Shoulder

Pain lifting overhead: start with the shoulder blade

Pain at the front or side of your shoulder when you reach up or press a weight overhead is often called impingement. The name suggests something is being pinched, but a more useful question is how your shoulder blade, upper back and rotator cuff (the small muscles that keep the ball of your arm centred) share the work. That is where I start.

Jeff Shaverian · Physical therapy · KPM

Two common patterns

Pattern 1

Hurts on the way up, worse after desk days

Pain at the front or outer side of the shoulder as your arm passes shoulder height
Your shoulder hikes up toward your ear to get the arm overhead
Your upper back is rounded and stiff, often from long desk and phone hours

In KPM terms this fits a downward rotation pattern: the shoulder blade does not turn upward enough as the arm rises.

Pattern 2

Hurts when you press, push or dip

Pain at the front of the shoulder at the bottom of a bench press, push-up or dip
Holding a squat bar with your elbows pulled far back also sets it off
Your training has far more pressing than pulling

This fits a humeral anterior glide pattern: the ball of the arm bone slides forward in the socket. Often the chest and front shoulder are outworking a rotator cuff and upper back that have not kept up.

Many people have some of both. A very loose shoulder needs control rather than more stretching, and pain that runs down the arm can come from the neck. Finding which movement brings your pain on, and which change takes it away, is the first job of the assessment.

Why it keeps coming back

When you lift your arm, the ball of the arm bone turns in a shallow socket while the shoulder blade turns upward and tips back on your ribs to keep the socket under it. The rotator cuff keeps the ball centred while bigger muscles do the lifting. The shoulder blade rides on your upper back, so a stiff, rounded upper back limits how far it can turn.

People with this kind of pain often move their shoulder blade differently, but research has not shown that shoulder blade position alone causes it. Some of the change may be a response to pain. So I don't treat posture as the enemy. I test it: if changing how your shoulder blade moves changes your pain, it is part of your problem.

Load matters too. Pain usually builds from repeated stress the tendons are not ready for, like a jump in pressing volume or a weekend painting a ceiling. General shoulder exercise helps most people. If your pain keeps returning, I check whether every rep still happens with a stuck shoulder blade or a ball sliding forward, and we train that too.

What to try this week

Find your painful range. For three days, note which movements hurt and where: on the way up, at the top, or at the bottom of a press. Note what eases it too. Bring this to your evaluation.
Test your posture, don't just fix it. Sit slumped and raise your arm forward and up. Note the height and the pain. Then sit tall, lifting your breastbone without arching your lower back, and repeat. If tall is easier, reach from there at work and in the gym.
Let the shoulder blade go around, not up. As you reach overhead, think of the shoulder blade wrapping around your ribs toward your armpit, not shrugging toward your ear. Practise by sliding your forearms up a wall, only as high as is comfortable.
Change the dose, don't stop. Exercise is the main treatment, so keep the arm working. For a few weeks, lighten overhead presses, dips and bench press, and add some easy rowing. Back off anything that gives sharp pain or leaves the shoulder clearly worse the next day.

Safety first

See a doctor first, or call 115 in an emergency, if you have:

Shoulder or arm pain with chest pain, chest tightness or difficulty breathing (call 115)
A fall or injury followed by severe pain, swelling, a misshapen shoulder or trouble moving the arm
A hot, red or swollen shoulder, especially with fever or feeling generally unwell
Sudden weakness, or being unable to lift your arm to shoulder height
Numbness, pins and needles or weakness spreading down the arm
A lump or swelling you cannot explain, or pain with unexplained weight loss or night sweats

How I treat it

A physiotherapist positioning a client’s arm and shoulder

I start by watching you reach, press, pull and lift, comparing your shoulder blades side to side. I check your upper back, your rotator cuff and shoulder blade strength, and your neck. Then I change one thing at a time: helping the shoulder blade turn upward, sitting you taller, moving your elbows or your grip. When a change in how you move changes your pain, we know what to work on. A scan can help, but it usually shows which tissue is irritated, not why.

From there, we build the corrected movement into your daily reaching and your lifts, then load it until it holds: rotator cuff and shoulder blade strength, including the serratus anterior (the muscle that wraps around your ribs and turns the shoulder blade upward), upper back mobility where needed, and a stepped return to pressing overhead. Hands-on treatment can be added. I don't use ultrasound, laser or shockwave, because research reviews find they add nothing here. Strength builds over weeks, not days, so we return to heavy overhead work in stages, and I won't promise you a date.

Evidence note: a review of systematic reviews strongly supports exercise as the first treatment for this kind of shoulder pain, with hands-on therapy as an add-on, and found moderate evidence that ultrasound, laser and shockwave add nothing (Pieters et al., JOSPT, 2020). Altered shoulder blade movement is common in painful shoulders, but it has not been shown to cause the pain (Ludewig and Reynolds, JOSPT, 2009).

Get back overhead

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Sources

Horschig A, Sonthana K. Rebuilding Milo. Las Vegas: Victory Belt Publishing; 2021. Chapter 4: Shoulder Pain.
Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. Journal of Orthopaedic and Sports Physical Therapy. 2009;39(2):90-104. doi.org/10.2519/jospt.2009.2808
Pieters L, et al. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of Orthopaedic and Sports Physical Therapy. 2020;50(3):131-141. doi.org/10.2519/jospt.2020.8498
Pandey RA, Singh HP, on behalf of the BESS Subacromial Pain Working Group. BESS patient care pathway: subacromial pain. Shoulder & Elbow. 2025;17(6):713-724. doi.org/10.1177/17585732251374282
Northern Health and Social Care Trust. Shoulder pain: causes and when to seek help. Patient information leaflet. Updated March 2023. www.northerntrust.hscni.net/wp-content/uploads/2023/05/What-causes-shoulder-pain-when-to-seek-help.pdf
Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St Louis: Mosby; 2002.

This article is general education, not a diagnosis. Reviewed October 2026.