Yoga guide
Shoulder impingement means pain on the outside of the shoulder and upper arm, worse lifting the arm out to the side or overhead, often at night; it's also called subacromial pain or rotator cuff related shoulder pain. The old explanation, a tendon pinched under the bone, is doubtful: shaving the bone to make room did no better than a placebo operation in two trials. Exercise is the first treatment, and the exercise that helps strengthens the rotator cuff and the muscles around the shoulder blade, gradually.
No trial has tested yoga for impingement, but yoga can supply much of that exercise if it's adapted: arms kept low at first, weight on the hands built up from a wall to the floor, and arms brought back overhead in front of you rather than in a wide sweep.
This guide covers what impingement is, how to raise your arms in yoga, building up to downward dog and plank, the poses to change, what the evidence shows and the classes to follow. Shoulder or arm pain with chest pain or breathlessness can be a heart attack: call 999.
A Dutch guideline says the pinching explanation isn't enough to account for the problem, and renamed it subacromial pain syndrome; others call it rotator cuff related shoulder pain. The NHS still describes a tendon that swells and rubs against tissue or bone.
In CSAW (313 people) and FIMPACT (210 people, followed for 10 years), shaving the bone did no better than a placebo operation, and a guideline panel recommends strongly against it.
In 102 people already waiting for surgery, rotator cuff and shoulder-blade strengthening, with pain allowed up to 5 out of 10, meant 20% chose surgery against 63% with general exercises, and the gap held at 10 years.
In GRASP (708 people), one physiotherapy session and a self-guided home programme did as well as up to six sessions of progressive exercise over a year.
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We found no trial of yoga in people diagnosed with impingement; the nearest is a weak 45-person trial in young overhead athletes with rotator cuff tendon pain.
The NHS advises not stopping moving your shoulder completely, but not carrying on with activities that involve repeatedly lifting your arm above your head while it hurts; the 2026 Dutch guideline update advises moving within your comfort zone and building load gradually. In yoga: fewer sun salutations, arms forward rather than in wide sweeps, weight on the hands built up from a wall, and chaturanga last.
The NHS lists "pain at the top and the outside of your shoulder", "shoulder pain that's worse when you lift your arm, especially when you lift it above your head" and "weakness in your arm". The Dutch guideline describes shoulder pain around the bony point at the top of the shoulder (the acromion), not caused by an injury, often worse during or after lifting the arm.
Impingement, subacromial pain, rotator cuff tendinopathy or tendinitis, subacromial bursitis and rotator cuff related shoulder pain all describe much the same picture, and a review says these labels relate more to a guess about the cause than to proof of it. The US orthopaedic surgeons' patient page still describes the bone rubbing on the tendon and surgery to make more room; the placebo-controlled trials don't support that model.
Changes under the shoulder's roof are common in shoulders without pain, often as common as in painful ones, and full-thickness rotator cuff tears showed on ultrasound in 11% to 17% of painless shoulders in two population samples.
The NHS says it usually gets better in a few weeks or months, though in one study quoted in a review, 54% still had symptoms after 3 years. In the Holmgren trial's 10-year follow-up, rotator cuff tears on scans rose from 28% to 55% whether or not people had surgery.
No trial has tested yoga for impingement, so this section gives the surgery and exercise trials, the nearest yoga studies and the injury surveys.
In CSAW (313 people at 32 UK hospitals, who had already tried exercise and at least one injection), shaving the bone gave no extra benefit at 6 months over a keyhole look inside the joint alone; both operations were slightly better than no treatment, but not by an amount that matters. In FIMPACT (210 people), shaving the bone gave no benefit over a placebo operation or exercise therapy over 10 years. A Cochrane review rates this as high certainty, and a BMJ review adds that the surgery probably carries a small risk of serious harm.
A BMJ guideline panel says this surgery should not be offered, though there is uncertainty about which alternative is best, and the Dutch guideline has recommended strongly against it since 2021. Both put exercise first.
In the Holmgren trial (102 people on a surgical waiting list), two lowering exercises for the rotator cuff, three for the shoulder-blade muscles and a stretch for the back of the shoulder, 3 sets of 15 twice a day for 8 weeks with pain allowed up to 5 out of 10, meant 20% chose surgery against 63% with general movement exercises. The gap held at a year (24% against 63%) and at 10 years (35% against 65%). It was a single-centre trial.
Reviews find exercise better than no exercise, and specific exercise better than general exercise, on very low quality evidence. A review of 16 reviews makes a strong recommendation for exercise as the first treatment, and in a network of 99 trials (6,764 people), only exercise held up once trials at high risk of bias were removed. The best type, dose and length are still uncertain.
In GRASP (708 people at 20 NHS trusts), one session with a physiotherapist plus a supported home exercise programme did as well over a year as up to six sessions of progressive exercise, and a steroid injection gave no long-term benefit. Both groups exercised, so this shows that more supervision didn't add benefit, not that exercise doesn't work.
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Our searches of PubMed and Europe PMC found no trial of yoga in people diagnosed with shoulder impingement or subacromial pain.
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In 45 young overhead athletes with rotator cuff tendon pain, shoulder-blade exercises plus yoga poses (including downward dog, upward dog and a modified plank) improved most, but there was no usual-care group, results were only at 8 weeks, and some range changes are hard to believe. In 72 people with frozen shoulder, standing yoga poses added nothing to usual care over a month, and a review calls the evidence on yoga and shoulder mobility limited.
Shoulders made up 9.0% of yoga injuries seen in US emergency departments over 20 years, and rotator cuff injuries were 6 of 89 yoga injuries at one US clinic. In a survey of 1,702 German practitioners, hand, shoulder and head stands were the practices most linked to sudden problems, and practising alone without supervision raised the risk. In randomised trials, yoga was about as safe as usual care and other exercise.
During shoulder strengthening, pain up to about 5 out of 10 is acceptable, and a little is expected. By your next session it should be back to where it was before. If it isn't, use a smaller range or less load next time, not nothing. This is how the Holmgren trial of 102 people set each person's load, and our shoulder guides use the same rule.
Stop for sharp pain, a feeling that the shoulder is slipping, pins and needles or numbness down the arm, or pain that is still worse by your next session after strengthening.
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The NHS advice for impingement: "do not stop moving your shoulder completely", but "do not carry on with activities that caused your shoulder pain or involve repeatedly lifting your arm above your head (such as swimming or playing tennis)". Repeated sun salutations are the yoga version of repeated overhead lifting (our reading).
The 2026 Dutch guideline update advises moving within your comfort zone, avoiding activities that are too long, heavy or frequent, and building up the shoulder's load gradually.
From the first block of our yoga for shoulder pain class unless marked. Pendulum: about 1 minute (10 small circles each way), 2 to 3 times a day (the move page's dose). Table slide: 10 slow reps, sliding only as far as is comfortable (adapted from the move page's dose). Shoulder rolls: 10 slow circles each way, small if it's sore (adapted from the move page's dose). Thoracic rotation: 6 rotations per side, moving with the breath (the move page's dose). Slow breathing: 2 minutes sitting tall, shoulders soft. Mountain pose: 5 breaths, palms turned forward. Chair pose: 3 holds of 15 seconds, arms forward at shoulder height or hands on your thighs. Warrior II: 3 breaths each side, hands on your hips if holding the arms out hurts.
3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoShoulder rollsBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoChair pose (Utkatasana)Beginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipmentThe exercise that kept people off the surgery list. Doses from our shoulder impingement guide's stages, which follow the Holmgren trial, unless marked. Band turn-out: 2 sets of 10 to 15, light band, elbow at your side (our yoga for shoulder pain class), building to 3 sets of 15. Side-lying turn-out: 3 sets of 15, once a day, lowering over 3 seconds. Scaption (raising the arms forward and a little out): 3 sets of 15, thumbs up, to shoulder height, lowering over 3 seconds. Face-down Y-T-W raises: 2 to 3 rounds of 8. Locust: 3 holds of 3 to 5 breaths, arms by your sides, arms forward only when that's pain-free (our yoga for shoulder pain class). Band row: 2 to 3 sets of 15 (adapted from the move page's dose). Scapular push-up: 3 sets of 10 to 15, on a wall or bench first, once the band work is comfortable (our suggestion on timing). Cross-body stretch: 3 holds of 30 to 60 seconds, only if there's no pinch at the front.
3D demoStanding band external rotationBeginner · A band + An anchor point
3D demoSide-lying external rotationBeginner · A dumbbell
3D demoScaption raiseBeginner · A dumbbell
3D demoProne Y-T-W raisesBeginner · No equipment
3D demoLocust pose (Salabhasana)Beginner · No equipment
3D demoBand rowBeginner · A band + An anchor point
3D demoScapular push-up (push-up plus)Beginner · No equipment
3D demoCross-body shoulder stretchBeginner · No equipmentIn 20 adults, plank, chaturanga, downward and upward dog and dolphin put a peak of 0.71 to 1.08 times body weight through the two hands together, and side plank 0.67 times body weight through one arm. No study has measured the load on the shoulder joint itself, or the space under the shoulder's roof, in these poses.
In 23 adults, push-ups with the hands raised or from the knees put less force through the hands than standard push-ups. More weight on the arms in plank variations meant more shoulder and shoulder-blade muscle work: useful once your shoulder can take it. In 15 static yoga poses, the shoulder-blade muscles worked at 3% to 57% of their maximum, and locust with the arms forward worked the lower trapezius hardest.
Pushing the shoulder blades apart at the top of a push-up works the muscle that holds them to the ribs, but in a bone-pin study the wall version put the shoulder blade in a position the authors link with impingement, and they advise caution early in rehabilitation. Add it after the band work is comfortable (our suggestion).
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Our editorial order, the same as in our shoulder pain and rotator cuff guides: wall push-ups, then hands on a table or chair seat, then knees down on the floor (cat-cow, a knee plank), then a full plank and downward dog, with chaturanga last. Move on when the step before is easy and pain stays within the 5 out of 10 rule.
While your shoulder hurts, lower with your knees down, go only halfway, or leave chaturanga out, keeping your shoulders above your elbows. Sun salutations take the shoulders from fully overhead and back down in every round, and the muscles worked harder moving between poses than holding them, so do fewer rounds and move slowly.
Wall push-up: 2 sets of 10, small range (our yoga for shoulder pain class). Cat-cow: 8 waves, slower than feels natural (the move page's dose), weight spread through the hands. Bird dog: 5 each side, reaching a leg only if reaching the arm hurts (the class). Knee plank: 3 holds of 10 to 20 seconds, on forearms and knees, shoulders over elbows (the class). High plank: holds of 10 to 20 seconds, building towards 3 holds of 15 to 30 seconds (adapted from the move page's dose), or hands on a bench. Downward dog: built up in the steps below, holds of 10 to 20 seconds, hands shoulder-width or a little wider, elbows soft (our suggestion). Chaturanga: last, knees down, halfway, or left out.
3D demoWall push-upBeginner · A wall
3D demoCat-cowBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoKnee plankBeginner · No equipment
3D demoStraight-arm plank (high plank)Intermediate · No equipment
3D demoDownward-facing dog (Adho Mukha Svanasana)Beginner · No equipment
3D demoFour-limbed staff pose (Chaturanga Dandasana)Advanced · No equipmentThe same steps as our yoga for shoulder pain guide: our editorial progression, built from the push-up studies (less force with the hands raised) and the hand-force study; no study has measured shoulder load in downward dog. With glaucoma or high blood pressure, keep your head higher, with your hands on a wall or chair.
See the movement on the 3D figure: Downward-facing dog (Adho Mukha Svanasana)
In healthy shoulders, the gap under the shoulder's roof was narrowest at about 90 degrees, around shoulder height, not fully overhead, and higher up the narrowest point moved away from the rotator cuff tendon. With the arm at 90 degrees holding a weight, turning the arm out gave more space than keeping it neutral. These were all healthy people, with the arm not bearing weight.
Raise your arms in front of you rather than out to the side, shoulder-width apart, thumbs up or palms facing each other, and only as high as stays comfortable. Don't interlace your fingers and force your elbows straight, and let your shoulder blades move up and around with your arms rather than pinning them down.
This is our suggestion, from imaging of healthy shoulders; no study has tested these cues in people with impingement. Pain through the middle of the range on the way up is a reason to stay lower for now.
Our sun salutation page says to substitute knees-chest-chin and cobra freely. Take fewer rounds, raise the arms in front rather than in a wide sweep, and keep the top hand on your hip in side bends such as reverse warrior and extended side angle while it hurts (our suggestion).
Arm positions are our suggestion. Breath reach: 5 breaths, exhale longer than inhale (the move page's dose), raising the arms in front of you, thumbs up, only as high as stays pain-free. High lunge and warrior I: hands on your hips first, then arms forward and up, shoulder-width apart. Sun salutation: fewer rounds, arms up in front, knees down for the lowering.
Most can come back as strength returns. Full chaturanga and repeated vinyasas: knees down, halfway, or skip. Upward-facing dog: its page says a recent shoulder injury means choose cobra instead, so use a low cobra. Dolphin: its page says shoulder impingement should be cleared with a clinician before you load overhead like this; the same goes for forearm stand, headstand, handstands and crow. Extended puppy: its page says skip it with a current shoulder injury. Binds such as humble warrior, and cow face and eagle arms, can aggravate a sore shoulder. Side plank: from the knees first. Sleeper stretch: its page says pressing through a pinch at the front of the shoulder can aggravate impingement. Thread the needle: ease off if it presses painfully into the shoulder you're lying on. Wheel, upward plank, camel and bow load the arm behind or overhead: later, if at all. Side bends with the top arm over the ear, such as reverse warrior and extended side angle: keep the top hand on your hip (our suggestion).
3D demoUpward-facing dog (Urdhva Mukha Svanasana)Intermediate · No equipment
3D demoDolphin pose (Ardha Pincha Mayurasana)Intermediate · No equipment
3D demoForearm stand (Pincha Mayurasana)Advanced · A wall
3D demoSupported headstand (Salamba Sirsasana)Expert · A wall
3D demoHalf handstand at the wall (Ardha Adho Mukha Vrksasana)Intermediate · A wall
3D demoHandstand at the wall (Adho Mukha Vrksasana, chest to wall)Advanced · A wall
3D demoCrow pose (Bakasana)Intermediate · No equipment
3D demoExtended puppy pose (Uttana Shishosana)Beginner · No equipment
3D demoHumble warrior (Baddha Virabhadrasana)Intermediate · No equipment
Cow face pose (Gomukhasana)Intermediate · No equipmentEagle pose (Garudasana)Intermediate · No equipment
3D demoSide plankIntermediate · No equipment
3D demoSleeper stretchIntermediate · No equipment
3D demoThread the needle (Parivrtta Balasana)Beginner · No equipment
3D demoWheel pose (Urdhva Dhanurasana)Advanced · No equipment
3D demoUpward plank pose (Purvottanasana)Intermediate · No equipment
3D demoCamel pose (Ustrasana)Intermediate · No equipment
3D demoBow pose (Dhanurasana)Intermediate · No equipment
3D demoReverse warrior (Viparita Virabhadrasana)Intermediate · No equipment
3D demoExtended side angle (Utthita Parsvakonasana)Intermediate · No equipmentOur yoga for shoulder pain class was built for this: pain-free range, arms-low standing poses, band turn-outs, a knee plank and locust, building up weight on the arms; three times a week is our editorial starting point. The shoulder mobility and stability routine has the band rotator cuff and shoulder-blade work. Once overhead work is comfortable, the Pilates for shoulder pain class and our yoga for swimmers class, a dryland class for the shoulder blades, add more.
A 20-minute yoga sequence for shoulder pain: gentle movement, standing poses with the arms low, shoulder strength, and weight on the arms built up from the wall.
20 minBeginner16 movesA bench or box, A wallA 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.
25 minBeginner12 movesA wall, A bandA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA 15-minute chair yoga routine done entirely sitting: slow breathing, neck, shoulder and wrist stretches, seated twists and side bends, and a calm finish.
15 minBeginner16 movesA bench or boxA 20-minute Pilates class for a sore shoulder: gentle range first, then shoulder-blade and rotator cuff strength, then light weight on the arms, in steps.
20 minBeginner15 movesA bench or box, Other / check instructionsA 25-minute dryland yoga class for swimmers: upper-back turns, shoulder-blade and trunk holds, hips for kicking and slow breathing, safe for loose shoulders.
25 minBeginner16 movesA wallThese are the warning signs from our shoulder pain, shoulder impingement and rotator cuff guides, word for word. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999.
Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.
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Stop and get checked if you get a sharp pain with a sudden loss of strength: a small tear can get bigger.
Stop for sharp pain, a feeling that the shoulder is slipping, pins and needles or numbness down the arm, or pain that is still worse by your next session after strengthening.
Stop an exercise, or shrink its range, if you get the feeling the shoulder is about to slip out (editorial).
A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans). Muscle soreness for a day or two after something new is normal. In a hot class, stop if you feel dizzy, sick or unwell; our hot yoga guide lists the signs of heat illness.
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With glaucoma, or high blood pressure that isn't under control, skip headstands, shoulder stands and long head-down holds. With osteoporosis, swap deep forward folds for a flat-back hinge from the hips, and twist smoothly. In pregnancy, our yoga in pregnancy guide covers the changes. NCCIH advises beginners to avoid headstands, shoulder stands, the lotus position and forceful breathing.
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Call 999 if:
Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
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The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
You can say no to any hands-on adjustment, and a teacher registered with Yoga Alliance must get your explicit consent each time.
A guideline says the pinching explanation isn't enough to account for the problem, and taking bone away did no better than a placebo operation, up to 10 years later.
In healthy shoulders, the gap under the shoulder's roof is narrowest around shoulder height, not fully overhead, and loading the shoulder gradually is the treatment. Arms come back overhead as strength returns, raised in front and within comfort.
The NHS says not to stop moving your shoulder completely, and the programme that kept people off the surgery list allowed pain up to 5 out of 10.
No yoga trial in impingement exists, and downward dog puts a lot of weight on the hands with the arms overhead, which a sore shoulder may need to build up to.
In GRASP, one session plus a home programme did as well as up to six sessions, and the steroid injection's benefit didn't last.
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No trial has tested this cue. Raising the arm normally needs the shoulder blade to turn upward with it, and in a lab study turning the arm out gave more space at shoulder height. Let your shoulder blades move with your arms rather than pinning them down (our suggestion).
It can be, if it includes gradual strength work for the rotator cuff and shoulder blades and builds up weight on the hands slowly. Yoga hasn't been tested for impingement itself; the evidence is for specific strengthening exercise.
Usually yes, with changes: arms low at first, fewer sun salutations, knees down in plank and chaturanga, and pain kept to about 5 out of 10 and back to where it was by your next session. Tell the teacher, and say no to hands-on adjustments that push your arms further.
While it hurts: full chaturanga and repeated vinyasas, upward dog (use a low cobra), dolphin, headstand, forearm stand and handstand, binds such as humble warrior and cow face arms, and the sleeper stretch. Most can come back as strength returns.
No pose is proven best. Try locust with your arms by your sides, then forward; cat-cow and a knee plank; wall push-ups; warrior II with your hands on your hips; and band turn-outs with your elbow at your side. In a lab study, locust with the arms forward worked the lower shoulder-blade muscles hardest of 15 poses.
Not necessarily, but it puts a lot of your weight on your hands with your arms overhead. Build up from hands on a wall, then a chair, then knees bent on the floor, and stop for a sharp pinch at the front or top of the shoulder.
No study has measured its load on the shoulder, but the hands carry up to about body weight at its peak. Lower with your knees down, go only halfway, or leave it out until wall and knee push-ups are easy, and keep your shoulders above your elbows.
Lift them in front of you, shoulder-width apart, thumbs up or palms facing, rather than sweeping them out to the side; don't interlace your fingers and force the elbows straight; and go only as high as is comfortable. That's our suggestion, from imaging of healthy shoulders, where turning the arm out gave more space at shoulder height.
Long passive holds with the arms overhead or bound don't build rotator cuff strength and can aggravate a sore shoulder. Add strength work, and keep any holds short of a pinch (our suggestion).
It hasn't been shown to cause it, but shoulders make up about 1 in 11 yoga injuries seen in US emergency departments, and hand, shoulder and head stands are the practices most linked to problems. Build load gradually, especially in fast flows.
Usually not: surgery to make more room did no better than a placebo operation in two trials, and a guideline panel recommends strongly against it. If you're not improving after a good 3 months of exercise, or the arm is clearly weak, ask for a specialist opinion.
The NHS says it usually gets better in a few weeks or months, though some people have symptoms for longer. The exercise programme in the main trial ran for 8 weeks, and its benefit on avoiding surgery lasted 10 years.
Call 999 for shoulder or arm pain with chest pain, especially with breathlessness, sweating or feeling sick. Get help the same day for sudden weakness lifting the arm after an injury or fall, or a hot, swollen shoulder with a high temperature. See a GP or physiotherapist if it's getting worse or hasn't improved after 2 weeks of looking after it yourself.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
