Shoulder pain — causes, fixes & when to see a physio

Not usually at first. Most shoulder problems are diagnosed clinically and respond to targeted rehab. We consider imaging if: symptoms don’t improve after a sensible period of good rehab (often 6–8+ weeks), there’s significant trauma (suspected fracture/dislocation), there are red flags (fever with redness/heat, unexplained weight loss), or there’s marked weakness after an injury suggesting a sizeable rotator‑cuff tear. Imaging supports decisions; it rarely replaces a good assessment.

Keep it moving within comfort. Short‑term adjustments are fine, but prolonged immobilisation can slow recovery. Use pendulums, supported wall slides, and gentle isometrics; for sleep, place a pillow under the arm or hug a cushion to reduce night pain. Avoid repeatedly forcing painful arcs overhead early on.

Timelines vary with the condition and irritability: impingement‑type/cuff overload often improves in 6–12 weeks; tendinopathy usually needs 8–12+ weeks of progressive loading; AC joint grade I–II sprains can settle in 2–8 weeks with the right progressions; frozen shoulder follows phases and may take 6–18+ months but improves over time. We’ll measure progress with function (reach, sleep, lifting) as well as pain.

Often yes, with modifications. Early on, pick pain‑tolerant ranges (e.g., incline press, neutral grip, elbows slightly in front of the body), reduce load, slow the tempo, and limit overhead work. Keep cardio and lower‑body training going. We’ll map a return‑to‑overhead pathway (e.g., landmine press → half‑kneeling press → light overhead press) when ready.

Sometimes considered for short‑term pain relief in subacromial pain or frozen shoulder. Injections are best used to enable rehab, not as a standalone fix. Options like hydrodilatation for frozen shoulder can be discussed with your GP/consultant where appropriate.

Often normal if it’s painless. Many shoulders click as tissues move; we focus on comfort and function. Painful catching with weakness after a trauma needs assessment; we’ll screen for cuff or labral injury.

After a fall or impact with deformity or inability to move the shoulder (suspected dislocation/fracture), if the shoulder is red/hot with fever, or if you develop new numbness/tingling/weakness in the arm or hand. Seek urgent medical advice.

Usually not. Many cuff tears (especially age‑related/degenerative) and impingement‑type pains improve without surgery. Referral is considered for large acute traumatic tears with persistent functional loss, recurrent instability that doesn’t respond to rehab, or specific labral injuries in overhead/throwing athletes.

On your back with a pillow under the arm, or on the opposite side hugging a pillow so the sore shoulder rests forward and supported. A small towel under the upper arm can reduce night pain. Try to keep the shoulder slightly away from end‑range while it calms.

Bring tasks closer to the body, use a step or lower shelf instead of frequent overhead reaching, share or split loads, and schedule micro‑breaks for gentle shoulder movement. At a desk, keep mouse/keyboard close, forearms supported, and vary positions through the day.

Posture/technique can influence symptoms, but capacity (strength/endurance) and training load matter more. We’ll fine‑tune technique where it helps and build the capacity to tolerate real‑life positions.

Short‑term taping or a soft support can improve confidence and sleep during a flare. We aim to wean supports as strength and control improve. Long‑term reliance is not the goal.

Simple function markers (e.g., pain‑free reach to cupboard, side‑lying sleep duration, press weight/reps, work tasks) plus symptom change. If progress stalls, we’ll adjust the plan or discuss onward options with your GP.