Shoulder Impingement Isn’t Real… and Why the Name Needs to Die

If you’ve ever been told you have “shoulder impingement,” you’re not alone.
It’s one of the most common labels in musculoskeletal healthcare.
It also happens to be one of the most misleading.

For decades, people were told that their shoulder pain came from a bone “pinching” a tendon. The explanation sounds simple, mechanical and scary enough to justify rest, scans, injections and sometimes surgery.

There’s only one problem.
Modern research shows this narrative doesn’t stack up.

In fact, the idea of “impingement” as a structural pinching injury has been quietly falling apart for years, and it’s time we stop pretending otherwise.

Let’s break down why this diagnosis needs to be retired and what shoulder pain really is.

How We Got Stuck With a Bad Diagnosis

The term “subacromial impingement syndrome” exploded in the 1980s and 1990s after surgeons observed rotator cuff tears and irritation under the acromion.
The story was simple:
Acromion too sharp → tendon gets pinched → pain.

Clinics adopted the model.
Exercise programs were built around it.
Surgical procedures like acromioplasty became routine.

It was neat. It was tidy.
And it was wrong.

What the Research Actually Shows

Here’s where things get uncomfortable.

1. People with ZERO shoulder pain have “impingement type” findings

Large imaging studies show that rotator cuff changes, bursitis and acromial shapes appear in pain free shoulders all the time.

If the structure alone caused pain, these people would hurt. They don’t.

2. Pain doesn’t reliably change when you change the space

If “impingement” was due to a tight space under the acromion, then widening the space should fix the pain.

Except it doesn’t.

The landmark 2019 Lancet trial by Beard et al. showed that subacromial decompression surgery offered no better outcomes than placebo surgery.

Yes, you read that correctly.
A surgery designed to “remove the impingement” didn’t outperform sham surgery where nothing structural was corrected.

That study shook the orthopaedic world.
It should have ended the impingement narrative on the spot.

3. The biomechanics don’t support the model

A shoulder isn’t a door hinge.
It’s a dynamic system of muscles, tendons and neural input.
Pain can come from sensitivity, overload, irritability or reduced capacity, not from a bone scraping a tendon.

When researchers look at scapular movement or humeral head position, the variations are normal, not pathological.

4. Even the experts want to retire the term

In 2020, a consensus statement formally recommended abandoning the diagnosis “subacromial impingement syndrome” because it is inaccurate, pathoanatomically misleading and harmful to communication with patients.

If the world’s leading researchers and clinicians have moved on, why are so many healthcare providers still handing out the label?

The Real Problem With the Word “Impingement”

Words matter.
Patients hear “impingement” and imagine something is being crushed, trapped or damaged. That creates fear and avoidance. They stop lifting, stop training, stop moving.

This self protective behaviour leads to:

• loss of strength
• poorer tissue tolerance
• reduced shoulder capacity
• increased pain sensitivity
• longer recovery times

All because the diagnosis pointed them in the wrong direction.

So What Is Causing the Pain?

Usually something far less dramatic.

Shoulder pain is often load related, meaning the tissues were asked to do more than they were ready for. It can also come from:

• irritability in the bursa or tendon
• deconditioning
• rapid spikes in training load
• reduced sleep
• stress
• changes in movement exposure
• low strength in the rotator cuff or scapular muscles

None of that requires being “pinched.”

So What Actually Helps?

Here’s the refreshing part.
The shoulder responds beautifully to progressive loading.

Strength training, exposure based rehab and restoring confidence in movement consistently outperform passive treatments or rest.

The research is so consistent that exercise is considered first line treatment globally.

Even in the trials where surgery offered no benefit, exercise performed just as well. Often better.

Which begs the question…
Why are we still telling people something is being impinged?

A Better Way Forward

It’s time to retire the myth.

Shoulder pain is real, but “impingement” isn’t the cause.
Once patients understand that no tendon is being crushed, their fear drops and their capacity to improve skyrockets.

Instead of telling people what’s wrong with their anatomy, we should be telling them what’s possible with their movement.

The shoulder isn’t fragile.
It’s adaptable.
It gets stronger.
And yes, it heals with the right plan.

If your physio is still blaming your bone shape for your pain, you might need a second opinion. Preferably one that’s up to date with research published this century.

Reference

Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo controlled, three group, randomised surgical trial. The Lancet. 2019;391(10118):329–338.