If you’ve had shoulder pain that just won’t go away, you may be at your wits’ end about how to help yourself. Is it better to move it or should you keep it still? We often see people at Sundial who started a series of exercises under their own steam by watching YouTube videos, only to make things worse. We are always happy to reassure them that most persistent shoulder pain isn’t serious. It will get better with a proper diagnosis and professional guidance, but the difficult bit is pinpointing exactly what is going wrong. That’s why a thorough assessment is necessary.
To help you get an understanding of the different causes of shoulder pain, we have outlined some of the most common conditions below, along with suggestions on how we would treat them. Here at Sundial, we can offer not only physiotherapy and chiropractic treatment, but also sports massage, low-level laser treatment and corticosteroid injections. That is because hands-on treatment from our physiotherapists or chiropractors is particularly helpful for painful shoulders, especially when the neck, upper back or ribs are involved. An injection can also be a useful – if temporary – window of relief from pain to get started on a strengthening exercise programme. We will always refer you to your GP or a specialist if that would be the most appropriate way to treat your particular issues.
Why shoulder pain is so common
The shoulder does a lot of work. It is the most mobile joint in your body, able to move through a very wide range in almost every direction. For that reason it has to be a complicated joint, which sits in a shallow socket. Its movements work with your collarbone, shoulder blade, ribcage and upper back and neck and all these areas can play a part in shoulder pain. A scan will not necessarily show you what’s happening within your shoulder to cause your pain. In fact, MRI results frequently pick up changes in the rotator cuff which the patient has not experienced as painful at all. These changes seem to occur as a natural part of ageing and do not necessarily cause any discomfort. It is therefore important to get a thorough examination to detect the root cause of your shoulder pain.
What the research says about recovery
A UK study in 2021 looked at two groups of patients with rotator cuff shoulder pain. One group received a single session of best-practice physiotherapy and the other received an intensive course of progressive exercises, with or without a steroid injection. The results showed that after 12 months, every person in the study had improved. This demonstrates that clear, targeted advice and a plan from a physiotherapist, even based on a single session, is more important than trying to do everything at once. Here are the options you’ll probably come across for tackling your shoulder pain. We’ve included the ones we do (and don’t) recommend.
- Manipulation and mobilisation. Shoulder pain is often associated with strain or injury in the neck, upper back and ribs. For this reason, manipulation and mobilisation of these areas can help you recover faster than exercise alone. A 2004 study found that treatment aimed at the spine and ribs (as well as the shoulder) alongside a home exercise plan produced optimum results in the quickest time. Our chiropractors and physiotherapists work alongside each other here at Sundial to provide the best combination of treatments for you.
- Injections. Corticosteroid injections, also available at Sundial, can help by reducing pain on a temporary basis. This enables you to move and exercise more comfortably, using the treatment plan given to you by your physio or chiropractor. Although a steroid injection can be part of your plan for recovery, it should not be relied on to provide long term solutions.
- Surgery. You may have thought about surgery to address your shoulder pain. However, it doesn’t necessarily offer better outcomes than the conservative care you can get from a physio or chiropractor. Studies that looked at the results of keyhole surgery on the shoulder found that results after 12 months were similar to physiotherapy. It makes sense to begin treatment for your shoulder pain with evidence-based conservative care.
Common causes of shoulder pain
Rotator cuff injury
This is the most common cause of shoulder pain. If you are an adult over 45 years old, you are most likely to experience pain related to your rotator cuff. This is a group of tendons which steer and steady the joint. As the shoulder has exceptional need of mobility, the ball of the upper arm sits against a shallow socket (imagine, for example, a golf ball set on top of a tee). With every movement, the tendons and muscles have to do a lot of work to hold the ball in its socket and even when you’re still, the muscles around your shoulder are unobtrusively working to hold your arm in place.
The cuff tendons pass through a narrow gap under the shoulder bone, which narrows whenever you raise your arm. Repeatedly reaching up and moving your arm (such as when cleaning windows, painting, etc.) can subject the tendons to pressure and irritation as they pass through this narrowed gap. They can get irritated and overloaded. That is when you may feel an ache on the outside of your shoulder, pain when you lift your arm and also pain at night. As parts of the tendons have a poor blood supply, they are slower to recover from irritation.
Most rotator cuff pain comes from this kind of irritation rather than a serious tear and will recover with sensible changes in activity and guided exercises. However, sudden pain and finding you can’t lift your arm after a fall or a “pop” sound means you should get it looked at promptly. Seek medical advice if you notice any of these signs:
- Difficulty lifting the arm after the pop, or a sudden drop in strength
- Visible deformity or a bulge in the upper arm
- Significant bruising or swelling
- The shoulder feeling unstable or slipping
Rotator Cuff exercises to try at home
1. Isometric external rotation
Set-up: Stand or sit with your elbow bent to 90° and tucked at your side (a small towel roll between the elbow and ribs helps). Put the back of your hand against a wall or door frame.
Dose: Press outward gently and hold 30 to 45 seconds x 5-10 reps, 1 to 2 times a day. If that is too long, hold for 10 seconds x 10 instead.
2. Isometric abduction
Set-up: Stand with your arm by your side, elbow straight or slightly bent, with the outside of your wrist against a wall.
Dose: Press sideways at about 30 to 50% effort and hold 30 to 45 seconds x 4 to 5 reps, 1 to 2 times a day.
3. Shoulder blade squeeze
Set-up: Sit or stand tall with your arms relaxed by your sides. Gently draw your shoulder blades back and down and squeeze your shoulder blades , without shrugging or arching your lower back.
Dose: Hold 10 seconds x 10 reps, 2 to 3 times a day.
Frozen shoulder
Frozen shoulder is caused by increasing stiffness in the joint, which is particularly noticeable when you rotate your arm outwards and move it upwards. Frozen shoulder can take over a year to get better (though this can vary) but it will improve more quickly with care. Typically, it occurs in three overlapping phases.
- Freezing
The first phase begins with inflammation in the lining of the shoulder (the synovial membrane) and the surrounding capsule, which is a tough bag protecting the joint. The outer surface of the capsule is made of collagen and its inner surface is the membrane which produces lubricating fluid for the joint. As the shoulder needs room to move and stretch, the whole capsule is formed with extra folds of tissue so that they can “unfold” when you raise your arm. - Frozen
As a frozen shoulder develops, these tissue pockets become inflamed and gradually thicken and tighten, so that the folds stick together in the form of scar tissue. This means there is less fluid to lubricate the joint and less available flexibility to move the shoulder. The irritation causes sharp, achy pain, especially at night. The stiffness is caused by the contraction of the capsule and the progression to the “frozen” phase is the result of this tightness. - Thawing
At this point, pain typically eases somewhat but movement remains limited. As the shoulder recovers, it enters the “thawing” phase, when movement begins to return. An assessment with a physiotherapist or chiropractor is the best way to get things on track for recovery.
Our physio Sakshi explains how she would recommend treating a frozen shoulder:
“Frozen shoulder usually moves through three phases (painful, stiff, then thawing) and can take a year or two to settle, but it is a recognised condition that does improve. We would start with a thorough assessment and clear explanation, then focus on calming pain with gentle, regular movement. As the shoulder loosens, a structured home programme, hands-on treatment, and gradual strengthening help you regain movement and return to everyday activities. If progress stalls after a few months, we can talk you through further options and refer you on if needed.”
Frozen shoulder exercises you can try at home
Gentle self-help is a good place to start. Keep the shoulder moving and avoid whatever makes it feel worse. Don’t push through pain but don’t stop using the arm altogether, because complete rest tends to leave shoulders stiffer and weaker. Change position often, and try not to hold your arm in one place for more than 30 to 45 minutes. Keep up activities you enjoy. Walking is an exercise that usually suits a sore shoulder, and many people find swimming comfortable once things settle, though you shouldn’t use any stroke that hurts. Heat or a warm shower can ease stiffness, and a cool pack can help if the shoulder feels hot and angry, so use whichever feels better. Your pharmacist or GP can advise on pain relief that suits you.
- Avoid heavy or awkward lifting above shoulder height while the shoulder is painful.
- Don’t sleep on the painful side or with the arm tucked under your pillow,
- Don’t repeat a movement that gives sharp, catching pain, and
- Don’t stretch aggressively into it.
- Discomfort is normal but sharp pain is telling you to ease off.
- In bed, lie on your back or your good side and hug a pillow so the sore arm is supported. If you work from home, bring the keyboard and mouse close, rest your forearms on the desk, keep your elbows near your sides and take a short movement break every half hour.
Three gentle movements are worth trying, stopping if any of them increases your pain for more than a short time or brings on pins and needles.
1. Pendulum swing
Lean forward with your good hand on a table, let the sore arm hang and sway it in small circles for 30 to 60 seconds.
2. Table slide
Sit with your hand on a towel on the table and slide your arm forward as if wiping the surface, then return, ten times.
3. Isometric hold
Stand with your elbow bent at your side and press the back of your hand lightly against a wall or door frame without moving the arm. Hold for 5 to 10 seconds and repeat five times.
Persistent pain is exhausting, and worry can turn up your sensitivity to it. Hurting doesn’t always mean harming, and most shoulders improve. Small steady steps are a better, healthier approach to recovery than trying for all-or-nothing. Just keep doing what you enjoy in a modified form.
When to be careful
Most shoulder pain comes from muscles, tendons, joints or nerves. Occasionally it points to something else, so read this before trying anything at home.
Call 999 or go to A&E if shoulder or arm pain comes with chest pain or pressure, breathlessness, sweating, nausea or pain spreading into the jaw, because it can be a heart problem. The same goes for sudden weakness in the arm, a drooping face or difficulty speaking, or a bad fall after which the shoulder looks out of shape or you can’t move your arm.
Contact your GP or NHS 111 promptly if the shoulder is hot, red and swollen, particularly with a fever. Do the same if the pain is constant, getting worse and eased by no position at all, or wakes you every night. Unexplained weight loss, night sweats or a history of cancer with new persistent pain also need checking, as does a lump, or numbness, pins and needles or weakness spreading into your arm or hand. If you suddenly can’t lift your arm after a pop or a tear, get it looked at within days.
If none of that applies, you’re most likely dealing with a common shoulder problem, and the best thing you can do is make an appointment to see a physio or chiropractor. You can book online here.
Frequently asked questions
Should I see a physio or a chiropractor for shoulder pain?
Either can assess it properly. The best choice depends on what’s going on, and many people do well with a joined-up approach. At a multidisciplinary clinic like Sundial you can be assessed once and guided to the most suitable option.
Do I need an injection for my shoulder?
Not always. Injections can give short-term relief for some shoulder problems and often work best combined with exercise. An assessment helps you decide whether it’s worth raising with your GP or a specialist.
Can a chiropractor help with shoulder pain?
For some people, yes, particularly when the neck, upper back or ribs are contributing. Research on manual therapy suggests it can help some people recover faster when it’s added to usual care.
How long does frozen shoulder last?
Often between one and three years, though pain frequently eases before full movement returns. Early advice makes the journey more manageable.
Is shoulder pain a sign of a heart problem?
Rarely, but it can be. Shoulder or arm pain with chest pain, breathlessness, sweating or nausea needs urgent help. Call 999.
Will I need a scan?
Often not. Scans show changes that are common in people without pain, so they’re usually kept for specific situations. We’ll tell you if we think one would help.
Should I rest my shoulder?
A short spell of relative rest during a flare is fine, but complete rest tends to leave shoulders stiffer. Gentle, regular movement within comfort is usually better.
Can I book without a GP referral?
Yes. Book directly with us, and we’ll say if we think you should see your GP as well.
Is there a physio in Brighton that can do more than exercises?
Physiotherapy often includes hands-on techniques, exercise, education and guidance on referral. At Sundial the team also includes chiropractors and massage therapists, so you can access more than one approach in one place.
References
Hopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet. 2021;398(10298):416-428.
Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020;396(10256):977-989.
Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581.
Bergman GJD, Winters JC, Groenier KH, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med. 2004;141(6):432-439.
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767.
Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-338.
Paavola M, Malmivaara A, Taimela S, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ. 2018;362:k2860.
About Matthew Bennett, Chiropractor Brighton
Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton.