Shoulder pain

The shoulder is a highly mobile joint, with heavy reliance on the muscles around it to function properly. Diagnosis of shoulder injuries involves obtaining a detailed history and a thorough assessment of movements.

Rotator cuff injury

A Rotator Cuff injury is a common cause of shoulder pain. Injury to the Rotator Cuff will usually begin as inflammation, commonly called Rotator Cuff tendonitis. If the cause of Rotator Cuff tendonitis is not addressed, a partial or complete Rotator Cuff tear can develop.

Physiotherapy is often effective in treating Rotator Cuff tendonitis. Tears of the Rotator Cuff are best treated by surgical repair.

Common Rotator Cuff Injury signs & symptoms:

Symptoms of Rotator Cuff injury include

  • weakness,
  • loss of full movement and
  • shoulder pain.

The amount of pain will depend on the extent of the injury. Patients with early-stage inflammation may only have pain with overhead activities, while those with a Rotator Cuff tear may not be able to sleep because of the pain.


We will conduct a thorough examination to determine the cause of your problem and formulate a plan as to the issues that need to be addressed to facilitate healing.

Physiotherapy is often effective in treating acute (short-term) inflammation and chronic (long-term) degeneration of the cuff where a tear is not present. The first aim of treatment is to reduce the amount of inflammation using ice therapy, active rest and avoidance of exacerbating positions / postures.

Once the inflammation and pain has settled, exercises to regain full movement can begin, followed by a carefully-graded strengthening and stabilising programme.

Preventing re-occurrence

Faults in sporting technique that may have caused the problem in the first place must also be rectified.

For athletes, attention must be paid to flexibility, strength and endurance of the shoulder muscles, ensuring that the muscles of the scapula are not neglected. Learning the correct technique and choosing proper equipment are also important.

In addition, any increases in the amount of training or competition must be gradual so as not to overload the rotator cuff.

A proper warm up and cool down may also help to prevent injury

Frozen shoulder

Frozen shoulder or ‘Adhesive Capsulitis’ is a common cause of shoulder pain in people aged between 40 and 60, with women affected more than men. Physiotherapy treatment is the first option for Frozen Shoulder treatment. Some evidence suggests that more aggressive shoulder mobilisation in conjunction with local anaesthetic and corticosteroid injections can provide shoulder pain relief and restore normal movement.

Common Frozen Shoulder signs & symptoms

Interestingly, the non-dominant shoulder appears to be affected more than the dominant shoulder. Those patients with frozen shoulder usually experience distinct phases with differing signs and symptoms.

First phase – gradual onset of pain and loss of movement

During the first phase pain comes on slowly and leads to a gradual loss in shoulder movement. Some patients may not notice anything until they struggle to, say, fasten a bra or comb their hair.

Second phase – restriction of shoulder movement

Eventually, over the space of a couple of months, the pain becomes so severe that it interferes with sleep because there is an exquisite pain when attempting to lie on the affected shoulder.

The second phase can last for up to a year.

Final phase – gradual increase in shoulder range of motion

The final phase can last between 5 months and two years, although some patients can experience a more rapid recovery. During this time there is a gradual increase in shoulder range of motion.

What you can do

Ice therapy or hot packs can be effective to help pain relief, depending on personal preference. Pain relieving medication prescribed by a doctor is particularly helpful during the early ‘freezing” phase.

Physiotherapy treatment is the first option for Frozen Shoulder. The main aim of physiotherapy treatment is to gently stretch the shoulder joint capsule. This is achieved through performing passive mobilisations which are done at various points in the range of shoulder movement. In addition, the patient must keep up a regular active stretching program to gently improve shoulder range of movement. All this stretching should be pain free.

Ice therapy or hot packs can be effective to help pain relief, depending on personal preference.

Some evidence suggests that more aggressive shoulder mobilisation in conjunction with local anaesthetic and corticosteroid injections can provide pain relief and restore shoulder range of movement.

If the arm can’t be lifted to the level of the shoulder after three months then manipulation under anaesthetic (MUA) by an orthopaedic consultant may be appropriate. Following the procedure, the affected arm is held ‘abducted’ away from the trunk in order to maintain range of movement. The day after the MUA, the patient must begin a series of active exercises to restore the full range of motion. If these conservative measures fail then surgery may be indicated to release the adhesions and restore range of movement.

It is important to avoid total disuse of the affected arm. This can lead to muscle wasting in the forearm and hand. This means that once the Frozen Shoulder pain resolves there will be a good level of function in the hand.

I have been totally involved at every stage of my assessment , treatment and rehabilitation. I have felt in control – a must for an athlete!
Steve Williams OBE Double Olympic Champion Mens Coxless Four

How can physiotherapy help?

After a thorough assessment we’ll prioritise the joints, nerves, muscles, ligaments that are contributing to your problem. This may be with hands-on treatment such as manipulation and mobilisation. This will always be combined with an exercise programme for you to carry out at home along with advice on subjects such as posture.

You will also be shown the best ways to prevent recurrence and given a programme which is tailored to your needs.

After conducting a thorough assessment, treatment may involve one or more of the following:

  • a specific exercise programme
  • an explanation as to how the pain can be managed
  • alternative therapies (e.g. acupuncture / pilates)
  • we will explain and demonstrate how you can contribute to your own recovery and prevent the problem from recurring.
  • manual therapy

Research clearly shows that physical activity and exercise will help recovery. One of our physiotherapists can provide an exercise programme based on your health, ability and fitness levels.

Body Movement Screen and Personalised programme

"It's like an MOT for your body"

We can offer you a full movement screen that analyses the way you move highlighting areas where you will benefit most from specific conditioning.

If you have a recurrent / long term problem, why not consider a body screen

Find out more about the Body MOT


30 minutes


45 minutes
(recommended 1st session)


60 minutes


30 minutes


45 minutes
(recommended 1st session)


60 minutes


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