Physical therapy and exercise for shoulder pain. When it works, when it does not work – Caring Medical Florida (2022)

Ross Hauser, MD

The controversy over physical therapy for shoulder injuries as a means to prevent the need for surgery.

For many patients, physical therapy represents a treatment that they want to do and have high expectation that the treatment will help them avoid a shoulder arthroscopic surgery, rotator cuff surgery or shoulder replacement surgery. Therefore, when physical therapy fails them, these people are often very confused as to why they have progressively more pain and less function in their shoulder, elbow and arm. Clinicians, doctors, and therapists can be equally confused.

This is very typical of the patients we see. They have been to physical therapy for months and nothing seems to have improved their arm and shoulder function and pain. Many have explored online resources to which there many “Do these great shoulder exercises” articles and videos to strengthen their shoulder. These people have been told that exercise will lead to greater pain relief and an increase in mobility. So why is it not working for them, when physical therapy and exercise are so beneficial to so many others?

Physical therapy and exercise should be explored in many patients as a means to help improve function and alleviate pain. The challenges are selecting those patients that therapy will work best for and understanding which patients physical therapy will not work for and why the treatment will fail.

While there are many videos and articles on the best exercises for shoulder pain, very few deal with the reasons why physical therapy and exercise will fail and ultimately that patient will have to have a shoulder surgery.

Article Summary

  • Physical therapy and shoulder exercise, initially beneficial and helpful, has plateaued. Progressive shoulder degenerative problems have resumed.
  • Must the failure of physical therapy be a signal to your doctor that you must have a surgery?
  • Favorable exercise outcomes from a good exercise program. Just as good as rotator cuff surgery?
  • Exercise and physical therapy for subacromial pain syndrome.
  • The ligaments of the shoulder – Once these structures are stretched or loosened, no amount of exercise will strengthen the shoulder joint enough to permanently hold it in place.
  • Cortisone injections and physical therapy in the case of a frozen shoulder.
  • Prolotherapy Injections

Physical therapy and shoulder exercise, initially beneficial and helpful, has plateaued. Progressive shoulder degenerative problems have resumed.

Doctors at Bond University in Australia wrote in August 2022 in the journal Musculoskeletal science & practice (7) “Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain. Despite this, many fail to substantially improve with exercise-based treatment.”

A July 2022 (1) study from E.W. Sparrow Hospital and Michigan State University puts it this way: “The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies.”

Physical therapy and exercise for shoulder pain. When it works, when it does not work – Caring Medical Florida (1)

For some people, excited by initial success, they have now reached a point where their shoulder physical therapy itself has become painful and difficult to do. Their pain is also spreading and getting “deeper.” As their shoulders become more unstable, pain spreads into the neck, upper back, and down their arms.

(Video) Can exercise and stretching help joint instability? When is Prolotherapy needed? FAQs about exercise

In June 2022, doctors writing in the journal Clinical rehabilitation (3) sought to identify barriers and facilitators related to self-management from the perspectives of people with shoulder pain and clinicians involved in their care. In reviewing previously published research, study authors noted that from the perspective of patients, three central themes emerged in why patients did not follow through with their physical therapy:

  • First, support for self-management, patient knowledge of the program and how to perform it, the time required, access to equipment necessary to perform certain exercises, and patient digital literacy (the ability to get self-help information.
  • Second, Personal factors, including patient beliefs, patient expectations, patient motivation, pain, and therapeutic response; and
  • Third, external factors, including influence of the clinician and therapeutic approach.
  • One of the reasons your physical therapy may fail is the same reason your shoulder replacement may fail. Unusual muscle activity and imbalance.
  • For physical therapy to be effective, the tendons, which hold the muscle to the bone must be strong so that the muscle can get the resistance it needs to “work out.”

Generally people do not need a research study to tell them that their physical therapy and exercise program will not work for them if they do not know how to exercise on their own, they do not have the equipment necessary to successful perform training routines, they get discouraged, their clinician does not believe exercise will help them, and their pain is not improving.

Must the failure of physical therapy be a signal to your doctor that you must have a surgery?

Two of the main rationale for having physical therapy are, first, the patient may have a physically demanding line of work, are active in sports, or are the primary caregivers for an ailing family member or spouse. Physical therapy may hold the promise to helping these people avoid a surgery that they do not have the time, energy or desire for. Secondly, your doctor may not be able to recommend a surgery through your insurance until physical therapy has failed.

Favorable exercise outcomes from a good exercise program. Just as good as rotator cuff surgery?

This is not to say physical therapy for shoulder pain typically fails. Many people have very successful outomes. One stuyd sufggests that physical therapy and exercise are just as good as a surgery.

Doctors at Aarhus University Hospital in Denmark published August 2022 findings on the feasibility of progressive shoulder exercises for patients with glenohumeral osteoarthritis or rotator cuff tear disease. In this study (2) the team investigated whether 12 weeks of progressive shoulder exercises provided beneficial changes in shoulder function and range of motion.

  • Twenty patients were included.
  • Eighteen patients (11 women, 15 with osteoarthritis), mean age 70 years (range 57-80), performed 12 weeks of progressive shoulder exercises with one weekly physiotherapist-supervised and two weekly home-based sessions.
  • Feasibility (is this program designed well enough that patients are willing to adhere to this program) was measured by dropout rate, adverse events, pain, and ability to stay with the exercise program.

Results: Two patients dropped out and no adverse events were observed. Sixteen of the eighteen patients (89%) had a high adherence (more than 70%) to the physiotherapist-supervised sessions. Acceptable pain levels were reported; in 76% of all exercise sessions. Shoulder and disability function improved.

The researchers found among this group that progressive shoulder exercises are feasible, safe and may relieve shoulder pain, improve function and range of motion in patients with glenohumeral osteoarthritis or rotator cuff problems. The patient-experienced gains after progressive shoulder exercises seem clinically relevant and should be compared to arthroplasty surgery in a rotator cuff setting.

Physical therapy and exercise for shoulder pain. When it works, when it does not work – Caring Medical Florida (2)

One of the reasons your physical therapy may fail is the same reason your shoulder replacement may fail. Unusual muscle activity and imbalance.

When being prescribed physical therapy or an exercise program to strength the shoulder, you may have it explained to you that the exercises are to strengthen the Teres muscles, Supraspinatus muscle, Infraspinatus muscle, and Subscapularis muscle. More commonly these are the muscles of the rotator cuff. Further the the powerful deltoid muscles and the Trapezius and Rhomboid muscles of the upper back and the biceps and triceps of the arm will also be included.

The problem of failed physical therapy is the inability to increase muscle strength and function. A reason an ultimate shoulder replacement may fail is not because of the hardware, but rather your shoulder’s inability to hold the hardware in place and provide muscle strength to function your arm normally.

(Video) How To Fix Your Shoulder Pain! (Fort Myers FL)

The caption of the image reads: Shoulder joint instability causes more force pressure on the rotator cuff tendons. Rotator cuff tendons are designed to move the shoulder joint, not stabile it. This causes the tendons to degenerate and become weaker which makes them care easier. The rotator cuff tear is the symptom of shoulder joint instability, the underlying cause as why physical therapy does not help shoulder pain in many people.

Physical therapy and exercise for shoulder pain. When it works, when it does not work – Caring Medical Florida (3)

Cortisone injections and physical therapy in the case of a frozen shoulder

In December 2020 doctors at the University of Glasgow wrote in the JAMA network open from the Journal of the American Medical Association (8) about the positive effect cortisone injections could have on helping patients with Frozen Shoulder. In this study, the doctors recommend the use of cortisone injections in patients who developed frozen shoulder but who had symptoms of less than one year. They recommend an accompanying home exercise program with simple range of motion exercises and stretches.

This article focuses on why physical therapy may not have helped your shoulder pain or helped you avoid a shoulder arthroscopic procedure or eventual shoulder replacement. This article also discusses treatments that may help the shoulder physical therapy work better.

For physical therapy to be effective, the tendons, which hold the muscle to the bone must be strong so that the muscle can get the resistance it needs to “work out.”

For physical therapy to be effective, the tendons, which hold the muscle to the bone must be strong so that the muscle can get the resistance it needs to “work out.” If the tendons or ligaments are damaged, as depicted in the above illustration where a Supraspinatus tendon tear is depicted as well as a ligament tear, the resistance may be non-adequate or may even be non-existent. The muscle cannot build. In some instance there is an imbalance in the way shoulder muscles are strengthening and at the same time atrophying. This creates another incidence of shoulder instability

Let’s explore a June 2022 paper from researchers atNorthwestern University and the University of Pittsburgh published in the journal Clinical orthopaedics and related research.(4) Here is the introduction to that paper:

“When nonoperative measures do not alleviate the symptoms of glenohumeral osteoarthritis, patients with advanced osteoarthritis primarily are treated with anatomic total shoulder arthroplasty (total shoulder replacement). It is unknown why total shoulder replacements performed in patients with eccentric (or unusual) (asymmetric glenoid wear) compared with concentric (even or typical) (symmetric glenoid wear) deformities exhibit higher failure rates, despite surgical advances.”

In other words, there are two types of wear and tear. The first mentioned is an unusual or eccentric wear and tear that is wear away at the shoulder in uneven unexplainable patters. The second wear and tear type is the concentric or even wear and tear type of “bone on bone” developing patterns. So you have abnormal, unexplainable wear and tear and the regular typical wear and tear. A concern the researchers are pointing out is the unusual wear and tear patterns are also causing total shoulder replacements to fail. Returning to the research:

“Persistent disruption of the posterior (front) -to- (back) anterior rotator cuff force couple resulting from posterior rotator cuff intramuscular degeneration in patients with eccentric (unusual) deformities could impair external rotation strength and may contribute to eventual total shoulder replacement failure. Pain and intramuscular fat within the rotator cuff muscles may impact external rotation strength measures and are important to consider.”

In simplest terms the researchers are suggesting an imbalance of the muscles. In examining their study group, the researchers made these observations:

(Video) Overcoming Shoulder Pain & Stiffness Webinar with Jacob Connelly, MD

“Patients with eccentric (unusual muscle) deformities demonstrated higher variability in strength compared with patients with concentric (standard wear and tear) deformities. This increased variability suggests patients with potential subtypes of eccentric wear patterns . . . may compensate differently for underlying anatomic changes by adopting unique kinematic or muscle activation patterns.” In other words you are overcompensating and your muscles are strengthening and weakening in unusual ways that do not support the strength of the shoulder.

The researchers conclude: “Our findings highlight the importance of careful clinical evaluation of patients presenting with eccentric deformities because some may exhibit potentially detrimental strength deficits. Recognition of such strength deficits may allow for targeted rehabilitation.” Rehabilitation post-surgery and pre-surgery).

Exercise and physical therapy for subacromial pain syndrome

A July 2022 study on the effects of exercise on clinical pain and pain mechanisms in patients with subacromial pain syndrome comes to us from Aalborg University in Denmark, published in the European journal of pain. (6)

This study examined:

  • If 8-weeks of exercise could modulate clinical pain or temporal summation of pain (this is a condition where the same arm movement causes an increase in pain intensity, if you lifted your arm above your head, it hurts worse the more you do it), conditioned pain modulation (the patient was given a treatment to lessen the pain), and exercise-induced hypoalgesia (exercise decrease pain intensity) and
  • If any of these parameters could predict the effect of 8-weeks of exercise in patients with un this stuyd of 37 patients, ilateral subacromial pain syndrome.

In this study of 37 patients , the researchers findings suggested reduction in pain and improved sleep quality after 8-weeks of exercise. Furthermore, the results suggests that low pain intensity and high temporal summation of pain scores (indicative for pain sensitization) may predict a lack of pain improvement after exercise.

  • The reason for physical therapy and exercise not being successful in some subacromial pain syndrome is that the patient suffers from a greater sensisity to pain and they have a lower tolerance for pain.

The ligaments of the shoulder – Once these structures are stretched or loosened, no amount of exercise will strengthen the shoulder joint enough to permanently hold it in place.

Another reason that physical therapy may not be helpful is because the ligaments that hold the shoulder together are weakened and cannot provide the stability the joint needs to build strength. The ligaments, muscles and tendons all work together to stabilize the shoulder.

In the medical publication StatPearls (5) part of the National Center for Biotechnology Information internet library doctors offered this assessment of the problem of multidirectional instability in the shoulder.

“Multidirectional instability is characterized as an imbalance between shoulder mobility and stability. The glenoid, glenoid labrum complex, glenohumeral ligaments as well as the negative pressure (the pressure of the lubricating synovial fluid at the ball and socket of the shoulder joint) created within the (shoulder) joint, all play roles as static stabilizers. The rotator cuff, long head of the biceps, periscapular muscles as well as the deltoid muscle, are all dynamic stabilizers. The interplay between the static and dynamic stabilizers is responsible for overall stability. ultidirectional instability is recognized as a continuum in which the static and/or dynamic stabilizers are no longer sufficient to maintain the congruence (the basic function of a pain free) glenohumeral joint.”

Physical therapy and exercise for shoulder pain. When it works, when it does not work – Caring Medical Florida (4)

Prolotherapy Injections

As documented in Caring Medical publications: Shoulder ligaments are strong bands of connective tissue that connect bones to bones. To treat shoulder joint instability, the ligaments and shoulder capsular structures (muscles, labrum and tendons) must be strengthened. The main shoulder capsular structure involved in the stability of the shoulder is the glenoid labrum, which holds the humerus bone to the glenoid cavity of the scapula. Other common reasons for shoulder joint instability involve weakness in the supraspinatus tendon, acromioclavicular ligament laxity, a weakened glenohumeral ligament, and weakness of the structures that attach to the coracoid process. A shoulder is usually unstable because these structures are torn or stretched. Once these structures are stretched or loosened, no amount of exercise will strengthen the shoulder joint enough to permanently hold it in place.

(Video) Dr. Lindbloom, Shoulder Stretches - Florida Orthopaedic Institute

Ross Hauser, MD discusses the Prolotherapy treatment results that were published a few years ago on part of our article series on the use of Hackett-Hemwall dextrose Prolotherapy, as well as shows a treatment demonstration from a Prolotherapy symposium he taught in 2021. The treatment addresses ligament laxity or ligament weakness caused by degenerative wear and tear or injury.

Please see our article: The different shoulder problems that can be treated with Prolotherapy as well as a general introduction article on Prolotherapy treatments.

To help physical therapy work better, the ligament and tendon attachments should be strong or made stronger to help supply the resistance the muscles need to strengthen.

I am going to discuss one of our own research papers that assessed Prolotherapy treatment on 94 patients with received Hackett-Hemwall dextrose Prolotherapy injections to the main areas we treated ligaments and tendons of the shoulder. The glenohumeral ligament, the bicep tendons and the rotator cuff tendons. Many of these patients had the common problems of the shoulder caused by shoulder instability.

  • Shoulder osteoarthritis
  • Shoulder impingement
    • See our article: Subacromial shoulder pain treatment for discussions on exercise and physical therapy.
  • Snapping scapula
    • See our article: Snapping Scapula Syndrome – Non-surgical options. In this article is a discussion why physical therapy may have failed you
  • Shoulder bone spurs
  • Shoulder labral tears
  • Rotator cuff tear
  • Rotator cuff tendonitis
    • See our article: Rotator Cuff Tendinopathy: Comparing physical therapy, injections, and surgical options.

The treatment begins at 3:30 of the video: Click on the image to watch the treatments at this point.

Physical therapy and exercise for shoulder pain. When it works, when it does not work – Caring Medical Florida (5)

Prolotherapy Research Shoulder Osteoarthritis, Tears and Chronic Pain Disorders

  • We assessed quarterly Prolotherapy injection outcomes in 94 patients with an average of 53 months of unresolved shoulder pain.
    • 60% of the patients were female
    • Average age 54 years old
    • They had previous consulted at least three doctors before they had Prolotherapy injections
  • An average of 20 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment.
    • The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, and crunching sensations (crepitation) level with Prolotherapy, including the 39% of patients who were told by their medical doctors that there were no other treatment options for their pain and the twenty-one percent who were told that surgery was their only option.
  • Over 82% of all patients experienced improvements in sleep, exercise ability, anxiety, depression, and overall disability with Prolotherapy. Ninety-seven percent of patients received pain relief with Prolotherapy.

Summary and contact us. Can we help you?

When traditional treatments such as physiotherapy, medications, electrical stimulation, manipulation, exercise, rest, or massage do not work, then consider that you may have ligament and tendon weakness.

We hope you found this article informative and it helped answer many of the questions you may have surrounding your shoulder problems and shoulder instability. If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

References
1 Vocelle AR, Weidig G, Bush TR. Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies. Journal of Hand
Therapy. 2022 Jul 30. [Google Scholar]
2 Larsen JB, Østergaard HK, Thillemann TM, Falstie-Jensen T, Reimer LC, Noe S, Jensen SL, Mechlenburg I. Are progressive shoulder exercises feasible in patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy?. Pilot and Feasibility Studies. 2022 Dec;8(1):1-0. [Google Scholar]
3 O’Shea A, Drennan J, Littlewood C, Slater H, Sim J, McVeigh JG. Barriers and facilitators related to self-management of shoulder pain: a systematic review and qualitative synthesis. Clin Rehabil. 2022 Jun 22:2692155221108553. doi: 10.1177/02692155221108553. Epub ahead of print. PMID: 35733369.
4 Coats-Thomas MS, Baillargeon EM, Ludvig D, Marra G, Perreault EJ, Seitz AL. No Strength Differences Despite Greater Posterior Rotator Cuff Intramuscular Fat in Patients with Eccentric Glenohumeral Osteoarthritis. Clinical Orthopaedics and Related Research®. 2022 May 10:10-97. [Google Scholar]
5 Johnson DJ, Tadi P. Multidirectional shoulder instability. InStatPearls [Internet] 2021 Sep 29. StatPearls Publishing. [Google Scholar]
6 Lyng KD, Andersen JD, Jensen SL, Olesen JL, Arendt‐Nielsen L, Madsen NK, Petersen KK. The influence of exercise on clinical pain and pain mechanisms in patients with subacromial pain syndrome. European Journal of Pain. 2022 Jul 19. [Google Scholar]
7 Powell JK, Schram B, Lewis J, Hing W. “You have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise.” A scoping review of the possible mechanisms clinicians use to underpin exercise therapy. Musculoskeletal Science and Practice. 2022 Aug 8:102646. [Google Scholar]
8 Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: A systematic review and meta-analysis. JAMA network open. 2020 Dec 1;3(12):e2029581-. [Google Scholar]

This article was updated August 24, 2022

(Video) Shoulder Pain Relief For The Everyday Athlete From Expert Author Dr. Jamie Bovay

FAQs

What if physical therapy doesn't work for shoulder pain? ›

If you are not responding well to conservative treatment methods such as therapy and pain-relief medication, the shoulder pain may be due to more severe damage than initially believed. If this is the case, your doctor may recommend surgery, such as rotator cuff repair.

Can physical therapy make shoulder pain worse? ›

Physical therapy decreases pain over the long-term

While many patients perceive physical therapy as a process that increases pain (with physical therapists sometimes referred to jokingly as “torturing” patients), the reality is that physical therapy's purpose is to reduce pain, not increase it.

What are three treatment options for shoulder pain? ›

How often should you do physical therapy for shoulder? ›

After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your shoulders. Performing the exercises 2 to 3 days a week will maintain strength and range of motion in your shoulders.

When is physical therapy not working? ›

Physical therapy might stop if the patient isn't seeing results or making progress within the time-frame their physical therapist thinks they should be. After all, it can be frustrating to attend regular appointments, perform all the instructed exercises and still not make progress toward your goals.

Why won't my shoulder impingement go away? ›

While shoulder impingement can be painful and affect your daily activities, most people make a full recovery within a few months. In many cases, you'll just need some rest and physical therapy. If those don't provide relief, you may need surgery, which can add a few months to your recovery time.

How long does physical therapy take for shoulder pain? ›

Oftentimes people with rotator cuff tears respond very well to 6-8 weeks of physical therapy and non-surgical treatments. Although you may be having significant pain and present with signs typical of a rotator cuff injury, the typical course of care does not involve having MRI performed immediately.

How many days a week should you do physical therapy? ›

A typical order for physical therapy will ask for 2-3 visits per week for 4-6 weeks. Sometimes the order will specify something different. What generally happens is for the first 2-3 weeks, we recommend 3x per week. This is because it will be the most intensive portion of your treatment.

Is it normal to be in more pain after physical therapy? ›

While it's not uncommon to feel sore after physical therapy, you should never experience severe pain. It's important not to confuse soreness with pain. Muscles that have become tight and weak over time require stretching and exercise which results in a lactic acid build-up that can cause irritation.

What is the best painkiller for shoulder pain? ›

To relieve minor shoulder pain you might try: Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may help.

What are 2 warning signs of a rotator cuff tear? ›

Signs of a rotator cuff tear include: Difficulty and pain caused by raising your arm. Popping or clicking sounds or sensations when moving your arm. Shoulder pain that worsens at night or when resting your arm.

Will my shoulder pain ever go away? ›

It can take four to six weeks to recover fully from mild shoulder pain. There are some things you should and shouldn't do to help ease shoulder pain.

How do you know if physical therapy is working? ›

Your pain is less intense.

As you work through physical therapy you may notice that your pain is less sharp or is at a lesser degree than it was before. If your pain was at a 10 before, and now you can say it feels more like an 8, that's significant progress even though it still hurts.

Should I do shoulder rehab everyday? ›

For the treatment to be effective, we highly recommend performing these exercises around 3 to 5 times a week for 2 to 3 weeks.

What do physical therapists do for shoulder pain? ›

Physical therapy treatments for shoulder pain may include: stretching, strengthening, joint mobilization/stabilization. Heat, ice, ultrasound, electrical stimulation or athletic taping may be part of your physical therapy program as well.

How long does it take to see results from physical therapy? ›

A good physical therapist will track progress and check whether you are making gains in range of motion, function, and strength. Generally, soft tissues will take between six and eight weeks to heal, meaning that a typical physiotherapy program will last about that long.

Can physical therapy make things worse at first? ›

Physical therapy is a common and legitimate treatment option for many different conditions, injuries, as well as surgery recovery. Physical therapy is aimed at improving symptoms and pain, but sometimes patients experience worsening symptoms after engaging in physical therapy exercises.

What are three types of physical therapy? ›

6 Common Types of Physical Therapy You Should Know
  • Neurological Physical Therapy. ...
  • Occupational Physical Therapy. ...
  • Geriatric Physical Therapy. ...
  • Pediatric Physical Therapy. ...
  • Rehabilitative Physical Therapy. ...
  • Hand Physical Therapy. ...
  • These Types of Physical Therapy Works Wonders.
17 Aug 2020

How can you tell the difference between a torn rotator cuff and impingement? ›

It differs from subacromial impingement syndrome where swelling due to repetitive or traumatic compression of structures causes pain and shoulder dysfunction, instead torn fibres of the muscle directly inhibit muscle function due to loss of structural integrity.

What does an impinged shoulder feel like? ›

Symptoms of shoulder impingement syndrome include: Pain when your arms are extended above your head. Pain when lifting your arm, lowering your arm from a raised position or when reaching. Pain and tenderness in the front of your shoulder.

When does shoulder impingement require surgery? ›

Surgery is only necessary when there is a significantly large rotator cuff tear caused by an acute traumatic event. If impingement results without a tear, surgery may not be needed. A “Scapular Tilt Test,” which I have performed for nearly 15 years, is one way to determine if surgery is needed.

What does bursitis in the shoulder feel like? ›

You may experience a dull ache, sharp pain or mild tenderness. Other signs of shoulder bursitis include: Shoulder stiffness or a feeling of swelling. Painful range of motion.

How painful is shoulder bursitis? ›

It is rarely painful and usually not reddened. However, this type of bursal swelling can get warm and painful without being infected. In infected bursitis patients usually experience excessive warmth at the site of the inflamed bursa. They often complain of a great deal of tenderness, pain, and fever.

Can a physical therapist diagnose shoulder pain? ›

Your physical therapist will gently touch your shoulder in specific areas to determine which tendon or tendons are inflamed, and may perform other special tests to detect rotator cuff tendinopathy. Generally, a physical examination is all that is needed to diagnose rotator cuff tendinopathy.

Should you do rehab every day? ›

Your body needs time to rest and heal, and going through your exercises every day doesn't provide the break your body needs. On the other hand, if you have a few different exercises, your provider may allow you to split them up and do them on alternating days.

Can you overdo physical therapy? ›

While your recovery is heavily influenced by your strength and mobility, it is still possible to overdo it if you aren't careful. Your physical therapist will talk to you about ways to balance physical therapy exercises and activities with proper amounts of rest.

When is physical therapy too much? ›

Signs your physical rehab program may be overdoing it include: Muscle failure while trying to tone and strengthen your body. Muscle soreness two days after a workout or rehab session. Excessive or “therapeutic” bruising from a deep tissue massage.

Should you ice or heat after physical therapy? ›

At home, use heat and a gradual warm-up before a workout, and apply cold after any strenuous activity. If you are injured, apply ice, 20 minutes on and 20 minutes off, for the first 24 to 48 hours to minimize tissue damage.

Can physical therapy make a rotator cuff tear worse? ›

A physical therapist can help you reduce the worsening of the symptoms of a rotator cuff tear and may decrease your risk of worsening a tear, especially if you seek assistance at the first sign of shoulder pain or discomfort.

Should I ice my shoulder after physical therapy? ›

Ice will work to cool and soothe the area – just as inflammation is a typical part of the healing process, ice should be a typical response to that inflammation. Apply ice for 20 minutes at a time, applying as often as you feel necessary.

Does physical therapy get worse before it gets better? ›

Physical therapy is a common and legitimate treatment option for many different conditions, injuries, as well as surgery recovery. Physical therapy is aimed at improving symptoms and pain, but sometimes patients experience worsening symptoms after engaging in physical therapy exercises.

Can physical therapy make a rotator cuff tear worse? ›

A physical therapist can help you reduce the worsening of the symptoms of a rotator cuff tear and may decrease your risk of worsening a tear, especially if you seek assistance at the first sign of shoulder pain or discomfort.

Does physical therapy hurt before it gets better? ›

Physical therapy is only painful if you don't put in the time for your body to rehabilitate and heal. Our bodies have this amazing capability to heal itself. They say those patients who are the most involved in their own care, are more likely to experience a successful outcome.

What do physical therapists do for shoulder pain? ›

Physical therapy treatments for shoulder pain may include: stretching, strengthening, joint mobilization/stabilization. Heat, ice, ultrasound, electrical stimulation or athletic taping may be part of your physical therapy program as well.

How do I know if physical therapy is working? ›

Is My Physical Therapy Working? How Track Your Progress - YouTube

Should you do physical therapy exercises everyday? ›

For the treatment to be effective, we highly recommend performing these exercises around 3 to 5 times a week for 2 to 3 weeks. In order to stick to this plan, we'd like to lay out the below advice: Block off 30 minutes in your calendar on days you'd like to perform these exercises.

Can you overdo physical therapy? ›

While your recovery is heavily influenced by your strength and mobility, it is still possible to overdo it if you aren't careful. Your physical therapist will talk to you about ways to balance physical therapy exercises and activities with proper amounts of rest.

When should you not have rotator cuff surgery? ›

Most rotator cuff tears don't require surgery to heal. This is because most people with rotor cuff tears don't have any problem with their shoulders. Even if the torn rotator cuff causes shoulder pain, you can get relief without surgical treatment.

What percentage of rotator cuff tears require surgery? ›

When does a partial rotator cuff tear need surgery? It is very uncommon to operate on a partial rotator cuff tear. In cases of deep partial tears — when more than 90 percent of the tendon is torn — surgery is recommended only if the symptoms can't be controlled with nonsurgical treatments.

Does a torn rotator cuff hurt all the time? ›

Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back. Over time, the symptoms become much worse, and are not relieved by medicines, rest, or exercise.

How long does physical therapy take to work? ›

A good physical therapist will track progress and check whether you are making gains in range of motion, function, and strength. Generally, soft tissues will take between six and eight weeks to heal, meaning that a typical physiotherapy program will last about that long.

Should you ice after physical therapy? ›

Ice will work to cool and soothe the area – just as inflammation is a typical part of the healing process, ice should be a typical response to that inflammation. Apply ice for 20 minutes at a time, applying as often as you feel necessary.

Can PT help shoulder arthritis? ›

Studies show physical therapy can be very effective in treating shoulder conditions that cause pain, such as rotator cuff injuries, shoulder arthritis, and shoulder impingements. It can even help delay or eliminate the need of shoulder surgery.

What does an impinged shoulder feel like? ›

Symptoms include: pain in the top and outer side of your shoulder. pain that's worse when you lift your arm, especially when you lift it above your head. pain or aching at night, which can affect your sleep.

Does shoulder impingement require surgery? ›

While most cases of shoulder impingement can be treated without surgery, sometimes it is recommended. A doctor may suggest surgery if nonsurgical treatment options do not adequately relieve shoulder pain and improve range of motion. Surgery can create more room for the soft tissues that are being squeezed.

What does bursitis in the shoulder feel like? ›

You may experience a dull ache, sharp pain or mild tenderness. Other signs of shoulder bursitis include: Shoulder stiffness or a feeling of swelling. Painful range of motion.

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Author information

Name: Lidia Grady

Birthday: 1992-01-22

Address: Suite 493 356 Dale Fall, New Wanda, RI 52485

Phone: +29914464387516

Job: Customer Engineer

Hobby: Cryptography, Writing, Dowsing, Stand-up comedy, Calligraphy, Web surfing, Ghost hunting

Introduction: My name is Lidia Grady, I am a thankful, fine, glamorous, lucky, lively, pleasant, shiny person who loves writing and wants to share my knowledge and understanding with you.