Shoulder pain: frozen shoulder, impingement and getting back to movement
The shoulder is the most mobile joint in the human body – and that is exactly why it is prone to problems. It hurts when getting dressed, when lifting your arm overhead or at night when you lie on it. Here are the most common causes of shoulder pain and how physiotherapy works with them.
Most common causes of shoulder pain
Impingement (painful arc syndrome)
The rotator cuff tendons get pinched in the narrow space under the acromion when you lift your arm. Typical is pain when raising the arm to the side roughly between 60° and 120°. It is often linked to posture, rounded shoulders and poor coordination of the muscles around the shoulder blade.
Frozen shoulder (adhesive capsulitis)
The shoulder joint capsule becomes inflamed, shrinks and thickens. At first the shoulder is very painful, then it gradually stiffens and movement in all directions is restricted – it is not just pain, the shoulder genuinely will not move. The condition goes through stages and lasts months, but therapy can ease its course and help restore mobility.
Tendon overload and injury
Repeated overhead movements (painting a ceiling, swimming, tennis, volleyball) or sudden overload can lead to inflammation or a tear of the rotator cuff tendons.
Pain referred from the neck
Not every shoulder pain comes from the shoulder. It may originate in the neck – especially if it comes with tingling down the arm. That is why we always check the neck as part of the examination.
How to tell what is going on
| Symptom | May point to |
|---|---|
| pain when lifting the arm to the side, but movement is possible | impingement |
| stiff shoulder, movement restricted in all directions | frozen shoulder |
| pain after a fall, weakness, unable to lift the arm | tendon injury – see a doctor |
| pain with tingling into the fingers | neck origin |
The table is only a rough guide; the exact cause can only be established by an examination.
What to do (and not do) at home
- Do not stop using the shoulder completely. Total rest leads to more stiffness. Move within a pain-free range.
- Pendulum: lean forward, support yourself on a table with your good arm and let the painful arm hang loose. Gently swing it in small circles, 1–2 minutes.
- Shoulder blades back and down: several times a day, gently draw your shoulder blades together and down, hold 5 seconds.
- At night support the arm with a pillow if the shoulder wakes you up.
- Avoid strength exercises and overhead movements “through the pain”.
What shoulder therapy involves
After examining the shoulder, shoulder blade and neck, we choose an approach based on the cause:
- releasing overloaded muscles and soft tissues,
- mobilising the shoulder joint and shoulder blade,
- exercises for good coordination of the shoulder blade muscles and rotator cuff,
- kinesio taping,
- for pain and swelling we can add Rebox, which is also suitable for frozen shoulder.
Home exercise is an essential part – the shoulder needs regular, well-dosed movement.
How long until it improves
With impingement or overload, improvement usually comes within a few weeks of regular therapy and exercise. Frozen shoulder is a longer journey – months. Regular physiotherapy, however, helps preserve as much movement as possible and shorten the period of restriction.
See a doctor after any shoulder injury, with sudden weakness of the arm, significant swelling or deformity, and also if shoulder pain comes with chest pain or shortness of breath.
Frequently asked questions
Should I cool or heat my shoulder? Cool a freshly overloaded, painful shoulder; for long-term stiffness, heat usually helps more.
Will an injection help? A doctor decides about injections. Physiotherapy can be combined with them – the injection dulls the pain, exercise addresses shoulder function.
Is shoulder pain related to tennis elbow? Not directly, but both are often linked to overuse and poor coordination of the arm muscles. Read more about the elbow in our article on tennis elbow.
This article is for general information only and does not replace a medical examination or an individual consultation with a physiotherapist.