Did you know that shoulder impingement accounts for 25% of shoulder complaints for those who go to get their shoulder pain checked out?
Personally I find that injuries come in trends and it’s almost like patients confer with others before coming in, because we can go 2-3 months without seeing a new patient for shoulder pain, and then out of nowhere, 4-5 appear in a week.
The statistic in the first line does hold some weight though, as the majority of shoulder complaints we see here at Care for Health are of an impinged pathology.
Today I want to discuss with you the effect of posture on acute and chronic shoulder pain, and try to make it easy to understand that many dominos can tumble before you experience pain.
Firstly, let’s briefly delve into shoulder impingement and what it actually is. It is kind of in the name; it occurs when structures (rotator cuff tendons and bursas) become compressed within the shoulder, therefore resulting in the shoulder space becoming small and a ‘pinching’ mechanism taking place when one moves their arm in an upward direction.
It is quite a complex condition and can have many different causes which often overlap each other. Very rarely is it down to one pinpoint thing. Causes such as muscular imbalances, rotator cuff weakness, overuse, daily habits, lack of scapula control and previous injuries/surgeries are often contributing factors seen in most cases of shoulder impingement. However another common denominator, which possibly plays the biggest role of all, is poor posture.
Poor posture tells us the story of your shoulder pain, and why it is happening. We understand no one is ever perfectly symmetrical, however in the majority of cases we see, there is a dropped shoulder playing a pivotal role in patients with shoulder impingement.
A dropped shoulder will biomechanically change:
- Depressed scapula (scapula sinks downward)
- Altered scapular upward rotation (The movement that the scapula does when you raise your arm)
- Reduced posterior tilt (The scapulas ability to tilt backwards, another movement that happens when you raise your arm)
- Increased downward pull from gravity and muscle imbalance (increased shoulder dropping)
Meaning that the way the humeral head and scapula work together has been majorly altered. This then causes the compression within the shoulder and causes pain when lifting an arm above the head.
How though?
Scapula sits in depression and downward rotation (the opposite of how we want it to sit). This will cause the acromion to lower (the bony prominent on the outside of your shoulder) resulting in a narrowing of the space within the shoulder and therefore causing compression and pinching of the rotator cuff and bursa.
Having a dropped shoulder will cause some muscles to become over-active and others to become under-active, creating an imbalance. This is a snowball effect, meaning that when you move your shoulder in sport and/or everyday life the shoulder compensates and uses the over-active muscles and ignores the inactive ones… this then causes the muscles to become more over-active and more under-active, leading to a further dropped shoulder and more chance of shoulder impingement. It’s a vicious cycle.
Dropped shoulder → poor mechanics → impingement → guarding → more dropping →repeat
Why does poor posture cause dropped shoulder?
There are a lot of factors that can contribute to this:
Ribs, Thoracic spine and clavicle:
- If these change (drop), then the shoulder blade will follow.
Forward head:
- The head moves forward leading to the upper back and shoulders rounding
- This causes the ribs to drop on one side, causing the shoulder blade to follow
Thoracic side bending
- Some people lean or favour one side when sitting or standing
- Scoliosis can be a factor here
- People sit, drive or stand twisted
- This causes the rib cage to depress on one side
- The scapula will sit lower
BREATHING!!!
- Did you know that… shallow breathing or belly dominant breathing can reduce the rib cage expansion and keep the ribs depressed
- This will limit the scapulas posterior tilt, as previously mentioned this movement is important for efficient movement of the shoulder
How would we treat shoulder impingement?
Don’t worry we are not going to just tell you why it’s happening without giving you an outline to treating the cause.
STEP 1: Re-establishing proper rib cage and breathing mechanics is a critical first step. Poor breathing patterns and rib positioning can reinforce shoulder depression and limit the scapula’s ability to posteriorly tilt and upwardly rotate. By restoring expansion of the rib cage – particularly through controlled breathing that emphasizes posterior and lateral rib movement – the scapula gains a more supportive surface, allowing the shoulder to rest in a more neutral position rather than being pulled down by gravity and muscle tension.
STEP 2: Equally important is addressing muscular imbalances that develop as a result of poor posture. Muscles such as the latissimus dorsi and pec minor often become overactive and shortened, exerting a constant downward and forward pull on the scapula. At the same time, key stabilizers—including the serratus anterior and upper traps—tend to become underactive or poorly timed. Corrective strategies should focus on restoring balance between these muscle groups, allowing the scapula to elevate, upwardly rotate, and posteriorly tilt as the arm moves.
STEP 3: Improving scapular control during arm elevation is essential for reducing impingement symptoms. Rather than forcing the shoulder down or avoiding elevation altogether, the emphasis should be on retraining smooth, coordinated movement between the scapula and humorous. When the scapula is able to rotate and tilt appropriately, it effectively clears space for the arm to move without compressing sensitive structures beneath the acromion.
STEP 4: Finally, corrective work must carry over into daily activities and movement patterns. Posture is not corrected by isolated exercises alone, but by reinforcing improved shoulder positioning during tasks such as sitting, reaching, carrying, and overhead movement. Gradually restoring tolerance to these activities—while maintaining proper scapular mechanics—helps prevent the recurrence of impingement and supports long-term shoulder health.
Conclusion
Shoulder impingement is a complex case, but that is often because it’s looked at in one dimension, with most treatment or remedies focussing on the symptom rather than the cause.
As I mentioned toward the start, there are many different variables that can manifest into shoulder impingement but the majority of people we see that suffer have a dropped shoulder on the same side.
I hope I have given you more of an understanding on how posture can affect the shoulder and be the first domino of many for causing shoulder impingement. If you happen to suffer with shoulder pain within the shoulder or feel as if your posture is not great then please do not hesitate to get in touch as we would love to help.
Jack Underhill
Sports Therapist