Shoulder Pain

Understanding Shoulder Pain

Shoulder pain can limit work, sport, and everyday tasks such as reaching, lifting, or sleeping on the affected side. The shoulder is highly complex and made up of the glenohumeral joint (so called ball and socket), acromioclavicular joint (where collar bone meets shoulder), sternoclavicular joint (where collar bone meets chest), scapulothoracic articulation (shoulder blade and ribs), and thoracic spine. Also included are the rotator cuff tendons, labrum, bursae, nerves and associated arm, neck and back muscles. Because so many structures interact, pain can arise from acute injury, repetitive overload, degenerative changes, or a combination of factors. Evidence-based physiotherapy targets the specific tissue drivers of pain while restoring movement, strength and coordinated control to reduce recurrence.

Does Any of This Sound Familiar

Do you have pain when lifting your arm overhead, reaching behind your back, or performing daily tasks?
Is pain worse at night or when lying on the painful side?
Have you tried treatments that gave short-term relief but not lasting improvement?
Have you been advised that painkillers or surgery are your only options?
Are you avoiding sport, work tasks or hobbies because of shoulder pain?

If you answered yes to any of the above, you’re not alone. Many shoulder problems respond well to a focused physiotherapy approach that addresses underlying mechanics, strength and load tolerance.

What Causes Shoulder Pain

Rotator cuff tendinopathy and tears

overload, tendon degeneration, or acute tears can cause pain. Often movement is affected and weakness may exist; tendinopathy is one of the most common sources of shoulder pain.

Subacromial irritation and bursitis

mechanical irritation of the rotator cuff under the acromion or coracoacromial arch, often associated with pain on elevation and nocturnal pain.

Shoulder instability

traumatic dislocation or micro instability leads to recurrent giving way or dislocation. You may experience pain with certain positions and altered muscle control.

Adhesive capsulitis / frozen shoulder

progressive stiffness and pain with marked loss of shoulder motion. May occur following a trauma or have a benign onset. Can be associated with perimenopause/menopause, breast cancer treatments, diabetes, heart disease or other factors.

Acromioclavicular joint pathology

localised top-of-shoulder pain aggravated by cross-body movements.

Labral pathology

the labrum is a fibrocartilage structure that facilitates the ball remaining in contact with the shoulder socket through deepening the socket. It creates a suction effect. Tears can cause pain, clicking, or catching, particularly in overhead activities.

Referral and nerve-related pain

cervical radiculopathy or thoracic dysfunction can present as shoulder pain; peripheral neuropathies may produce atypical symptoms.

Biopsychosocial contributors

persistent pain is often influenced by activity load, fear of movement, sleep disturbance, and daily demands.

Why Shoulder Pain Might Not Be Improving

Incomplete loading progression

temporary pain relief from passive modalities without graded strengthening and exposure to load slows true recovery.

Unaddressed movement and scapular control

poor shoulder blade and/or spinal mechanics, rotator cuff activation and muscle forces can perpetuate shoulder stress.

Excessive rest or premature return

both prolonged immobilisation and rapid return to high-demand activities delay tissue adaptation.

Sleep disturbance and night pain

poor sleep increases pain sensitivity and reduces capacity for rehabilitation.

Expectations and passive-only care

patients often expect quick fixes; evidence supports active, progressive rehabilitation as the primary treatment for most non traumatic shoulder problems.

How Evidence-Based Physiotherapy Helps

Thorough assessment and individualised diagnosis:

We evaluate shoulder range, rotator cuff and scapular muscle strength, thoracic and cervical mobility, occupational and sport-specific demands, and pain behaviour to identify contributing factors.

Progressive exercise therapy:

High-quality evidence indicates progressive, graduated loading of the rotator cuff and scapular stabilisers reduces pain and improves function more reliably than passive treatments alone. Exercises are progressed from low-load start positions to heavyslow resistance and functional task loading as tolerated.

Scapular and motor control retraining:

Targeted training of scapula muscles and control reduces shoulder stress and improves arm mechanics.

Biopsychosocial contributors:

persistent pain is often influenced by activity load, fear of movement, sleep disturbance, and daily demands.

Biopsychosocial contributors:

Joint and soft tissue techniques can reduce pain and restore mobility but are most effective when combined with active rehabilitation.

Load management and graded return to activity:

We create a staged plan to increase tolerance for daily tasks, work demands and sports-specific movements while monitoring symptoms and function.

Education and behavioural strategies:

Pain neuroscience-informed education, sleep optimisation, ergonomic advice and graded exposure will reduce fear-avoidance and support adherence to exercise.

Adjuncts used selectively:

For persistent tendinopathy or where indicated, adjunct treatments such as ultrasound-guided injections, shockwave therapy or referral for diagnostic imaging may be considered alongside conservative rehabilitation.

Prehabilitation and surgical rehabilitation:

For patients requiring surgery, pre-op strengthening and post-op staged rehabilitation accelerate recovery and improve outcomes.

The Importance of Early, Targeted Care

Early, targeted physiotherapy maximises the chance of recovery for most rotator cuff and shoulder disorders. It can prevent secondary problems such as neck pain or compensatory shoulder dysfunction and shortens time away from work and sport. Active rehabilitation that emphasises progressive loading, movement retraining and realistic return-to-activity has the best available evidence as first-line care for the majority of non-traumatic shoulder conditions.

Next Steps

If shoulder pain is restricting your activities, book a detailed assessment so we can identify the drivers of your pain and design a personalised, evidence-based rehabilitation plan. Expect a clear