SHOULDER PAIN

Shoulder pain physio is all about figuring out if it’s a joint issue, muscle/rotator cuff problem, nerve issue, or posture/mobility thing - because the shoulder moves more than any other joint, so it fails in more ways.

1. *Assessment first*

Physios check:

- *Pain pattern*: Front = often biceps/pec tightness. Side = rotator cuff/subacromial. Deep ache = joint or labrum. Down the arm = nerve/nerve root.

- *Range of motion*: Can you lift overhead without shrugging? Is internal/external rotation limited?

- *Strength test*: Rotator cuff, scapular muscles, serratus anterior. Weak scapular control is behind most shoulder issues.

- *Posture & scapula movement*: Rounded shoulders + winging scapula = impingement risk.

- *Red flags*: Sudden weakness after injury, numbness down arm, night pain not relieved by position - needs medical review.

2. *Pain reduction & mobility phase*

If it’s inflamed or guarded:

- *Gentle mobilizations*: Joint glides to restore glide/roll in the glenohumeral joint.

- *Soft tissue work*: Pec minor, levator scapulae, upper traps often get overworked.

- *Pendulum/Codman exercises*: Let the arm hang and gently swing to maintain motion without loading.

- *Posture resets*: Chin tucks, thoracic extensions to open up the space for the shoulder.

3. *Strength & scapular control phase*

The shoulder joint is unstable by design, so it relies on muscles for control.

- *Rotator cuff*: External rotation with bands, prone Y/T/W lifts. Start light, high reps.

- *Scapular stabilizers*: Serratus punches, wall slides, prone rows, scapular retraction. If the shoulder blade doesn’t move right, the arm can’t move right.

- *Thoracic spine mobility*: Stiff mid-back forces the shoulder to compensate.

- *Eccentric loading*: Slow lowering phases for tendinopathies like supraspinatus or biceps tendon issues.

4. *Functional & load progression phase*

Once pain is down, you train for real movements.

- *Overhead mechanics*: Wall slides → dumbbell presses with proper scapular control.

- *Push/pull patterns*: Push-ups, rows, face pulls with good form.

- *Throwing/sport-specific drills*: Plyometric catches, resisted throws if you play sport.

- *Endurance*: High-rep, low-load work to build tendon tolerance.

5. *Common conditions and targets*

- *Rotator cuff tendinopathy*: Eccentric external rotation, scapular strength, load management.

- *Subacromial impingement*: Posture correction, lower trap/serratus strengthening, avoid painful arcs.

- *Frozen shoulder/adhesive capsulitis*: Gentle stretching + joint mobilizations over months. Forcing it makes it worse.

- *Instability*: Focus on rotator cuff, scapular control, proprioception drills.

- *Labral tears*: Depends on type. Many do well with strength + stability; some need surgery.

What works best

Evidence favors *exercise therapy + manual therapy* over rest or passive modalities alone. Cortisone shots can help short-term for inflammation, but they don’t fix movement faults. Surgery is usually last resort unless there’s a full tear or instability that won’t hold.

When to get checked urgently

- Can’t lift arm at all after injury

- Shoulder looks dislocated/deformed

- Numbness/weakness down arm with neck pain

- Severe night pain with unexplained weight loss

Shoulder rehab is slower than knee/ankle because it’s a mobile joint - expect 6-12 weeks for tendon issues, longer for frozen shoulder.

What’s your shoulder doing? Pain with lifting, reaching behind back, sleeping on it? That’ll tell me which muscles and movements to focus on.

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