If your shoulder starts aching every time you reach for something overhead, you are not alone. This is one of the most common complaints heard in chiropractic and physical therapy offices, especially as summer sports season gets going. Swimming, tennis, baseball, and paddleboarding all put repeated stress on the shoulder, and for many people that stress adds up fast.
The condition most likely behind that nagging pain is called shoulder impingement syndrome. Understanding what it is and why it happens can help you figure out what to do about it.
What Is Shoulder Impingement?
The shoulder is a complex joint. The rotator cuff is a group of four muscles and tendons that hold the upper arm bone in place and control how the arm moves. These tendons pass through a narrow space under a bony arch at the top of the shoulder called the subacromial space.
When those tendons become irritated or inflamed, they can pinch against that bony arch every time you lift your arm. That pinching is impingement. Over time, the tendons can develop small tears, thicken, or lose elasticity. Doctors call that progression tendinopathy. It sounds serious, but most cases respond well to the right treatment.
Why Does This Happen in Summer?
Summer is prime time for overhead activity. A 2024 study published in the International Journal of Sports Physical Therapy found that years of swimming participation were directly tied to supraspinatus tendon thickening and tendinopathy. The researchers noted that overhead sport athletes develop tendinopathy at rates up to 40 percent, compared to roughly 20 percent in the general population. [1]
Volume of activity is only part of the story. Weak muscles around the shoulder blade, poor posture, and movement habits that slipped over the winter all contribute. When these factors combine with a sudden return to swimming laps or playing tennis three times a week, the shoulder can protest loudly.
Shoulder pain is also connected to how the neck and upper back move. If you have had lingering stiffness in your neck or upper back, that can shift how the shoulder blade moves and put extra load on the rotator cuff tendons.
What Does Recovery Look Like?
Here is the reassuring part: shoulder impingement responds well to conservative care for most people.
A 2025 systematic review published in PMC found strong evidence for targeted exercise as the first-line treatment for overhead athletes with shoulder impingement. The key is specificity. Generic shoulder exercises are not always enough. Exercises that train the muscles around the shoulder blade, called scapular stabilizers, tend to produce the most lasting results. [2]
A 2023 randomized clinical trial published in JOSPT Open followed 93 patients with subacromial shoulder pain. Half received exercise alone; the other half received exercise combined with manual therapy, which is hands-on joint mobilization. At the 52-week mark, patients in the combined group had significantly better scores for pain and disability. The study concluded that manual therapy alongside exercise improves long-term recovery in ways that exercise alone does not consistently achieve. [3]
Rest alone is rarely the answer. Complete rest reduces blood flow to tendons, which already have poor circulation, and can actually slow the healing process.
When Should You See a Professional?
Most shoulder impingement does not require surgery. A 2025 review in PMC confirmed that conservative management, including hands-on care, exercise, and activity modification, is the right first step for the vast majority of patients. [4]
See a provider if pain has lasted more than a few weeks, if it is waking you up at night, or if you notice weakness that was not there before. Weakness in particular can signal a rotator cuff tear that needs imaging to rule out.
If you are dealing with shoulder, elbow, or wrist pain from summer sports, a thorough evaluation can identify which muscles are not doing their job and build a plan specific to what you do.
A 2025 clinical practice guideline for rotator cuff tendinopathy discourages routine early imaging and prioritizes a careful physical exam and history instead. [5] That kind of individualized assessment is what a chiropractic evaluation is built around. Find out more about what Dr. Slovin treats and how the practice works to see if it is the right fit for your shoulder pain.
The shoulder heals well with the right input. Getting an accurate picture of what is going on, and then doing the work, is usually enough to get back to the activities you enjoy.
Sources
- Magee et al. “Shoulder Pain in Competitive Swimmers: A Multi-Site Survey Study.” International Journal of Sports Physical Therapy, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11297363/
- Salamh et al. “Therapeutic Exercise Prescription for Overhead Athletes with Shoulder Impingement Syndrome: A Systematic Review and CERT Analysis.” PMC, March 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11901016/
- Chester et al. “Adding Manual Therapy to an Exercise Program Improves Long-Term Patient Outcomes Over Exercise Alone in Patients With Subacromial Shoulder Pain.” JOSPT Open, 2023. https://www.jospt.org/doi/10.2519/josptopen.2023.1134
- Cardoso et al. “Shoulder Impingement Pain Syndrome: Pathophysiology, Diagnosis, and a Review of Current Treatment Strategies.” PMC, 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514857/
- Physiotutors. “Rotator Cuff Tendinopathy Clinical Practice Guideline 2025.” https://www.physiotutors.com/rotator-cuff-tendinopathy-the-new-2025-clinical-practice-guideline/
