Subacromial Pain Syndrome: Causes, Symptoms & How Physiotherapy Can Help

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Subacromial pain syndrome (SAPS) is a common cause of shoulder pain, particularly with reaching overhead, lifting, exercising, or lying on the affected side. 

What Is Subacromial Pain Syndrome? 

Subacromial pain syndrome (SAPS) is a common shoulder condition characterized by pain around the shoulder, often during activities that involve lifting or raising the arm. 

You may have previously heard this condition called “shoulder impingement” or “shoulder impingement syndrome.” The term impingement is still widely used by patients, but modern approaches recognize that shoulder pain is more complex than simply one structure being “pinched.” 

SAPS can involve the rotator cuff tendons, subacromial bursa, and surrounding shoulder tissues, with symptoms influenced by factors such as tissue sensitivity, strength, physical load, movement, and activity levels. 

The condition is also closely related to the broader term rotator cuff-related shoulder pain (RCRSP). Exercise-based treatment is a key component of conservative management for these conditions. 

What Causes Subacromial Pain Syndrome? 

SAPS often develops gradually rather than from one specific injury. 

Potential contributing factors include: 

• Repetitive overhead activities  

• Increasing exercise volume too quickly  

• Repetitive lifting  

• Overhead work  

• Changes in training or activity levels  

• Reduced shoulder strength or capacity  

• Reduced shoulder mobility

• Previous shoulder injuries  

• Age-related changes in the rotator cuff  

Shoulder pain can develop when the physical demands placed on the shoulder exceed its current ability to tolerate that load.  This does not necessarily mean that a particular movement is damaging your shoulder. Instead, rehabilitation focuses on gradually improving the shoulder's capacity to tolerate the activities you need and want to perform. 

What Are the Symptoms? 

Common symptoms of subacromial pain syndrome include: 

• Pain when lifting your arm overhead  

• Pain reaching behind your back  

• Pain when putting on a shirt or jacket  

• Pain when lifting or carrying objects  

• Pain during exercise or sports  

• Pain when sleeping on the affected side  

• Shoulder weakness  

• Painful or restricted shoulder movement  

Pain is commonly felt around the front or outer portion of the shoulder and may extend toward the upper arm. 

How Is Subacromial Pain Syndrome Diagnosed? 

A physiotherapist will assess your: 

• Shoulder range of motion  

• Shoulder and rotator cuff strength  

• Pain with different movements  

• Shoulder blade movement  

• Neck and upper-back function  

• Activity and exercise history  

• Work and sport demands  

  
  

How Can Physiotherapy Help? 

Your physiotherapist may focus on: 

•  Progressive Exercises 

  •  (Rotator cuff muscles, Shoulder muscles, Scapular stabilizers, Upper back, Core and trunk, General upper-body strength) 

• Rotator Cuff/Scapular Strengthening  

  • (External rotation, Internal rotation, Shoulder elevation, Isometric exercises, Resistance-band exercises, Progressive weight training) 

•  Improving Shoulder Mobility 

• Activity Modification 

• Education & Self-Management 

Can Subacromial Pain Syndrome Be Prevented? 

Helpful strategies include: 

• Increase training volume gradually  

• Include regular shoulder strengthening  

• Avoid sudden increases in overhead activity  

• Allow adequate recovery between demanding workouts  

• Maintain general physical fitness  

• Address persistent shoulder pain rather than repeatedly pushing through it  

  
  

When Should You See a Physiotherapist? 

Consider seeing a physiotherapist if you have: 

• Shoulder pain lasting more than a few weeks  

• Pain with overhead activities  

• Difficulty lifting your arm  

• Shoulder weakness  

• Pain affecting your sleep  

• Difficulty exercising or participating in sports  

• Symptoms that are not improving with activity modification  

Looking for Subacromial Pain Syndrome or Shoulder Physiotherapy in Waterloo? 

At Waterloo Sports Medicine Centre, our physiotherapists provide individualized assessment and treatment for shoulder pain and musculoskeletal conditions!