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Shoulder Impingement Protocol
Open up the subacromial space
Do NOT start this protocol if:
Loading an injured tissue without assessment can make things significantly worse. If any of these apply, see a physiotherapist or physician before starting.
- •Cannot lift the arm above 90 degrees actively (possible full-thickness rotator cuff tear) — see a physician for imaging
- •Pain at rest or pain that wakes you at night consistently
- •Recent significant trauma (fall, direct blow) before symptom onset
- •Visible deformity, severe swelling, or weakness that feels different from pain — seek assessment
When to see a physiotherapist
See a physiotherapist if you experience: pain that radiates down a limb, numbness or tingling, swelling that does not resolve within 72 hours of rest, or symptoms that worsen over 1–2 weeks of consistent protocol.
Overview
Progressive loading protocol for subacromial (shoulder) impingement and rotator cuff tendinopathy. Focuses on restoring scapular control first, then progressive rotator cuff loading. Supported by the Kuhn et al. meta-analysis of non-surgical management.
Equipment Needed
- •Light resistance bands (multiple strengths)
- •Light dumbbells (1–5 kg range)
- •Floor mat or bench
Phases
Scapular Control
Weeks 1–4Before loading the rotator cuff directly, the shoulder blade has to move correctly. These exercises retrain the scapular stabilisers — the lower trapezius, serratus anterior, and rhomboids — so that the humerus can rotate without impinging the tendon.
Goals
- →Restore proper scapular movement patterns
- →Reduce pain during active shoulder movement
- →Prepare the shoulder for progressive loading in phase 2
| Exercise | Sets | Reps | Hold | Frequency |
|---|---|---|---|---|
Y-T-W Raises Lie prone on a bench or the floor. With light weights (or no weight), raise both arms in three shapes in sequence: Y (arms overhead at 45°), T (arms straight out to the sides), W (elbows bent, pulling down and back). Focus on squeezing the shoulder blades together and down. | 3×10-15 | 10–15 per shape | — | Daily |
Scapular Push-Up In a push-up position (knees or feet). Without bending the elbows, protract (push the upper back toward the ceiling) and then retract (let the shoulder blades pinch together). The arms stay straight throughout — the movement is entirely at the shoulder blade. | 3×10-12 | 10–12 | — | Daily |
Progressive Rotator Cuff Loading
Weeks 5–12Once scapular control is restored and pain-free range of motion is available, begin progressive loading of the rotator cuff. Start with light resistance bands and increase resistance weekly. Some discomfort during exercise is acceptable; sharp pain is not.
Goals
- →Build rotator cuff strength and endurance
- →Restore full pain-free range of motion
- →Return to overhead activities and sport
| Exercise | Sets | Reps | Hold | Frequency |
|---|---|---|---|---|
Banded External Rotation Stand with the affected arm at your side, elbow bent 90° and tucked to your ribs. Hold a light resistance band anchored at waist height in front of you. Rotate the forearm outward while keeping the elbow pinned to your side. | 3×12-15 | 12–15 | — | 3× per week |
Prone External Rotation Lie prone on a bench with the affected arm hanging off the edge, elbow bent 90°. Holding a light dumbbell, rotate the forearm up until it is parallel to the floor. Lower slowly under control. | 3×10-12 | 10–12 | — | 3× per week |
Sources
- •Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study — Kuhn JE, Dunn WR, Sanders R, et al. (MOON Shoulder Group) (2013)
- •Exercise for rotator cuff tendinopathy: a systematic review — Kuhn JE (2010)
- •Subacromial impingement syndrome — effectiveness of physiotherapy and manual therapy — Hanratty CE, McVeigh JG, Kerr DP, et al. (2013)
Last updated: 2026-04-10
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Medical Disclaimer
This is a research summary, not medical advice. Body Signals is an independent research digest — it summarises published research for informational purposes and is not a healthcare provider. Stop immediately if pain increases, radiates, or persists beyond the session. Seek a physiotherapist for acute injuries, swelling, numbness, tingling, or symptoms that worsen over 1–2 weeks of consistent protocol. Movement-based rehab should gradually reduce pain, not cause it. In an emergency, call 911.
Need hands-on guidance?
A physiotherapist can tailor this programme to your injury severity, mobility level, and recovery goals.
Find a physiotherapist near you