Shoulder Pain

Shoulder pain can affect reaching, lifting, dressing, sleeping, working, exercising and many other everyday activities. Symptoms may begin after an injury or develop gradually without one obvious cause.

At Core Physio, your physiotherapist will consider how the problem began, which movements affect it and what you need your arm to do. The assessment will also explore whether symptoms extend towards the neck, upper back or arm.

Treatment is personalised around your symptoms, current abilities and goals. Depending on the assessment, your plan may include movement exercises, progressive strengthening, activity advice and hands-on physiotherapy where appropriate.

Understanding Shoulder Pain

The shoulder is a highly mobile area formed by several joints working together with muscles, tendons, ligaments and surrounding soft tissues.

The main shoulder joint is a ball-and-socket joint between the upper arm and shoulder blade. Movement also depends on the collarbone, shoulder blade, upper back and the muscles that control the arm.

Symptoms may be felt:

At the front of the shoulder
Along the outside of the upper arm
Across the top of the shoulder
Around the shoulder blade
Deep within the joint
Alongside neck or upper-back discomfort
During particular reaching or lifting movements

The location of discomfort can provide useful information, but it does not always identify one specific structure as the cause.

An individual assessment considers the complete presentation, including movement, strength, previous injuries, general health and the activities that influence your symptoms.

Common Symptoms

Shoulder problems can affect people in different ways. You may experience:

Aching around the shoulder or upper arm
Sharp discomfort during a particular movement
Difficulty raising the arm
Pain while reaching behind your back
Stiffness after rest
Discomfort when lying on the affected side
Pain during lifting, pushing or pulling
Weakness or fatigue through the arm
Clicking, catching or grinding sensations
Reduced confidence using the arm normally

Symptoms may change according to the position of the arm and the amount of activity completed. For example, work at waist height may feel comfortable while reaching overhead increases discomfort.

A physiotherapy assessment can help determine whether rehabilitation is appropriate and which findings are most relevant to your treatment.

What Can Cause Shoulder Pain?

There are many possible causes. Some problems follow an identifiable injury, while others develop gradually as activity, work or exercise changes.

Possible contributing factors include:

A fall, collision or sporting injury
Lifting or catching a heavy object
A rapid increase in exercise or training
Repeated reaching or overhead activity
A physically demanding occupation
Reduced strength or physical capacity
A previous shoulder injury or dislocation
Age-related changes within muscles, tendons or joints
Prolonged reduction in normal shoulder movement
Medical conditions affecting muscles or joints

Symptoms may also originate from the neck or another part of the body. Therefore, treatment should not be based solely on where the discomfort is felt.

Your physiotherapist will assess whether the presentation appears suitable for routine musculoskeletal rehabilitation or requires medical or specialist investigation.

When May Physiotherapy Help?

Physiotherapy may be appropriate when pain, stiffness, weakness or restricted movement begins to interfere with everyday activity.

Consider arranging an assessment when:

Symptoms are not improving as expected
The problem repeatedly returns
You are uncertain which activities remain appropriate
Reaching or lifting has become difficult
You have lost movement or strength
Sleep is repeatedly disturbed
You are struggling with work-related tasks
Pain is preventing exercise or sport
You are recovering after an injury
You need a structured rehabilitation programme

You do not need to know the precise diagnosis before booking. Establishing the likely nature of the problem and deciding on suitable next steps form part of your initial assessment.

Your Initial Physiotherapy Assessment

Your first appointment begins with a detailed discussion about your symptoms, how they developed and the effect they have on your daily life.

During the consultation, your physiotherapist may ask:

When the problem began
Whether there was a specific injury
Where you feel pain or discomfort
Which movements increase or reduce the symptoms
Whether the pain extends into your arm or neck
Whether you experience weakness, numbness or tingling
How the problem affects sleep and daily activity
What your work involves
Which exercise or sport you normally complete
Whether you have previously injured or dislocated the shoulder
What treatment or investigations you have already received
What you would like to return to doing

Bring any relevant scan reports, consultant letters or other medical information to your appointment.

Your Physical Assessment

The examination will be adapted to your symptoms and current abilities.

Your physiotherapist may assess:

How far you can comfortably raise the arm
Movement when reaching behind your head or back
Shoulder and arm strength
Movement of the shoulder blade
Neck and upper-back movement
Sensation and reflexes where appropriate
Muscular sensitivity around the shoulder
Lifting, pushing or pulling movements
Tasks connected to your work or exercise

Specific clinical tests may also be used when instability, a tendon injury or another particular problem needs to be considered.

You will not necessarily require every test. The examination should focus on findings that are relevant to your symptoms and likely to influence treatment.

Your physiotherapist will explain what the assessment suggests and discuss whether rehabilitation can begin or whether another healthcare professional should be involved.

Your Shoulder Rehabilitation Plan

Treatment will be based on the assessment rather than following the same exercise sheet for every person.

Your plan may include:

Education about the likely nature of the problem
Advice for managing a painful flare-up
Guidance for remaining appropriately active
Exercises to restore comfortable movement
Progressive shoulder strengthening
Shoulder-blade and upper-back exercises
Practice of reaching, lifting or carrying
Hands-on physiotherapy where appropriate
Temporary modification of aggravating activities
A gradual return to work, exercise or sport

The programme should develop as your movement, strength and physical confidence improve.

Progress will not be judged only by a pain score. Your physiotherapist will also consider whether you can dress, sleep, reach, lift, work or exercise more comfortably.

Exercises for Shoulder Pain

Exercise is often an important part of rehabilitation because it can improve movement, muscular strength and tolerance for physical activity.

Early exercises may focus on:

Comfortable arm movement
Gentle assisted reaching
Shoulder-blade movement
Low-resistance muscular exercises
Maintaining movement through the elbow and hand
Regaining confidence using the arm

As your abilities improve, rehabilitation may progress towards:

Resistance-band or weight exercises
Pushing and pulling movements
Reaching overhead
Lifting and carrying
Weight-bearing through the arm
Faster or more demanding movements
Work-specific or sport-specific exercises

There is no single exercise that is best for every shoulder problem. The appropriate starting point and rate of progression depend on your symptoms, diagnosis and goals.

How Much Discomfort Is Acceptable During Exercise?

Rehabilitation does not always need to be completely pain-free. A small and manageable increase in familiar discomfort may occur when movement or strengthening is introduced.

However, an exercise should be reviewed when it causes:

Severe or sharp pain
A significant loss of movement
New numbness or tingling
Increasing weakness
Marked swelling
Symptoms that continue to worsen after exercise
A reaction that does not settle as expected

Your physiotherapist can adjust the range, resistance, frequency or type of exercise according to your response.

Remaining Active During Recovery

A painful shoulder can make avoiding arm movement feel like the safest option. Short periods of reduced activity may occasionally be appropriate after an injury or severe flare-up, but stopping all movement can contribute to stiffness and loss of strength.

Where it is safe, you may be advised to:

Continue comfortable everyday movement
Use the arm for manageable tasks
Change position regularly
Temporarily reduce particularly aggravating activity
Keep the elbow, wrist and hand moving
Gradually rebuild your normal routine

Your physiotherapist can help you identify an appropriate starting level rather than repeatedly alternating between complete rest and doing too much at once.

Rotator Cuff-Related Shoulder Pain

The rotator cuff is a group of muscles and tendons that help move and support the shoulder.

Rotator cuff-related symptoms are commonly felt around the outer shoulder or upper arm. Discomfort may increase when lifting the arm, reaching overhead or lying on the affected side.

You may also have heard terms such as:

Shoulder impingement
Rotator cuff tendinopathy
Shoulder bursitis
Supraspinatus tendinopathy
Subacromial pain

These terms may describe overlapping presentations rather than entirely separate conditions.

Several factors can influence symptoms, including:

A recent increase in lifting or exercise
Repeated overhead activity
Reduced shoulder strength
Changes in tendon capacity
Previous injury
The demands placed on the arm

Rehabilitation commonly involves gradually strengthening the shoulder and rebuilding tolerance for reaching, lifting and other relevant activities.

Rotator Cuff Tears

A rotator cuff tear can develop gradually or follow an injury. The significance of a tear depends on its size, how it occurred and the effect it has on strength and function.

Possible symptoms include:

Pain when raising the arm
Weakness during lifting
Difficulty reaching overhead
Night-time discomfort
Reduced confidence using the arm

Changes involving the rotator cuff can also appear on scans in people without severe symptoms. Imaging findings therefore need to be considered alongside your history, physical assessment and functional difficulties.

Many stable presentations can initially be managed with progressive rehabilitation. However, sudden loss of strength following an injury requires prompt assessment because specialist investigation may be needed.

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, causes pain and progressive restriction of shoulder movement.

People commonly experience:

Pain that may be worse at night
Difficulty raising the arm
Reduced ability to reach behind the back
Problems dressing or washing
Stiffness affecting most shoulder movements
Difficulty lying on the affected side

The condition often develops gradually and may remain present for many months. Movement and symptoms can change through painful, stiff and recovery phases.

Frozen shoulder is more common in people with diabetes and can also develop after surgery or an injury that limits normal arm movement.

Physiotherapy may include advice, appropriately paced movement and exercises selected according to the current stage and level of irritability.

Forceful stretching is not automatically better. Exercises should be adjusted when they cause a significant or prolonged increase in symptoms.

Shoulder Instability

Shoulder instability describes excessive movement or reduced control of the joint. It may develop after a dislocation, repeated sporting activity or because the joint is naturally more mobile.

You may experience:

A feeling that the joint may slip or move out of place
Apprehension during particular arm positions
Repeated subluxations or dislocations
Clicking or clunking
Weakness or reduced control
Difficulty returning to overhead or contact sport

Rehabilitation may focus on muscular strength, shoulder-blade control, coordination and gradual exposure to the positions that currently feel unreliable.

A suspected first-time dislocation or a shoulder that remains visibly out of position requires urgent medical treatment. Do not attempt to force the joint back into place yourself.

Shoulder Pain After a Dislocation

Rehabilitation after a dislocation depends on the injury, your age, activity goals and whether other structures were affected.

Physiotherapy may progress through:

Restoring comfortable movement
Developing rotator cuff strength
Improving shoulder-blade control
Building confidence in vulnerable positions
Preparing for lifting or overhead activity
Returning gradually to sport

Repeated instability or further dislocations may require specialist shoulder assessment in addition to physiotherapy.

Acromioclavicular Joint Pain

The acromioclavicular joint sits at the top of the shoulder where the collarbone meets the shoulder blade.

Symptoms may be felt directly over the top of the shoulder and can increase during:

Reaching across the body
Pressing movements
Sleeping on the affected side
Carrying bags or equipment
Contact sport

Problems may develop gradually or follow a fall directly onto the shoulder.

Significant pain, deformity or swelling after an injury requires prompt assessment to determine whether an X-ray or specialist treatment is needed.

Shoulder Osteoarthritis

Osteoarthritis can affect the shoulder joint and may cause pain, stiffness and difficulty completing everyday activities.

Symptoms may include:

Reduced shoulder movement
Pain during reaching or lifting
Stiffness after rest
Grinding or creaking sensations
Difficulty dressing or washing
Loss of strength through the arm

Management may include appropriate movement, strengthening, activity advice and discussion of pain-management options.

When symptoms remain severe despite conservative care, your GP or physiotherapist may recommend specialist assessment.

Shoulder Pain and the Neck

Shoulder and neck symptoms can overlap. Pain originating from the neck may sometimes be felt around the shoulder blade, upper arm or hand.

Features suggesting that the neck or a nerve may be involved include:

Pain extending below the elbow
Pins and needles
Numbness or altered sensation
Weakness through the arm or hand
Symptoms affected by neck movement
Pain around the shoulder blade without clear shoulder restriction

Your physiotherapist may assess both the shoulder and neck before deciding which area should be the primary focus of treatment.

Increasing weakness, widespread altered sensation or problems with coordination require appropriate medical assessment.

Shoulder Pain at Night

Shoulder symptoms can disturb sleep, particularly when lying on the affected side.

Practical measures may include:

Sleeping on the opposite side
Supporting the affected arm with a pillow
Placing a pillow behind your back to limit rolling
Finding a comfortable position when sleeping on your back
Following appropriate pain-management advice

There is no single sleeping position that suits everyone. The aim is to find an arrangement that reduces pressure and allows the arm to rest comfortably.

Persistent night pain accompanied by unexplained illness, weight loss or rapidly worsening symptoms requires medical advice.

Shoulder Pain at Work

Symptoms can affect people in both desk-based and physically demanding occupations.

Your role may involve:

Working with the arms raised
Lifting and carrying
Pushing or pulling
Repeated reaching
Operating tools or machinery
Prolonged computer work
Driving
Supporting weight through the arms

Your physiotherapist can consider the actual demands of your job and help you build tolerance for the movements involved.

This may include temporary modification of particular duties, progressive strengthening and gradual exposure to more demanding work tasks.

Desk Work and Shoulder Symptoms

Desk work does not automatically damage the shoulder. Nevertheless, remaining in one position for an extended period can become uncomfortable.

Practical strategies may include:

Supporting the forearms where comfortable
Positioning frequently used items within easy reach
Changing sitting position during the day
Taking brief movement breaks
Alternating between different tasks
Continuing regular physical activity

The aim is not to maintain one perfect posture. Movement, variation and physical capacity are generally more practical than attempting to remain completely still.

Returning to the Gym

Reduced pain does not always mean that the shoulder is immediately ready for full resistance training.

Rehabilitation may need to restore:

Comfortable movement
Rotator cuff strength
Shoulder-blade control
Pushing and pulling capacity
Overhead strength
Tolerance for repeated lifting
Confidence under greater resistance

Exercises can progress from lighter and more controlled movements towards heavier or more complex training as your abilities improve.

The programme should reflect the exercises you want to resume rather than stopping permanently at basic rehabilitation.

Returning to Sport

Sporting demands differ considerably. A swimmer, tennis player, rugby player and recreational runner will not require identical shoulder rehabilitation.

Depending on your activity, the programme may progress towards:

Repeated overhead movement
Throwing
Serving or striking
Supporting body weight through the arms
Absorbing contact
Fast or reactive arm movements
Strength under fatigue
Sport-specific drills

A gradual return helps bridge the gap between basic strengthening and the actual speed, load and repetition required by your sport.

Hands-On Physiotherapy

Hands-on treatment may be included when your physiotherapist believes it can support movement or symptom management.

Techniques may include:

Joint mobilisation
Soft-tissue treatment
Massage techniques
Guided shoulder movement
Upper-back mobilisation

Manual treatment is not essential for every shoulder problem. Furthermore, it cannot independently rebuild strength or prepare the arm for demanding activity.

Where hands-on physiotherapy is used, it should complement exercise, education and active rehabilitation rather than replace them.

Injections and Other Treatments

Some shoulder conditions may be treated with medication or an injection alongside rehabilitation.

An injection may occasionally help reduce symptoms sufficiently for movement and exercise to become more manageable. However, suitability depends on the suspected condition, your health and the potential benefits and risks.

Your physiotherapist may recommend discussing medication, injection treatment or further investigation with your GP or an appropriate specialist.

An injection should not automatically replace the rehabilitation required to restore movement, strength and physical capacity.

Do I Need an X-Ray, Ultrasound or MRI?

Not every shoulder problem requires a scan before physiotherapy can begin.

Imaging can identify structural changes, but these do not always explain the severity of someone’s symptoms or physical limitations.

An investigation may be considered when:

A fracture or dislocation is suspected
There has been a significant injury
You have experienced sudden loss of strength
A serious underlying condition is suspected
The result is likely to change treatment
Specialist or surgical assessment is being considered
Progress is different from what would normally be expected

Your physiotherapist can explain whether rehabilitation appears appropriate or whether medical investigation should be requested.

Managing a Flare-Up

A temporary increase in symptoms does not necessarily mean that new damage has occurred.

Flare-ups may follow:

An unusual lifting task
A rapid increase in exercise
Repeated reaching or overhead work
Reduced sleep or recovery
Illness or general fatigue
A change in work demands

During a flare-up, it may help to:

Reduce particularly aggravating activity temporarily
Continue comfortable movement where possible
Use exercises previously recommended for you
Avoid repeatedly testing the most painful movement
Break larger tasks into manageable stages
Return gradually to your normal routine
Seek advice when symptoms are unusual or worsening

Your physiotherapist can help you develop a practical plan for future episodes without becoming unnecessarily inactive.

When Should I Seek Urgent Medical Advice?

Contact NHS 111 or request an urgent medical assessment when:

Pain begins suddenly and is very severe
You cannot move the arm
The shoulder or arm has changed shape
The area is badly swollen
Persistent pins and needles develop
There is no feeling in the arm or shoulder
The arm becomes unusually hot or cold
Symptoms began after a fall or accident
You develop severe pain in both shoulders
You feel feverish or generally unwell

These symptoms may indicate a fracture, dislocation, significant tendon injury, infection or another problem requiring prompt medical investigation.

Do not wait for a routine physiotherapy appointment when urgent symptoms are present.

When Is Emergency Assessment Required?

Call 999 or attend A&E following a serious accident, an obvious dislocation, loss of circulation or sensation in the arm, collapse or another potentially life-threatening emergency.

Shoulder or arm discomfort occurring with severe chest pain, difficulty breathing, sweating, faintness or sudden neurological symptoms also requires emergency medical attention.

Physiotherapy for Shoulder Pain at Core Physio

Core Physio provides personalised assessment and rehabilitation for shoulder pain, stiffness, weakness, rotator cuff-related symptoms, frozen shoulder and selected sports or exercise-related injuries.

Your programme may include education, movement exercises, progressive strengthening and hands-on physiotherapy according to your assessment.

Physiotherapy is available at our London Bridge clinic and East Dulwich clinic.

You can also explore our broader Physiotherapy service and the other Medical Conditions We Treat.

Frequently Asked Questions

Do I need a GP referral?

You can normally arrange private physiotherapy directly without first seeing your GP. Some private health insurers may require authorisation or a referral before agreeing to cover treatment.

Should I stop using my arm?

Complete rest is not normally recommended for uncomplicated symptoms. Comfortable movement can help preserve mobility, although particularly aggravating activities may need to be reduced temporarily.

Will I need a scan?

Not necessarily. Many shoulder problems can be assessed clinically. Imaging may be appropriate following significant injury, sudden strength loss or when the result is likely to change treatment.

Can physiotherapy help rotator cuff pain?

Physiotherapy may include progressive shoulder strengthening, movement exercises and guidance for returning to reaching, lifting, work or sport.

Can physiotherapy help frozen shoulder?

Physiotherapy can provide advice and exercises to help maintain or gradually restore movement. The programme should be adjusted according to the level of pain and stiffness.

Does clicking mean that my shoulder is damaged?

Clicking and other joint noises can occur without significant damage. Arrange an assessment when clicking is painful or accompanied by instability, weakness, locking or a recent injury.

Will I receive strengthening exercises?

Most rehabilitation programmes include progressive strengthening. The exercises will be selected according to your symptoms, abilities and the activities you want to resume.

Can I continue using the gym?

This depends on the problem and how your shoulder responds. Some exercises may continue normally, while particular loads or overhead movements may need to be modified temporarily.

Can I sleep on the painful shoulder?

You can use any position that remains comfortable. When lying on the affected side increases symptoms, supporting the arm with pillows or sleeping on the opposite side may help.

Does physiotherapy include massage?

Massage or other hands-on techniques may be used when appropriate. However, they are normally combined with exercise and active rehabilitation rather than provided as the only treatment.

How many appointments will I need?

The number varies according to the problem, how long it has been present, your goals and how you respond to rehabilitation. The recommended plan will be discussed after your assessment.

What should I wear?

Wear comfortable clothing that allows the shoulder, upper arm and shoulder blade to be assessed. A vest or loose-fitting top may be helpful.

When should I seek urgent help?

Seek urgent assessment for sudden severe pain, inability to move the arm, deformity, significant swelling, persistent pins and needles, loss of sensation or symptoms following an accident.