Patient resource: Subacromial shoulder pain

This section is for GP’s and their patients and provides information and exercise videos for the most common cause of shoulder pain.

 These booklets and videos have been prepared by BESS surgeons and BESS physiotherapists with the support of the NHS Getting it Right First Time Programme (GIRFT).

 Below you can download these booklets for use at home on your device or print in different formats. The content of the booklet also appears on this web page along with our videos. The videos are now also available via YouTube.

Why have you been given this information?

Your GP has diagnosed you with a common shoulder problem which causes a type of shoulder pain called subacromial shoulder pain.

Research has demonstrated that if people suffering with this common problem do the right type of rehabilitation exercises then they can successfully treat themselves.

If you follow the instructions and exercises in the booklet and below, there is an excellent chance you will improve your shoulder pain and not need any more treatments or referral to the hospital.

You can download the below information as a PDF if you prefer (see above).

What is subacromial pain?

Subacromial pain is very common and causes pain in the shoulder and upper arm.It can spread further down the arm and up towards the neck and shoulder blade. It can feel worse when the arm is moved away from the body such as reaching up or when placing the hand behind the back.

Pain can come on slowly over time or quite quickly if the shoulder has been used for an activity that is much more demanding than it is used to doing each day.

What is the exercise treatment?

Your shoulder should start to feel better within 6 to 12 weeks if you do the simple exercises on the following pages. These have been recommended by the UK’s leading shoulder physiotherapists and proven to reduce pain and improve your shoulder.  This booklet will show you how to do them within the comfort of your home. You can also watch videos of how to do these daily exercises on youtube.  

You may only be able to move your arm a small amount at the start but this will improve over time. A small increase in pain while exercising is ok as long as it goes away within 30 minutes and is not worse the next day. If this happens, don’t worry, do less repetitions the next time and then gradually build up again.   

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It may take 6 weeks before you start to see improvement.  

If your shoulder does not improve over 6-12 weeks, or gets worse despite the exercises, you will need to visit your doctor again. 

The key to success and getting the most from your exercises are:

· Build the exercises into your daily routine so you can do them regularly.

· Find time when you are not under pressure and can give the exercises your full attention.

· Build the exercises into your daily routine so you can do them regularly.

· Find time when you are not under pressure and can give the exercises your full attention.

· Try to do the exercises on six days each week with one day off. If you want to get better, you will need to do them on at least four days of the week.

· You don’t have to do all three exercises straight away – you can start with two and build in the third when you get confident.

· It helps to keep an exercise diary to record how many repetitions you have done and see how you are progressing.

· If one particular movement causes more pain, then use it each week to test if you are improving and getting better.

Exercise 1

Wall slides

Find a smooth wall or wall mirror and a cloth that will slide easily on the wall (or put clean socks on your hands). Stand facing the wall. Place the edges of your hands against the wall with your thumbs facing you.  

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Now  step  forward  as  you  gently push into the wall and slide your hands up as far as you can. Relax and return to start position. 

· Repeat 8 times

· Rest for a minute

· Repeat 8 times

· Rest for a minute

· Repeat 8 times

When  you  can  do  this  exercise  easily  you  can  progress  by  doing  it  without the support of the wall and adding a light weight.

Exercise 2

Push ups against the wall

Now put your hands on the wall as if you are going to do a pushup. Make sure your hands are placed a little wider than the width of your shoulders,  your  hands  are  turned  out  slightly  and  your  elbows  are  below  your shoulders. 

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Now lower your body towards the wall keeping your body nice and tall. 

· Repeat 8 times

· Rest for a minute

· Repeat 8 times

· Rest for a minute

· Repeat 8 times

When  you  can  do  this  exercise  easily  you  can  progress  and  increase  load by moving your feet further from the wall.

Exercise 3

Shoulder rotation exercises

Sit next to a table with your elbow supported just below shoulder height on a rolled up towel.

Now  make  a  gentle  fist,  keep  your elbow   bent   and   then   rotate   your forearm to point upwards. 

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Return to the start position and relax. 

Make sure you sit up tall whilst you do this. 

When it is easy for you to do this you can add a light weight – start with half kilo or a small 500ml water bottle.  

As the exercise gets easier you can increase the weight: 

•       First to 1 kilo

•       Then to 1 and a half kilos

•       Then to 2 kilos.

Other top tips

  • Be patient! It may be 6 -12 weeks before you see a big change in your pain so you need to stick with it. 
  • Don’t  stop  moving  your  shoulder  –  muscles  need  movement  to keep them healthy.
  • If your sleep is poor, try supporting your arm on a pillow and roll a pillow  up  behind  your  back  to  stop  you  rolling  on  to  your  painful shoulder.
  • Step towards things rather than stretch for them to make movement easier for your shoulder.
  • General exercise can really help your recovery so try to keep going with other activities you enjoy to keep fit.
  • If you don’t exercise regularly try and build something in – even a brisk 20 minute walk 3 times a week will help.

Published by BESS with support from GIRFT

Written and produced in 2018 by Jonathan Rees, Ro Kulkarni, Jo Gibson, Clare Connor. 

Supported by Matthew Barker and Rachel Yates.

© British Elbow and Shoulder Society. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. The British Elbow and Shoulder Society should be acknowledged in any such reproduction as the author and copyright holder, and the reproduction should not be used for commercial exploitation unless the permission of the copyright owner has been explicitly granted.