Shoulder Pain: Common Causes, Treatment and Exercises

Shoulder pain is extremely common and can significantly affect daily activities. Understanding the cause of your shoulder pain is the first step to effective treatment. This comprehensive guide covers common causes, treatment options, and exercises for shoulder pain relief.

Common causes of shoulder pain

Rotator cuff problems

Most common cause of shoulder pain

• Tendinopathy: Wear and tear of tendons
• Impingement: Pinching of tendons
• Tears: Partial or complete tendon tears
• Symptoms: Pain with overhead activities, weakness, night pain

Frozen shoulder

• Stiffness and pain
• Restricted movement in all directions
• Gradual onset
• Can last 1-3 years
• More common in diabetes

Arthritis

• Osteoarthritis or rheumatoid arthritis
• Pain with movement
• Stiffness
• Grinding or clicking
• Gradual worsening

Bursitis

• Inflammation of bursa (fluid sac)
• Pain on side of shoulder
• Worse with overhead activities
• Tender to touch

Referred pain

• From neck
• From heart (left shoulder)
• From gallbladder (right shoulder)
• Important to identify

When to seek urgent help

Red flags — see doctor immediately

• Sudden severe pain with breathlessness
• Pain after trauma with deformity
• Complete inability to move arm
• Numbness or weakness in arm
• Fever with shoulder pain

Self-assessment

Rotator cuff problems likely if

• Pain with overhead activities
• Painful arc (60-120 degrees)
• Night pain
• Weakness with certain movements
• Gradual onset

Frozen shoulder likely if

• Severe stiffness
• Cannot reach behind back
• Cannot lift arm fully
• Severe night pain initially
• Gradual onset over weeks

Initial management

First 48-72 hours

• Rest from aggravating activities
• Ice: 15-20 minutes, 3-4 times daily
• Pain relief: Paracetamol or ibuprofen
• Gentle movements within comfort
• Avoid complete rest

Beyond 72 hours

• Gradually increase movement
• Start gentle exercises
• Heat may help more than ice
• Continue pain relief as needed
• Modify activities, do not stop completely

Exercises for shoulder pain

Pendulum exercises

Good for: All shoulder pain, especially early stages

1. Lean forward, support with good arm
2. Let painful arm hang down
3. Gently swing arm in circles
4. 10 circles each direction
5. 3-4 times daily

Shoulder shrugs

1. Stand or sit upright
2. Lift shoulders towards ears
3. Hold 5 seconds
4. Relax down
5. 10 reps, 3 times daily

Shoulder blade squeezes

1. Sit or stand upright
2. Squeeze shoulder blades together
3. Hold 5 seconds
4. Relax
5. 10 reps, 3 times daily

Wall slides

1. Face wall, hands on wall
2. Slowly slide hands up wall
3. Go as high as comfortable
4. Slide back down
5. 10 reps, twice daily

External rotation

1. Elbow at side, bent 90 degrees
2. Hold resistance band or light weight
3. Rotate forearm outward
4. Keep elbow at side
5. 10-15 reps, twice daily

Internal rotation

1. Elbow at side, bent 90 degrees
2. Rotate forearm inward against resistance
3. 10-15 reps, twice daily

Stretches for shoulder pain

Cross-body stretch

1. Bring arm across body
2. Use other hand to pull gently
3. Hold 30 seconds
4. Repeat 3 times, twice daily

Doorway stretch

1. Stand in doorway
2. Hands on door frame
3. Lean forward gently
4. Feel stretch across chest
5. Hold 30 seconds
6. Repeat 3 times, twice daily

Towel stretch

1. Hold towel behind back
2. Good arm pulls painful arm up
3. Hold 30 seconds
4. Repeat 3 times, twice daily

Activity modification

Sleeping

• Avoid lying on painful shoulder
• Use pillows for support
• Try semi-reclined position
• Pillow under arm may help

Daily activities

• Avoid prolonged overhead work
• Take regular breaks
• Use step stool instead of reaching
• Modify lifting technique
• Keep loads close to body

Work ergonomics

• Adjust desk and chair height
• Keep keyboard and mouse close
• Avoid reaching repeatedly
• Take regular movement breaks

Treatment options

Physiotherapy

Joint Pain & Muscle Injury Treatment provides:

• Accurate diagnosis
• Personalized exercise programme
• Hands-on treatment
• Activity modification advice
• Progression guidance

Medication

• Paracetamol for pain
• NSAIDs (ibuprofen) for inflammation
• Topical gels
• Stronger painkillers if needed

Injections

• Corticosteroid injections
• Can provide temporary relief
• Allow engagement with physiotherapy
• Not a cure alone
• Discuss with GP or specialist

Surgery

• Usually last resort
• For severe tears or arthritis
• After failed conservative treatment
• Options: Repair, decompression, replacement

Recovery timeline

Acute pain (recent onset)

• Improvement within 2-6 weeks
• With appropriate treatment
• Consistent exercises crucial

Chronic pain (>3 months)

• Slower improvement
• May take 3-6 months
• Requires patience and persistence
• Professional guidance helpful

Frozen shoulder

• Freezing phase: 2-9 months
• Frozen phase: 4-12 months
• Thawing phase: 5-24 months
• Total: 1-3 years typically

Preventing shoulder pain

Posture

• Avoid slouching
• Keep shoulders back
• Chin tucked in
• Regular posture breaks

Strengthening

• Regular shoulder exercises
• Maintain rotator cuff strength
• Scapular stability work
• 2-3 times weekly

Activity modification

• Avoid repetitive overhead work
• Take regular breaks
• Use proper lifting technique
• Warm up before sports

When to seek professional help

Consider physiotherapy if:

• Pain not improving after 2 weeks
• Pain affecting sleep
• Difficulty with daily activities
• Weakness developing
• Stiffness increasing
• Unsure of diagnosis
• Want personalized treatment

The bottom line

Managing shoulder pain effectively requires:

• Accurate diagnosis
• Appropriate pain management
• Regular exercises
• Activity modification
• Patience with recovery
• Professional guidance when needed
• Addressing underlying causes

Most shoulder pain improves with conservative treatment. The key is starting exercises early, being consistent, and seeking professional help if not improving.

About the author

Lizzie Thornton is a specialist community physiotherapist with over 15 years of experience treating shoulder pain and musculoskeletal conditions. She is HCPC registered and a member of the Chartered Society of Physiotherapy. Lizzie provides home physiotherapy visits across Staffordshire Moorlands and Cheshire East.

View Lizzie's profile