Shoulder pain



Shoulder Pain can be an annoying nag on certain movements, or become excruciatingly painful, keeping you from sleeping, interfering with everyday chores, or affecting your work.

The position of pain is often on the front of the shoulder, but can literally be anywhere around the joint, it can feel superficial (near the surface) or deep inside the shoulder.

Classically, movements that aggravate are things like putting on or taking of jumpers or putting your coat on. Reaching up to top shelves in the kitchen can be painful, or any movement out to the side. You may only get the pain when you are in bed at night, it may not matter which side you sleep on, the bad shoulder still hurts!


So what can be done? Well the good news is that often even the most chronic (long term) conditions can be dramatically improved with the right treatment.

The first thing is to establish if there is any pathology present (pathology, in this context, means disease process such as arthritis, excessive wear, damage or growths).

Muscles and pain...

If you look in a medical book of shoulder pain you will find reference after reference to countless pathologies of the shoulder, but rarely will you find reference to the true cause of most shoulder pain – Muscles. More specifically Muscle imbalance. There are around 18 different muscles that relate to the shoulder. Any or all of these may need to be evaluated and treated. Every muscle works slightly differently, with all the other muscles, depending on the position of the arm.

The most important thing to remember is that it’s not just muscles. Muscle dysfunction can cause the most excruciating pain, or the most annoying, nagging pain. It can mimic just about every pathology described in medical textbooks, there is one major difference however; the muscle imbalance is a dysfunction which can be fixed, often very quickly. Pathology is damage or disease that needs rest, and possibly surgical repair.

The good news is that most shoulder pain is muscle dysfunction. Indeed most pathologies are a natural progression of muscle dysfunction! If muscles are pulling excessively on their attachments or causing the joint excess stress on certain movements the joint will tend to wear at a rate faster than the body can repair it leading to disease.see why do I hurt?

Complicated Pully system...

The shoulder, from a muscular point of view, is the most complicated joint in the body with around six muscles stabilising the shoulder blade so the arm can move on it, and another 12 muscles involved in moving the arm from the shoulder, the task of discovering which muscles are dysfunctional, and in which range of motion they are dysfunctional  is often difficult.

Again the good news is that I have become very proficient at doing this, and my success rate for helping shoulder symptoms to disappear is excellent.

Underlying factors...

Another important factor, as ever in physical therapy, is identifying underlying causative factors. Your shoulder may be painful but what led to the condition? Nothing is arbitrary about the human body; if you have the pain, there is a reason for it. In the case of your shoulder these causes may be related to a problem in your neck, and the nerves supplying the shoulder. The cause may be your occupational posture, the way you drive your car or the way you sleep. Sometimes it may be due to obscure dysfunction of other important muscles in your torso (body), or in your arm. Sometimes, rarely, even one of your internal organs can be responsible for your pain! All of these factors need to be identified and ideally treated or modified.

All in all, treating the painful human shoulder is much, much more than rubbing the painful area.


One more thing, even if it turns out that you have a pathology, this kind of work can still be very helpful, as improving the health of the surrounding tissues can help with any healing process the body is trying to implement in the area of pathology. Of course we will be liaising with your doctor should  this be the case, and treatment will only continue for as long as you feel the benefit of it.

Regarding treatment, in most cases I will be able to identify pathology in the first session and we will then discuss the merits of continuing treatment.

If there appears to be only muscle dysfunction (remember this is the most common reason for shoulder pain, no matter how intense or how long you’ve had it), then you should expect improvement with every treatment with most symptoms being gone within 3-6 sessions.
Back to: Treatable conditions