Shoulder pain – common causes and physiotherapy management

Shoulder pain is a common issue that can be caused by a variety of factors, such as injury, overuse, or degenerative conditions. 

Some of the common causes of shoulder pain are,

  • Sub acromial bursitis
  • Rotator cuff tendinitis
  • Bicipital tendinitis
  • Labral tear
  • Frozen shoulder

Subacromial Bursitis:

Subacromial bursitis is a condition in which the bursa (a small fluid-filled sac) located between the acromion (a bony prominence on the shoulder blade) and the rotator cuff (a group of muscles and tendons that attach the shoulder blade to the upper arm bone) becomes inflamed. This inflammation can cause pain and limited range of motion in the shoulder. Subacromial bursitis is often caused by repetitive overhead motions or injury, and can be treated with physical therapy, corticosteroid injections, and in some cases surgery.

Rotator cuff tendinitis:

Rotator cuff tendinitis is a condition characterized by inflammation of the tendons that attach the muscles of the shoulder blade (scapula) to the upper arm bone (humerus). Symptoms include pain and weakness in the shoulder, especially when lifting or rotating the arm. Treatment options include physical therapy, anti-inflammatory medication, and in some cases, surgery. Resting and avoiding activities that aggravate the shoulder, such as overhead reaching and lifting heavy weights, can also help alleviate symptoms.

Frozen shoulder:

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It typically occurs after an injury or surgery, and can also be associated with certain medical conditions such as diabetes. Symptoms usually develop gradually and may include difficulty moving the shoulder, a dull ache in the shoulder, and a gradual loss of range of motion. Treatment options include physical therapy, pain medication, and, in some cases, surgery.

Labral tear:

A labral tear is an injury to the labrum, a ring of cartilage that surrounds the socket of a ball-and-socket joint, such as the shoulder or hip. Symptoms of a labral tear include pain, stiffness, instability, and a popping or clicking sensation. The cause of a labral tear can be from repetitive motions, trauma, or degeneration. Treatment options include physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and surgery.


Bicipital tendinitis:

Bicipital tendinitis is an inflammation of the tendons that attach the biceps muscle to the shoulder bone. Symptoms include pain and tenderness in the front of the shoulder, weakness in the biceps muscle, and a crackling sensation when the shoulder is moved. The condition is usually caused by overuse or repetitive motions, and can be treated with rest, physical therapy, and medication. In some cases, a corticosteroid injection may be used to reduce inflammation. Surgery is rarely needed.

Here are some tips to prevent shoulder pain:

  1. Maintain good posture: Poor posture can put stress on your shoulders and lead to pain. Make sure you sit and stand up straight, with your shoulders back and down.

  2. Stretch regularly: Tight muscles can also contribute to shoulder pain. Incorporate shoulder stretches into your daily routine to keep your shoulder muscles flexible.

  3. Avoid repetitive movements: Repetitive motions, such as typing or playing sports, can cause shoulder pain. Take breaks often and stretch your shoulders during these activities.

  4. Use proper technique: If you are lifting weights or performing other activities that require arm movements, use proper form to avoid putting unnecessary stress on your shoulders.

  5. Warm up before exercise: Always warm up before any physical activity. This can help prevent injury and reduce the risk of shoulder pain.

  6. Avoid carrying heavy bags on one shoulder: Carrying a heavy bag on one shoulder can cause shoulder pain. Use a backpack or carry the weight evenly on both shoulders.
  7. Get enough rest: Lack of sleep and rest can lead to shoulder pain. Make sure to get enough sleep and rest your shoulders when needed.

  8. Seek medical attention if needed: If you experience persistent or severe shoulder pain, seek medical attention. A healthcare provider can help diagnose the underlying cause and provide appropriate treatment.

Physiotherapy Management:

Physiotherapy can be an effective non-surgical and non-pharmacological treatment for shoulder pain, as it can help to reduce inflammation, improve range of motion, and strengthen the muscles that support the shoulder joint.

We will do a thorough assessment to identify the underlying cause of your pain. There can be a single defining injury or a surgery or sometimes there can be multiple causative factors. Whatever the case may be, it is really important to understand the causative factors to be able to address the overall problem effectively.

We will review your relevant medical history and any test reports (MRI, CT scan, ultrasound, X-Ray) that you bring along. We may ask your family doctor to send your medical imaging results to us if you do not bring them.

We will then do a physical assessment of your shoulder through a variety of tests including strength, joint range of motion, muscle flexibility and movement patterns.

We will discuss our findings with you and then start your treatment. 

Our physiotherapy techniques to treat shoulder pain would include exercises to improve flexibility and range of motion and manual therapy techniques such as joint mobilization and soft tissue mobilization to reduce pain and improve movement. We will also use modalities such as Therapeutic Ultrasound, LASER, Dry Needling, and Shockwave Therapy to facilitate the healing process.

It is also important to address any underlying issues or contributing factors and would include ergonomic strategies to modify activities that cause repetitive strain and address poor posture, or muscle imbalances, in order to prevent the recurrence of the shoulder pain.

If you have shoulder pain, book an appointment today with one of our physiotherapists to help you get better and get back to doing things that you love.

This article was written with the help of and was vetted for accuracy by a Registered Physiotherapist before publishing. This article is not intended to replace any medical advice, if you have shoulder pain you are advised to consult your healthcare practitioner to arrive at a diagnosis and proper treatment plan. Thank you.

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