Physiotherapy for Shoulder Pain

One of the most common concerns people have when they develop shoulder pain is that they have damaged something or that there is a tear that needs to be repaired.

Rotator cuff and other tendon changes are common, particularly as we get older. Some of these changes can also be seen on ultrasound or MRI scans in people who have little or no shoulder pain.

This means that findings on a scan don't always tell us how much pain you should be experiencing or what you are capable of doing.

Even when a scan shows a rotator cuff tear or other structural changes, this doesn't automatically mean that you need surgery or that your shoulder is too damaged to exercise.

In many cases, gradually improving your strength, movement and physical capacity can help you become more comfortable and confident using your shoulder.

Your scan is only one piece of the puzzle. Your symptoms, clinical assessment and how your shoulder functions are much more important when deciding how best to manage your problem.

This is a common question, particularly when shoulder pain has been present for some time.

Scans can be useful in certain circumstances, particularly when there is a concern about a significant injury, a substantial loss of strength or another condition, or when the results are likely to change how your treatment is managed.

However, imaging isn't always necessary.

Ultrasound and MRI scans can show changes in the tendons and other structures around the shoulder that are also present in people without pain. A scan can therefore provide useful information, but it doesn't necessarily explain all of your symptoms.

A good clinical assessment is often the starting point.

If you already have an X-ray, ultrasound or MRI report, we can help you understand what the findings mean in relation to your symptoms and what they mean for your activity.

The rotator cuff is a group of four muscles and their tendons that help control movement and stability of your shoulder.

Rotator cuff problems are a common cause of shoulder pain. They can develop gradually over time or suddenly, after a specific injury.

You may have been told that you have rotator cuff tendinopathy, a partial tear or a full-thickness tear.

These terms can sound worrying, but a tear on a scan doesn't automatically mean that your shoulder cannot function normally or that surgery is required.

For many people, improving the strength and capacity of the shoulder through a structured rehabilitation programme can make a significant difference.

The right approach depends on your symptoms, your strength and movement, how your shoulder is functioning and what you want to get back to doing.

Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder gradually becomes painful and increasingly stiff.

People often notice difficulty reaching overhead, putting on a coat, fastening a bra, reaching behind their back or sleeping comfortably.

Frozen shoulder can take time to settle, and the symptoms can change over the course of the condition.

Physiotherapy can help you understand what is happening, maintain as much movement and function as possible and find appropriate ways of managing your symptoms.

The treatment approach will depend on the stage of the condition, how irritable your shoulder is and how much your symptoms are affecting your daily life.

Sometimes you may need to temporarily modify what you are doing, particularly if your shoulder pain has followed an injury or has suddenly become much worse.

However, complete rest is rarely the long-term answer.

Your shoulder needs appropriate movement and loading to maintain and build its capacity.

You may initially need to reduce activities that are aggravating your symptoms, such as heavy lifting, overhead exercises, pressing movements, throwing or certain gym exercises.

That doesn't necessarily mean you need to stop them altogether.

We'll help you work out what you can safely do now, what may need to be modified and how you can gradually build your activity back up.

Shoulder pain is common in people who lift weights, play sport or exercise regularly.

Sometimes the problem develops after increasing the amount or intensity of your training too quickly. It can also happen when the demands being placed on your shoulder increase faster than its current strength and capacity.

This doesn't necessarily mean that you need to stop exercising.

Depending on your symptoms, it may be possible to modify your training while continuing to work on your fitness and strength.

We'll look at what you're currently doing, identify the movements and loads that are aggravating your symptoms and help you gradually build your shoulder back towards the activities you enjoy.

For someone who wants to return to the gym or sport, the goal isn't simply to make the shoulder comfortable. It's to build enough capacity to tolerate the demands you're going to place on it.

Not necessarily.

Depending on the cause and severity of your symptoms, it may be possible to continue exercising while modifying your training.

This might mean temporarily reducing the weight, number of repetitions, range of movement or certain exercises before gradually building back up.

Having one episode of shoulder pain can sometimes make future episodes more likely.

That doesn't necessarily mean that your shoulder is becoming weaker or more damaged.

Shoulder pain can flare when the demands placed on your body increase faster than your current capacity.

This might happen after a period of inactivity, increasing your gym training, returning to sport, doing more lifting at work, a busy period or simply doing more than you're used to.

Sometimes people also become cautious about using a painful shoulder, which can gradually reduce their strength, movement and confidence.

One of the most useful things you can do is gradually build your capacity so that your shoulder is better prepared for the demands of everyday life and the activities you enjoy.

This is why our approach isn't just about getting you through the current episode. Where appropriate, we'll also look at how you can reduce the impact of future flare-ups and become more confident managing your shoulder yourself.

Weakness can contribute to some types of shoulder pain, but shoulder pain isn't simply caused by having a weak rotator cuff.

Your overall strength, activity levels, previous injuries, training load and how your shoulder responds to different activities can all be relevant.

Improving strength and physical capacity can be an important part of treatment, but the aim is to understand the bigger picture rather than simply identify one weak muscle.

Not necessarily.

Rotator cuff tears vary considerably in size, cause and effect on shoulder function. Some tears occur gradually with age and may not cause significant symptoms.

For many people, rehabilitation can help improve pain, strength and function without surgery.

However, some significant injuries, particularly following trauma and where there is substantial weakness or loss of function, may require further medical or surgical assessment.

"Shoulder impingement" is a term that has traditionally been used to describe shoulder pain associated with certain movements, particularly lifting the arm.

However, shoulder pain is more complicated than simply having something being "pinched" inside the shoulder.

Your symptoms can be influenced by the strength and capacity of the shoulder, the activities you are doing and how your shoulder responds to load.

We'll look at the bigger picture rather than assuming that one structure is being damaged every time you lift your arm.

Often, yes, although the type and amount of exercise may need to change depending on how irritable your shoulder is and what stage of the condition you are in.

The aim isn't to force your shoulder through painful movements. We'll help you find an appropriate level of movement and exercise and gradually progress this as your symptoms allow.

Yes.

Persistent shoulder pain can be more complicated than a recent injury, but that doesn't mean nothing can be done.

Treatment may involve gradually increasing your physical capacity, improving confidence with movement, addressing factors that may be contributing to flare-ups and developing strategies that allow you to manage your symptoms more effectively.

Yes.

The neck and shoulder are closely connected, and pain from the neck can sometimes be felt around the shoulder or arm.

This is why a good shoulder assessment doesn't just look at the shoulder itself.

We'll consider your neck, shoulder, upper back and arm when appropriate to help determine where your symptoms may be coming from.