As a physiotherapist with over a decade of experience treating shoulder pain, I often see patients struggling with a condition known as Subacromial Impingement Syndrome (SIS)—one of the most common causes of shoulder discomfort. It’s frustrating, painful, and can significantly affect your ability to work, sleep, or enjoy your daily activities.
But the good news? In most cases, this condition can be managed effectively without surgery—and the earlier you address it, the better your outcome.
What Is Subacromial Impingement Syndrome (SIS)?
Your shoulder is a complex joint. SIS occurs when the tendons of your rotator cuff or the bursa (a fluid-filled sac that cushions the shoulder) get irritated or compressed in the narrow space beneath the top part of your shoulder blade called the acromion.
This irritation can lead to pain, inflammation, and stiffness—especially when lifting your arm, sleeping on your side, or reaching behind your back.
Common Causes of SIS
- Repetitive overhead movements (like painting, swimming, or lifting weights)
- Poor posture, especially rounded shoulders
- Muscle imbalances or weakness around the shoulder blade
- Sleep position, especially lying on the painful shoulder
- Wear and tear with age
Symptoms You Shouldn’t Ignore
- Pain when lifting your arm or reaching overhead
- Difficulty sleeping on the affected side
- Weakness or stiffness in the shoulder
- A clicking or grinding feeling when moving your arm
If left untreated, SIS can lead to chronic pain, limited shoulder function, and even tears in the rotator cuff.
The Role of Sleep, Posture, and Lifestyle
Recent research has shown that poor sleep habits and excessive phone use can actually increase your risk of developing SIS. One high-quality study from Finland used genetic analysis to find that short sleep and insomnia increase the risk by up to 66% (Lv et al., 2024). Another study found that people who used their phones excessively were over 4 times more likely to develop shoulder impingement (Lv et al., 2024).
Do I Need Surgery?
Not usually.
Multiple systematic reviews have found that surgery is not more effective than physiotherapy for most people with SIS (Lähdeoja et al., 2020; Hanratty et al., 2012). In fact, the long-term results of tailored physiotherapy can be just as good—if not better—without the risks or downtime of surgery.
Effective Treatments That Actually Work
1. Exercise Therapy Targeted shoulder exercises are the gold standard. Research shows they reduce pain and improve function, especially when they focus on strengthening the rotator cuff and scapular (shoulder blade) muscles (Hanratty et al., 2012).
2. Manual Therapy Hands-on treatments like joint mobilizations and soft tissue techniques can complement exercises and improve movement (Chester et al., 2010).
3. Postural Training Correcting slouched posture is crucial. A forward shoulder posture can compress the subacromial space and irritate tendons.
4. Sleep Position Coaching Avoid sleeping on the painful shoulder. Try sleeping on your back with a small pillow tucked behind your shoulder to reduce pressure.
5. Shockwave Therapy (ESWT) This is particularly helpful in cases of calcific tendinitis, where calcium builds up in the tendons. Studies show ESWT can help dissolve calcium and reduce pain (Xie et al., 2023).
6. Cortisone Injections Short-term relief can be achieved through corticosteroid injections. However, they should be used cautiously and not as a long-term solution.
What You Can Do Right Now
- Avoid overhead tasks until you’re assessed
- Sleep on your back with shoulder support
- Begin gentle stretches if pain allows
- Book an appointment with a physiotherapist early
Final Takeaway
Shoulder pain doesn’t have to be part of your daily life. Subacromial Impingement Syndrome is treatable—and often without surgery. The key is early intervention, consistent exercise, posture correction, and sleep hygiene.
If you’re experiencing shoulder pain, don’t wait. A customized physiotherapy plan can help restore your movement, reduce pain, and improve your quality of life—safely and naturally.
References
Chester, R., Smith, T. O., Hooper, L., Dixon, J. (2010). The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: A systematic review of EMG studies. BMC Musculoskeletal Disorders, 11(1), 45. https://doi.org/10.1186/1471-2474-11-45
Hanratty, C. E., McVeigh, J. G., Kerr, D. P., Basford, J. R., Finch, M. B., Pendleton, A., & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 42(3), 297–316. https://doi.org/10.1016/j.semarthrit.2012.01.005
Lähdeoja, T., Karjalainen, T., Jokihaara, J., Salamh, P., Kavaja, L., Agarwal, A., … & Vandvik, P. O. (2020). Subacromial decompression surgery for adults with shoulder pain: A systematic review with meta-analysis. British Journal of Sports Medicine, 54(11), 665–673. https://doi.org/10.1136/bjsports-2019-101333
Lv, Z., Cui, J., Zhang, J., & He, L. (2024). Lifestyle factors and subacromial impingement syndrome of the shoulder: potential associations in Finnish participants. BMC Musculoskeletal Disorders, 25, Article 220. https://doi.org/10.1186/s12891-024-07345-w
Xie, X., Ma, J., Feng, H., & Zhang, Y. (2023). Effectiveness of extracorporeal shockwave therapy for rotator cuff tendinopathy: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 24, 189. https://doi.org/10.1186/s12891-023-06345-3
