Shoulder pain is one of the most common musculoskeletal complaints in the adult population and can affect simple activities such as putting on a coat, reaching for an object or sleeping on the affected side.
Although common, it does not always mean a serious structural injury. Pain is a complex experience, influenced by biological, psychological and social factors.
Why does the shoulder hurt?
The shoulder has great mobility and depends on coordination between various structures. The most common causes include pain related to the rotator cuff, repetitive strain and changes in scapular control.
It is important to note that structural changes, such as partial tears of the rotator cuff, are often found in people without pain, especially with advancing age. Thus, the presence of changes in the image does not, by itself, explain the symptoms.
Why does the pain persist?
Persistent pain may be associated with:
- maintaining excessive loads
- reduced movement due to fear
- lack of strength and control
- psychosocial factors, such as fear or catastrophising
Current evidence recommends an active approach, focused on gradual progression of load and recovery of function.
How can physiotherapy help?
The intervention begins with a detailed clinical assessment, including analysis of movement, strength, control, and functional pattern.
The approach is based on:
Education
Understanding pain reduces fear and increases confidence.
Progressive therapeutic exercise
Exercise is considered a first-line intervention for rotator cuff-related pain.
Load management
Temporarily adjusting activities without eliminating movement.
Individualised follow-up
Each plan is tailored to the patient's reality.
Conclusion
Shoulder pain is common, but it should rarely be considered irreversible. With proper assessment and evidence-based intervention, it is possible to recover function, reduce pain, and restore confidence in movement.
At Physioclem, we care for the shoulder, and the person, in an integrated, responsible, and science-based manner.
References
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982. doi:10.1097/j.pain.0000000000001939.
Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of rotator cuff tear prevalence in asymptomatic individuals. J Shoulder Elbow Surg. 2014;23(5):e91–e100. doi:10.1016/j.jse.2013.10.001.
Martinez-Calderon J, Zamora-Campos C, Navarro-Ledesma S, Luque-Suarez A. The role of psychological factors in patients with rotator cuff–related shoulder pain: a systematic review. British Journal of Sports Medicine. 2018;52(22):1452–1459. doi:10.1136/bjsports-2017-098325.
Littlewood C, Bateman M, Clark D, Selfe J, Watkins R, et al. Rehabilitation for rotator cuff–related shoulder pain: a systematic review. Br J Sports Med. 2020;54(11):641–650. doi:10.1136/bjsports-2019-101229.
