Shoulder Pain
A sore shoulder can be frustrating to live with, because it is involved in almost everything we do with our upper body. It can make it difficult to reach a shelf, lie on that side, put on or take off a coat or shirt, or take part in a sport you enjoy. I also know from first-hand experience with my own shoulder troubles over the years just how much it can get under your skin and affect you day-to-day. I see patients struggling with shoulder pain quite regularly in my clinic. The reassuring thing is that there is usually a good deal that can be done to help.
What shoulder pain can feel like
Shoulder pain can affect people in many different ways and the descriptions below are some of the things you might recognise if you’re suffering from a shoulder issue:
- Pain when lifting your arm above your head or to the side
- A feeling of locking or catching when lifting your arm
- Difficulty reaching behind your back, getting your arm into a sleeve, unhooking your bra or reaching for a seatbelt
- A deep ache that’s often worse at night and means you can’t lie on that side
- Pain reaching for things, lifting a kettle, a shopping bag or your child
- Pain when walking the dog, especially when they pull on the lead
- Pain during specific lifting in the gym, when throwing or playing certain sports
- Pain over the shoulder and spreading into the upper arm or sometimes into the neck and shoulder blade
These symptoms can have different causes that will vary from person to person. Finding out the cause is important as that guides what we do about it and some problems are managed in different ways.
Why shoulder pain happens
Shoulder pain can be caused by a few different things:
- Muscle, tendon or ligament injuries, including rotator cuff strain or irritation
- A joint problem in the shoulder
- A referred pain from the neck
The shoulder relies on the rotator cuff and other muscles, tendons and ligaments working together to give us the large amount of movement we have available. If we end up overusing some of them, they can become overloaded, irritated, and they let us know about it. These kinds of irritations and the inflammation they can cause are sometimes referred to as impingement, bursitis, or tendonitis. In reality, there is a bit of overlap and crossover here. What’s important is looking at how your shoulder moves and where it is limited, so we can calm things down and reduce that irritation as part of a wider treatment plan. Patients often think their pain means something in the shoulder is permanently damaged. Thankfully, this is rarely the case and it’s likely you won’t need a scan or surgery.
How I assess and treat shoulder pain
I’ll ask you questions about your pain, how it came on, what movements you struggle with and your lifestyle to help guide my assessment. I’ll then look at how your shoulder, upper back, neck and shoulder blades move, and incorporate some specific clinical tests to help me figure out what is going on. I check the neck too, as it can be common for issues in the neck to refer into the shoulder or shoulder blade area and if that’s the case, we’ll treat the neck itself.
Once we’ve identified your particular issue, I’ll develop a treatment plan to address what I’ve found and get you back to activities again without as much pain or limitation. I find the best approach is a mixture of hands-on manual therapy to reduce pain, ease the stiffness and guarding that often happens in the muscles, and improve the quality of movement. I’ll also likely give you some specific exercises to help build back your tolerance to movement and improve any strength loss. They work really well together, with hands-on treatment improving how things feel and the exercises reinforcing this over the long term.
Part of my assessment will also screen for the small number of shoulder problems that may need further investigation and if I think you need this I’ll help you get to the right place.
If you’ve got a shoulder issue that’s holding you back, let’s put a plan together to help.
What to expect
Since there are so many different things that could cause shoulder pain, they have variable recovery rates and often require a bit of patience. Problems that haven’t been there long may settle over weeks. It’s not uncommon for some shoulder problems to take a few months to resolve. Certain symptoms will settle before others. You may find you can sleep more comfortably through the night at first, before the discomfort on movement reduces or range of motion starts to return.
Recovery will almost invariably have some setbacks and flare-ups along the way, since you need to use your shoulder every day. This is entirely normal and not something to worry about.
Regardless of your particular condition, the end goal is getting you back to doing what you need and want to do. That will start with reducing pain and making you more comfortable so that we can introduce appropriate movement and exercise to get your range of motion and function back. I’ll be honest with you on how long I think it might take so you’re not left confused about the plan or where we are in terms of progress.
Frozen shoulder
Frozen shoulder is a condition that remains poorly understood. We know it involves thickening and scarring of the shoulder capsule, severely limiting range of motion. We’re much less clear on why it happens. It often follows its own, rather long, course of recovery, taking many months or even a year or more. One thing worth saying is that many people are told they have frozen shoulder when they might not, as it is often overdiagnosed.1, 2 It is therefore important to assess properly as a misdiagnosis can cost time on the wrong management. Managing frozen shoulder can be difficult and I will be honest with you about that and the treatment options available, including ones I can’t do and would refer you on for.
The vast majority of shoulder problems are not serious. However, there are a few symptoms that require further medical investigation instead of booking with me:
- If your shoulder is hot, red or swollen, particularly with fever or feeling unwell
- Sudden loss of strength or inability to lift the arm after an impact or fall
- Your arm or shoulder is deformed, changed shape or badly swollen
- You’ve lost feeling in your whole arm or shoulder
The following symptoms would require urgent investigation by going to A&E:
- Shoulder or arm pain, especially left-sided, with chest pain or tightness, breathlessness, sweating or feeling sick
These are rare, but if you’re in any doubt about the above, it’s best to get it looked at.
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about shoulder pain
Most of the time a scan isn’t necessary and I can tell you what’s likely going on after our assessment. Scans will often show “wear and tear” or “degeneration” that would show up in people not in pain, and aren’t always a good indicator of why you’re in pain. Very occasionally a scan may be necessary and if you need one, I’ll let you know.
Most shoulders recover very well using conservative approaches. That means hands-on therapy and exercise can help in many cases. The research shows this kind of approach often does just as well as surgery in certain cases.3, 4 Shoulders that haven’t responded to conservative care, or with more serious or complex pictures, may need a surgical opinion and if you need this I’ll tell you and help get you referred.
Osteopathy can help with frozen shoulder but the management will look quite different to other conditions. While the aim is to help reduce pain in the early stages and support range of motion improvements, it runs its own slow course, and can often take months or even a year or more to recover. I’ll talk you through the options, including other treatment such as injections or specialist referrals if that’s the better option for you.
When a shoulder is painful and irritated, simply lying on it can directly compress those irritated structures, causing more pain. Lying still and not moving also contributes, as the lack of movement can mean the inflammation from the body’s healing process builds up and creates irritation. Sometimes simply changing your sleep position or using pillows to support your arm can help reduce this and make things more comfortable.
Complete rest is rarely the best action to take with a painful shoulder. The right kind of movement, that is tolerable for you without flaring things up further, will be the better approach. This is why the right kind of exercise progression is important. Part of my treatment approach is giving you the right exercises that won’t flare things up and advising on when to push on versus when to back off for your particular shoulder complaint.
Osteopathy can help with shoulder bursitis, impingement and rotator cuff issues. They’re often labels with a lot of crossover and similar symptoms. To manage them effectively, I’ll investigate why you have a particular condition and am interested in looking at how your shoulder and upper back move, and what is ultimately driving the pain. This then guides the hands-on work and exercises I give to help calm symptoms down and build your shoulder back up.
Patients often ask me about rounded shoulders or similar postural concerns. The way our shoulders sit can often be normal variation in how people are built and not always something that needs fixing. The link between posture and shoulder pain isn’t clear-cut, and is usually weaker than most people assume. I don’t automatically look to ‘correct’ your posture but I will look at it to see whether it could be contributing, and why. If there are postural elements involved, I’ll be looking to improve mobility and strength so your shoulder has more capacity and tolerance to the demands on it. This usually results in some postural change, but we’re not looking to create a ‘perfect’ posture, and we don’t need to for you to get out of pain.
I can often help even with long-standing shoulder pain, though the longer you’ve had an issue the longer it usually takes to resolve. The goals are the same and we’ll look to reduce pain and help get you more comfortable so we can then improve how your shoulder moves and build strength up. I’ll give you an honest view of how long I think it’ll take and the expectations after I’ve assessed you.
With shoulders, it really depends on what problem you have and how long you’ve had it, so it’s hard to give a single number honestly. Shoulders may take more time than other areas of the body and it’s not uncommon to have the odd setback here and there. What’s important is that we review progress regularly and if not making headway within three to six sessions, we’ll change the plan to make sure we are.
Does this all sound familiar?
Let’s take a look.
If you’re suffering with shoulder pain that is affecting your daily life, let’s figure out where it’s coming from and what can be done about it.