onset cases.
Imaging may be considered if:
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Symptoms do not improve with appropriate rehabilitation
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There is significant weakness following trauma
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A full-thickness rotator cuff tear is suspected
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Surgical decision-making is being considered
Ultrasound or MRI findings are interpreted carefully, as structural changes are common in pain-free shoulders.
Physiotherapy rehabilitation for subacromial pain
Rehabilitation focuses on restoring the shoulder’s ability to tolerate load rather than simply reducing pain.
Key components include:
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Progressive rotator cuff strengthening
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Scapular and upper limb control exercises
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Gradual exposure to overhead and functional tasks
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Load management for work, sport, and training
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Education to reduce fear and improve confidence
Rehab is progressed based on symptoms, strength gains, and functional tolerance — not arbitrary timelines.
Is surgery required?
Surgery is rarely the first-line treatment for subacromial pain.
Research shows that exercise-based physiotherapy is highly effective for most people, with outcomes comparable to surgical approaches in many cases. Surgery may be considered only after a comprehensive trial of rehabilitation and in specific clinical scenarios.
Return to work, sport, and overhead activity
Safe return to higher-level activity requires:
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Adequate rotator cuff and shoulder strength
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Ability to tolerate repeated or sustained overhead loads
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Good movement quality under fatigue
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Confidence using the shoulder without fear of pain or damage
Our physiotherapists guide graded return to work and sport using functional testing and progressive loading.
How our physiotherapists help
At Fit2Function Allied Health, we:
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Use contemporary, evidence-based shoulder pain models
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Avoid fear-based or outdated explanations
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Individualise rehabilitation to your goals and lifestyle
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Focus on long-term shoulder health and capacity
Book a shoulder assessment
If shoulder pain is limiting your work, sport, or daily activities, our physiotherapists can help clarify the diagnosis and guide effective rehabilitation.
Learn More About Knee Injuries & Physiotherapy
Explore our other knee condition pages to understand evidence-based assessment, rehabilitation, and return-to-activity strategies: ACL Injuries | Meniscus & Cartilage Injuries | Patellofemoral Pain | MCL & LCL Injuries | Patellar Tendinopathy| Knee Osteoarthritis.
Our physiotherapists provide tailored programs to restore function, reduce pain, and support safe return to your activities.
