Shoulder pain can be frustrating—whether it’s a dull ache while reaching overhead, stiffness that limits daily activities, or discomfort that seems to appear without injury. The good news? For most non-traumatic shoulder pain, physiotherapy is not only effective, it’s often the best place to start.
Understanding Your Shoulder Pain: Not all pain is the same
Non-traumatic shoulder pain can have many causes, and identifying the driver is key. Here’s a breakdown of common conditions:
- Rotator Cuff-Related Shoulder Pain: Often linked to tendinopathy or small tears. Pain usually worsens with lifting or reaching.
- Sub-Acromial Impingement & Bursitis: Irritation of the tendons or bursa (a small fluid-filled sac) under the acromion can cause pain with lifting the arm, especially overhead.
- Shoulder Instability: When the shoulder joint is excessively loose, either from previous dislocations or general ligament laxity, it can create pain, weakness, or a sense of “giving way.”
- Frozen Shoulder (Adhesive Capsulitis): Characterised by progressive stiffness and pain, often without a clear cause. More common in women over 40, especially with risk factors such as diabetes, thyroid dysfunction and hormonal changes associated with menopause.
- Shoulder Osteoarthritis: Degeneration of joint cartilage, leading to pain, stiffness, and sometimes a grinding sensation.
- Calcific Tendinitis: Calcium deposits in the rotator cuff tendons can cause intense, sudden pain, particularly when inflamed.
- Referred Pain from the Neck: Cervical spine issues like disc degeneration can refer pain to the shoulder, often accompanied by neck stiffness or tingling down the arm.
A skilled physiotherapist is trained to assess and differentiate between these causes, ensuring you receive the right care and are fast on the road to recovery.
What Does the Research Say About Treatment?
Rotator Cuff Tears: Surgery or Physio?
For many people with non-traumatic rotator cuff tears, physiotherapy provides outcomes comparable to surgery with respect to reduction and pain and improvement in function at 2 year follow up. Non-surgical management is therefore recommended as the primary choice for rotator cuff dysfunction.
Should You Worry About Your MRI or X-ray?
Many people worry when imaging shows rotator cuff tears, arthritis, or tendon issue - but did you know?: these findings are common even in people without pain. A landmark 2014 study found that up to 65% of asymptomatic adults had rotator cuff abnormalities on imaging. That means imaging alone doesn’t tell the whole story - your symptoms and movement matter more.
Exercise for Mechanical Shoulder Pain
For conditions like impingement, bursitis, and instability, research consistently shows that structured exercise programs can reduce pain and improve function and are superior to passive treatments.
Why Physiotherapy Is A Great First Step
• Accurate Diagnosis: A physiotherapist can identify the driver of your pain and rule out more serious issues.
• Personalised Treatment: You’ll receive a treatment plan tailored to your condition, lifestyle, and goals.
• Avoid Unnecessary Surgery or Imaging: Starting with physiotherapy often reduces the need for costly scans or surgery.
• Empowerment and Recovery: Learn strategies to manage your pain and restore function naturally.
Bottom Line
If you're dealing with non-traumatic shoulder pain, you don’t need to wait for a scan or a surgical consult. A physiotherapy assessment is the safest, most effective, and evidence-based place to start. Most shoulder issues respond well to conservative care, and early intervention often means faster recovery.
References Cederqvist S, et al. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2 year follow up after initial rehabilitation. Ann Rheum Dis 2021;80:796–802 Yamamoto A, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J shoulder Elbow Surg 2020 Jan 19(1): 116-20 Littlewood C, et al. Exercise for rotator cuff tendinopathy: a systematic review. Br J Sports Med. 2015 49(4):289-292. Kuhn J. Exercise in the treatment of rotator cuff impingement: a systematic review and synthesized evidence-based rehabilitation protocol. J shoulder Elbow Surg 2009 Feb 18(1):138-60. Griffin J et al. A systematic review to compare physiotherapy programmes for atraumatic shoulder instability. Shoulder and Elbow 2023 Feb 15(4).
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