Your shoulder is one of the most mobile joints in your body. It helps you perform a wide variety of movements that are necessary for everyday life. Whenever you reach for a glass in the cabinet or pull a gallon of milk from the refrigerator, you use your shoulders’ strength and flexibility to complete the task. 

However, greater mobility also increases instability. Joints with a wide range of motion can be vulnerable if not properly stabilized. As a complex joint with excellent mobility, the shoulder can be susceptible to an injury that causes pain.

Shoulder pain is defined as discomfort in the shoulder joint. It may be caused by issues with the bones or soft tissues around the shoulder, including muscles, tendons, and ligaments. Some neck conditions may also lead to shoulder pain. 

Shoulder pain is a very common condition, affecting 18%—26% of adults at any given time. Its symptoms can be persistent and affect daily life at home and at work. This can lead to avoiding important events or activities or missing work due to pain.

Physical therapy can treat shoulder pain and get you back to doing what you love. With Direct Access, you don’t need a referral from your primary care provider to get started. Keep reading to learn more about shoulder pain and how physical therapy for shoulder pain can help.

Causes of Shoulder Pain 

The shoulder joint is a complex structure with many parts working together to achieve excellent mobility. Due to its complexity, it can be hard to pinpoint the exact cause of pain. However, here are some common causes shoulder pain could be related to:

• Rotator cuff injuries (tendinitis or tears) include damage or injury to any of the four muscles or tendons comprising the rotator cuff. The rotator cuff muscles are essential to supporting and moving the shoulder joint. Pinching of the tendon can also be called shoulder impingement.
• Arthritis in the shoulder joint
• Bursitis (inflammation of the fluid sacs around the joint)
• Biceps tendinopathy is the irritation and inflammation of the biceps tendon that crosses the front of your shoulder joint. 
• Labral tears occur when there is injury to the shoulder’s labrum, a ring of cartilage that surrounds the shoulder socket.
• Frozen shoulder, or adhesive capsulitis, is a condition that causes stiffness and loss of motion in the shoulder.
• Bone spurs grow on the edges of the shoulder bones, causing irritation and inflammation. They typically develop in response to injury or wear and tear to the joint.
• Shoulder dislocation occurs when your upper arm bone (humerus) slips out of its socket, usually a result of trauma like a fall or other impact.
• Fractures
• Overuse injuries
• Nerve irritation
• Muscle strains

There are a number of risk factors for shoulder pain, including older age and obesity. Sports that involve overhead motion can also increase the risk of shoulder pain. Additionally, you may be at higher risk of shoulder pain if your work activities include repetitive motions, working above shoulder height, or heavy lifting. 

Some underlying health conditions may also contribute to shoulder pain. For example, a nerve irritation in the neck may cause pain in the shoulder. When pain originates in a different body part than where it’s felt, it is called referred pain. 

Symptoms of Shoulder Pain

Common shoulder pain symptoms include:

• Sharp, stabbing, or throbbing pain.
• Dull, aching pain.
• Painful clicking or popping in the joint.

Your pain may worsen when you raise your arm overhead, reach across your body, or put your arm behind your back. It may also be painful at night, making it difficult to sleep comfortably. 

Diagnosing Shoulder Pain 

Treating your shoulder pain early is important to avoid worsening pain and symptoms. You should contact a physical therapist if you’ve had shoulder pain for two weeks without improvement. Even if you’ve had shoulder pain for a long time, it’s still valuable to make an appointment. You don’t need a referral to be seen—with Direct Access, you can call a physical therapist today for an appointment. 

After a medical history review and pain assessment, your physical therapist will evaluate your range of motion and strength. They will monitor your pain levels throughout the process, ensuring your comfort while obtaining measurements. Based on these findings, your physical therapist will prescribe a personalized exercise program that includes movements to be performed at home. Your plan of care may also include manual therapy, where your therapist uses their hands to move and manipulate your shoulder for optimal recovery.

After your initial evaluation, your physical therapist may refer you to your doctor for further imaging or diagnostic tests. Diagnostic imaging may include X-rays, MRI, or ultrasound.

Treatment Options

Non-Surgical Treatment Options

Physical therapy

Physical therapy is a first-line conservative treatment option for shoulder pain. With Direct Access, you can make an appointment with a physical therapist today to assess your shoulder—no need to wait! Our experienced physical therapists will treat shoulder pain using a combination of personalized exercise prescriptions and manual therapy techniques. This strategy has been proven to improve pain, mobility, and function in patients with shoulder pain.

Medication

Over-the-counter (OTC) medications may be helpful in conjunction with your shoulder physical therapy treatments. Your physical therapist will refer you to your doctor to discuss medication options if needed. This may include OTC pain relievers like ibuprofen or naproxen for mild to moderate pain. Your doctor may prescribe stronger OTC medication or muscle relaxants for more persistent pain.

Corticosteroid Injections

Corticosteroid injections, or cortisone injections, are administered by a doctor to relieve shoulder pain and inflammation. These injections can reduce pain and improve function; however, physical therapy helps restore strength and flexibility in the joint after pain levels are reduced. 

Activity modification

Activity modification refers to adjusting how you physically participate in your daily life or at work. It aims to minimize pain and discomfort while allowing you to remain active and engage in your favorite activities. Your physical therapist can help you navigate these changes. They can help you determine an activity’s optimal intensity or duration, adjust your position or posture, or provide recommendations for assistive devices as needed. 

Surgical Treatment Options

If you are considering shoulder surgery, talk to your physical therapist first. They can provide individualized recommendations for additional conservative treatments or activity modifications to get you back to your activities without surgery. 

However, there may be reasons to support surgical intervention. These include severe, persistent pain, significant shoulder instability, or a greatly diminished range of motion affecting daily function.

There are many different surgical procedures, depending on the underlying cause of your shoulder pain. No matter the procedure, your physical therapist can guide you through your post-surgical rehabilitation and help restore your shoulder function. 

• Labral repair focuses on repairing the labrum, the ring of thick cartilage around the shoulder joint socket.
• Biceps tenodesis is a procedure to repair the biceps tendon that crosses the front of the shoulder. It involves releasing the tendon from its attachment point on the shoulder socket and reattaching it to the upper arm bone (humerus).
• Shoulder debridement is an arthroscopic procedure to remove damaged or loose tissue from inside the shoulder joint. The goal is to reduce pain and improve mobility.
• Arthroscopy procedures are minimally invasive repairs with small incisions and a camera to visualize the joint. 
• Rotator cuff repairs reattach a torn rotator cuff tendon to restore function. This may be done arthroscopically or with an open procedure. Recovery times vary due to the size of the tear.
• Shoulder replacement (Total Shoulder Arthroplasty, or TSA) involves replacing the shoulder joint. It is recommended for severe shoulder arthritis in which the joint surfaces are significantly damaged. Surgeons will replace the ball on the humerus and the socket on the shoulder blade with artificial components. 
• Reverse shoulder replacement (RSA) is used when a shoulder replacement is indicated, but the rotator cuff is severely damaged. The implant positions are reversed, with the ball attached to the shoulder blade and the socket placed on the humerus. Patient outcomes following the TSA and RSA show low pain scores, high satisfaction scores, and improved shoulder mobility. 
• Partial shoulder replacement (hemiarthroplasty) is when only half of the shoulder is replaced. Typically, the head of the humerus (ball) is replaced while leaving the shoulder blade socket intact.

Preventing Shoulder Pain

Shoulder pain can be debilitating, preventing you from enjoying the activities you love. While physical therapy can help you regain your strength, mobility, and function, there are preventative ways to reduce your risk of developing shoulder pain.

• Warm up – Ensure you warm up properly before exercising or participating in other vigorous activities. A brief 5-10 minute warm-up consisting of light cardio to generate body heat and dynamic stretching can go a long way toward preparing your shoulders for the activity to come. Here are a few shoulder mobility exercises to try during your next warm-up:
  • Arm circles
  • Shoulder rolls
  • Arms across chest

Try to include positions that mimic the activity you’re about to do. For example, an overhead activity should include an overhead warm up. Many times, the best warm up for an exercise is the same exercise with lighter weights. For instance, a weightlifter could use just the bar to warm up for their bench press set before adding additional weight.

Your physical therapist can create an individualized warmup routine for you. They will work with you to prepare your body for your favorite activity or sport.

• Proper rest and recovery – If you are going to participate in exercise or vigorous activity, you must give your body enough time to rest and recover between bouts. For more strenuous activities, you may need a few days of rest to let your muscles recover. For lighter activities, shorter rest periods are sufficient. Your physical therapist can help address any questions regarding rest times for your favorite activities.
• Nutrition – Your body needs good nutrition to repair and strengthen. Eating enough protein is essential to muscle health and growth. Choose complex carbohydrates like whole grains to fuel your muscles and healthy fats to support body functions and development. 
• Activity modification – As discussed above, activity modification involves adjusting your daily activities to minimize pain and promote participation. Your physical therapist can help you determine the right intensity or duration of an activity or recommend assistive devices.

Living with Shoulder Pain

There are several ways to cope with chronic shoulder pain. In addition to seeking help from an experienced physical therapist, here are a few strategies to try:

• Mindfulness and deep breathing techniques
• Activity pacing (breaking larger activities down into smaller, manageable pieces)
• Movement and staying active
• Positive self-talk
• Good sleep habits

Despite efforts to prevent pain, sometimes flare-ups happen. If you are experiencing a flare-up of shoulder pain, focus on rest, gentle movement, and stress reduction techniques. Contact your physical therapist—they can help you through your flare-up and get back on track.

Managing your emotional well-being is also important. Research indicates that depression and pain are tightly linked. By supporting your emotional health, you’re also supporting your physical health.

Activity modification is helpful when living with shoulder pain. Adjusting your activities to minimize pain can improve your enjoyment and engagement.

Physical Therapy For Shoulder Pain 

You can make an appointment with one of Confluent Health’s experienced physical therapists without a doctor’s referral. Our therapists use a combination of personalized exercise prescriptions and manual therapy to get you feeling better fast. Each patient’s case will be different based on their individual needs, and you will be reassessed frequently to ensure you are achieving the goals you set with your physical therapist at your first visit.

While each case is unique, there are a few common shoulder exercises that you may learn with the guidance of your therapist:

• Rows: Loop a medium resistance band around a sturdy anchor and hold both ends. Standing tall with your chest high, pull your hands toward your chest, bending your elbows. Squeeze your shoulder blades together as you pull, stopping as your hands reach the sides of your chest. Release slowly with control to the starting position. Repeat 10-15 times. 
• Overhead pressing: Hold a light dumbbell in each hand and bring them to your shoulders. Stand tall and keep your chest high as you press the dumbbells overhead. Fully straighten your elbows, keeping the weights above your head. Lower slowly with control to your starting position. Repeat 10-15 times.
• Resisted internal/external rotation: Loop a light resistance band around a sturdy anchor and hold both ends in one hand. Turn your body so your opposite shoulder faces the anchor point. Bend your elbow to 90° and tuck it into your side. Keeping your upper arm against your ribcage, rotate the forearm of your bent arm away from your torso. This is called resisted external rotation. 

To perform resisted internal rotation, turn your body around so the shoulder of the hand holding the resistance band is facing the anchor point. Adjust your distance as needed from the anchor point to keep the right resistance. Keeping your upper arm against your side, rotate your bent forearm inward toward your stomach. Repeat each exercise 10-15 times.

• Reverse flyes: Hold a light dumbbell in each hand. Bend at the waist, keeping your knees slightly bent and your back straight. Let your arms hang down toward the ground with your palms facing each other. Keeping a slight bend in your elbow, lift your arms to the side, moving the dumbbells away from each other. Squeeze your shoulder blades together as you lift. Lower slowly with control to the starting position. Repeat 10-15 times.

There are many other shoulder exercises physical therapy can utilize to improve your strength and mobility. You will work with your physical therapist to determine the best for you.

Your physical therapist may also use manual therapy techniques, using their hands to manipulate your shoulder in specific ways to improve range of motion or joint mobility. Other modalities, like heat, ice, or dry needling, may also be used to optimize your rehabilitation. 

Throughout your treatment sessions, your physical therapist will reassess your progress and monitor your pain levels. This information will decide your treatment plan to help you achieve your therapy goals. Your therapist will work with you to set these goals at the start of physical therapy.