Physical Therapy for Shoulder Pain - GetPT Blog (2022)

In a metaphorical context, the shoulder often is associated with carrying great weight—for example, “shouldering the blame” or “crying on someone’s shoulder.” But while the shoulder is not an inherently weight-bearing joint, it is one of the most commonly injured structures in the human body.

Luckily, physical therapy is highly effective in treating most shoulder conditions and injuries. But before we go into depth about various treatments for shoulder pain, let’s go over the basic anatomy of this famous connective structure.

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The Anatomy of the Shoulder

Often compared to a ball and socket, the shoulder connects the upper arm with the upper torso. Specifically, it holds together the humerus (i.e., the upper-arm bone), the scapula (i.e., the shoulder blade), and the clavicle (i.e., the collar bone). Soft-tissue elements of the shoulder include numerous ligaments and muscular attachments that support the joint and allow for movement.

While most people think of the shoulder as a single joint, it actually is a combination of three separate joints. They are:

  1. The glenohumeral (GH) joint, in which the rounded end of the humerus sits inside of the slightly cupped surface of the glenoid.
  2. The acromioclavicular (AC) joint, which joins the scapula to the clavicle.
  3. The scapulothoracic (ST) joint, which is the area in which the scapula lies over the back of the rib cage, also known as the thorax.

Another anatomical structure contained within the shoulder—and often affected by injury—is the rotator cuff. The rotator cuff is made up of four muscles that wrap around, and help stabilize, the shoulder joint. Various tendons attach the muscles to the shoulder bones. Bursa sacs—small, fluid-filled membranes—help cushion the shoulder joints and minimize friction.

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The shoulder is one of the most mobile parts of the human body, featuring a larger, more varied range of motion than any other joint. However, this extraordinary flexibility comes at a cost: instability. Because of that instability, the shoulder is prone to many problems. While some shoulder issues respond well to good old-fashioned rest, many require medical attention. And physical therapy has proven highly effective in the treatment of shoulder injuries.

Shoulder Problems and Causes

Generally, shoulder problems develop as the result of one or more of these factors:

  • Aging: As the body gets older, the tissue around the shoulder joint becomes less resilient, thus increasing the risk for injury. Also, as people become less active, disuse and atrophy lead to stiffness and weakness—two more injury risk factors.
  • Strain and overuse: These often are associated with repetitive motion and/or fatigue resulting from certain athletic activities (e.g., pitching a baseball) or job functions (e.g., lifting heaving objects, especially above the head).
  • Trauma: These types of injuries most commonly result from sports contact (e.g., football tackling) or accidents (e.g., falling on the shoulder). There are two types of trauma:
    • Macrotrauma occurs as the result of strong, violent force and often involves fractures, major tears, or dislocation.
    • Microtrauma is less severe and usually occurs as a consequence of non-violent strain, often resulting from everyday activities such as dragging a heavy piece of furniture or reaching for a box on the top shelf of the kitchen cabinet.

Common Shoulder Conditions

Pain or decreased mobility in the shoulder often result from one of the following issues:

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  • Rotator cuff tendonitis: The tendons in the rotator cuff sometimes get pinched underneath a bony prominence on the shoulder blade. When this happens, the tendons can become inflamed and painful.
  • Biceps tendonitis: The biceps tendon connects the biceps muscle in the upper arm to the front portion of the shoulder. It basically serves as a fifth rotator cuff tendon, providing additional stability to the front of the joint. Pain and inflammation can develop if the tendon gets pinched by the shoulder blade or by the ligaments connecting the collarbone and the shoulder blade.
  • Bursitis: If the bursa sacs in the shoulder joint become inflamed, they can thicken and impede movement in the joint. This results in pain and stiffness.
  • Osteoarthritis: This condition occurs when the cartilage in the shoulder deteriorates, thus increasing friction within the joint. It can result from several factors, including wear-and-tear over time, disease, infection, or injury. In addition to being painful, arthritis leads to stiffness that can impede full movement of the joint.
  • Subluxation: Sometimes referred to as a “partial” dislocation of the shoulder joint, this condition occurs when the bones in the joint quickly pop out and in. Most common among people who are 14-30 years old, subluxation often occurs while playing sports that require overhead motion (e.g., tennis or swimming). While it may not cause a lot of trouble at first, subluxation can develop into other, more serious conditions over time.
  • Dislocation: Whereas subluxation is a relatively minor injury, dislocation is far more serious and debilitating. This injury occurs when the bones separate from the shoulder joint but do not pop back in; it also usually involves strain, tearing, or other damage to the soft tissues in the joint.
  • Impingement: This condition occurs when the shoulder joint does not have enough room to function properly, either due to an existing structural issue (e.g., a bone spur) or an environmental issue (e.g., poor posture).
  • Adhesive capsulitis: Often called “frozen shoulder,” this condition is characterized by gradual loss of motion, which can last up to a year and a half.
  • Fracture: Shoulder fractures—involving the clavicle, the scapula, the humerus, or a combination of all three—typically result from significant trauma to the joint and its surrounding structures.

Treatment for Shoulder Pain

If your shoulder pain is the result of a trauma event—such as a fall or auto accident—you should seek medical attention immediately following the incident. Similarly, if you have had shoulder pain for more than two or three weeks—even if it was not the result of trauma—then it’s time to see a healthcare provider (e.g., a physical therapist). That way, you can prevent the issue from compounding and potentially developing into a more serious condition.

With most shoulder injuries, you should rest the joint for at least two to three days, icing it periodically. During this time, you can move the shoulder gently to maintain mobility if you are able. After a few days, you can begin exercising the joint to strengthen the muscles around it and improve range of motion. If the pain persists, you should seek professional medical treatment. While surgery may be necessary to repair damage caused by certain conditions, many problems are treatable with physical therapy alone. Your physical therapist (PT) can evaluate your pain and provide you with an appropriate diagnosis and a personalized treatment plan. When you first begin physical therapy, your PT will conduct a variety of tests and assessments to gain as much knowledge as possible about your specific shoulder condition. These include:

  • Using a goniometer to measure the strength and range of motion of the shoulder as well as the quality and coordination of the motion
  • Evaluating your posture
  • Performing upper extremity screening tools to pinpoint the specific area of injury

After completing your evaluation, your PT will develop a rehabilitation program—also called a plan of care—to rehabilitate your injury and reduce your pain. This program will include a variety of exercises specifically designed to improve strength, mobility, and flexibility as well as eliminate any deficiencies in those areas, thereby preventing the development of any chronic, ongoing shoulder issues. These activities may include:

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  • Water exercises (e.g., arm circles or shoulder rolls)
  • Proprioception training (i.e., exercises designed to increase awareness of shoulder position, movement, and orientation)
  • Agility and endurance exercises

Your PT also will provide you with a home exercise program, which is a set of exercises—along with recommended frequencies and durations—that you are responsible for completing at home. Additionally, your PT may use passive treatment methods such as ultrasound, hot-cold therapy, or electrical stimulation to relieve pain and swelling and increase blood flow. In many instances, manual therapy (i.e., hands-on manipulation, mobilization, or massage) may be appropriate.

The length of your treatment and the frequency of your therapy sessions will both depend on your specific condition, its severity, and whether you underwent reparative surgery. Rehabilitation could take anywhere from several weeks to several months. That said, remember that the duration of your overall therapy treatment is greatly affected by your commitment to your plan of care. Therefore, it’s imperative that you follow your PT’s plan—especially your home exercise regimen—as closely you can. That way, you’ll be able to resume your normal routine—and eliminate your shoulder pain—as quickly as possible.

Sources:

(Video) Consensus Statement on Managing Rotator Cuff Related Shoulder Pain | SYNOPSIS

About.com (“Physical Therapy for Shoulder Pain”)
Advancedphysicaltherapist.com (“Shoulder Pain”)
Orthopedicsatoz.com (“Shoulder Physical Therapy”)

FAQs

How often should you do physical therapy for shoulder? ›

Performing the exercises 2 to 3 days a week will maintain strength and range of motion in your shoulders.

How long does it take a rotator cuff to heal with physical therapy? ›

How many weeks of physical therapy do you need for rotator cuff surgery? Generally, a patient wears a sling for the first two to three weeks and begins physical therapy one week after surgery. The physical therapy program typically lasts for three to four months.

Does physical therapy work for shoulder pain? ›

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.

How long is physical therapy 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.

Can you overdo physical therapy? ›

Balancing Physical Therapy and Rest

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 I stop physical therapy? ›

In general, you should attend physical therapy until you reach your PT goals or until your therapist—and you—decide that your condition is severe enough that your goals need to be re-evaluated. Typically, it takes about 6 to 8 weeks for soft tissue to heal, so your course of PT may last about that long.

When is it too late for rotator cuff surgery? ›

Delaying surgery for 12 months or more after a rotator cuff tear diagnosis is associated with almost twice the odds of needing a subsequent revision surgery compared to having surgery between six weeks and one year after diagnosis, according to a retrospective study of records from thousands of patients across the ...

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 many physical therapy sessions are needed for rotator cuff surgery? ›

Physical therapy after rotator cuff repair may last 3-6 months after surgery. It often begins at two times per week and then decreases to 2-4 times per month toward the end of the treatment time.

What she should do if the physical therapy does not resolve the shoulder pain? ›

If therapy doesn't help, a steroid injection is sometimes the next step. The injections can help when the shoulder pain interferes with daily activities, but are not a long-term solution since patients can only receive so many steroid injections before they lose their effectiveness.

Why does my shoulder hurt more after physical therapy? ›

Discomfort and soreness are to be expected, because physical therapy, in order to work, must train your body. This is the same principle that applies when building strength through exercising or working out. The muscles must experience a certain amount of stress, which can lead to irritation and soreness.

What should I expect at shoulder for physical therapy? ›

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.

What is the fastest way to cure shoulder pain? ›

Home Care
  1. Put ice on the shoulder area for 15 minutes, then leave it off for 15 minutes. Do this 3 to 4 times a day for 2 to 3 days. ...
  2. Rest your shoulder for the next few days.
  3. Slowly return to your regular activities. ...
  4. Taking ibuprofen or acetaminophen (such as Tylenol) may help reduce inflammation and pain.

Can PT help rotator cuff pain? ›

While physical therapy itself cannot heal a torn rotator cuff tendon, it does strengthen the shoulder muscles and restoring shoulder mechanics. By strengthening all the surrounding muscles, therapy can help compensate for the damaged tendons and improve the mechanics of the shoulder joint.

What exercises to avoid if you have shoulder pain? ›

Those with shoulder injuries should initially steer clear of exercises that involve pressing movements or overhead movements. Forget activities like throwing a ball, or specific weight training at the gym like overhead presses and pull downs.

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

How long does physical therapy treatment take? 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.

How do I know if physical therapy is working? ›

Of course, each treatment program is tailor to each person's need, so your results will be unique. But generally, after each appointment, you should notice improvements in movement and a reduction in pain. If you do not feel you're progressing, tell your therapist about your concerns.

Can physical therapy do more harm than good? ›

“No.” “No” is the simple answer. Physical therapy patients often fear that their discomfort will worsen as a result of their treatment. But, as long you and your physical therapist agree, there should never be any painful or incontinental treatment.

What happens if you don't complete physical therapy? ›

Slower Recovery: Missing a physical therapy session will ultimately increase the time you will have to spend in recovery. The reason for this is because the exercises and activities that you will be engaging in a treatment session are designed to help you regain total movement ability.

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.

What can you not do in physical therapy? ›

Physical therapy never includes sex. It also never includes verbal sexual advances or any other kind of sexual contact or behavior. Sexual contact of any kind in the course of a physical therapy treatment is illegal and unethical.

Is rotator cuff surgery successful in 70 year old? ›

In conclusion, arthroscopic rotator cuff repair in patients over 70 years of age showed good clinical results and high satisfaction rate and can thus be considered a valid option of treatment after failure of conservative approach.

What will happen if I don't get rotator cuff surgery? ›

Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.

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.

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

The pain associated with a rotator cuff injury may:
  • Be described as a dull ache deep in the shoulder.
  • Disturb sleep.
  • Make it difficult to comb your hair or reach behind your back.
  • Be accompanied by arm weakness.
18 May 2022

Can you live with a fully torn rotator cuff? ›

Non-operative management usually consists of pain control with anti-inflammatories or steroid injections, rest or activity modification, and physical therapy. Patients with “well-balanced” massive rotator cuff tears may still have good active motion and be able to perform their activities of daily living.

How do I get my rotator cuff to stop hurting? ›

Moist heat, such as a hot bath, shower, or a heat pack, can help loosen up your shoulder when you feel pain in your shoulder. An ice pack applied to the shoulder 20 minutes at a time, 3 to 4 times a day, may also help cut down the swelling when you are in pain. Wrap the ice pack in a clean towel or cloth.

Can physical therapy help a full thickness rotator cuff tear? ›

Non-operative treatment using this physical therapy protocol is effective for treating atraumatic full thickness rotator cuff tears in approximately 75% of patients followed for two years.

How much physical therapy is needed after shoulder surgery? ›

After shoulder surgery, your doctor and physical therapist will typically recommend rehabilitation activities like exercising and/or stretching for 10 to 15 minutes, two to three times per day.

What is the fastest way to recover from shoulder surgery? ›

8 Tips to Speed Recovery After Rotator Cuff Surgery
  1. Wear a sling. To speed recovery, it is important to keep your shoulder immobilized initially after surgery so your tendon can heal. ...
  2. Sleep carefully. ...
  3. Ask for help. ...
  4. Watch for complications. ...
  5. Do the physical therapy. ...
  6. Keep comfortable. ...
  7. Be mindful of your movement. ...
  8. Pace yourself.

Should physical therapy be done 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.

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

How long does physical therapy treatment take? 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.

How many physical therapy sessions are needed for rotator cuff surgery? ›

Physical therapy after rotator cuff repair may last 3-6 months after surgery. It often begins at two times per week and then decreases to 2-4 times per month toward the end of the treatment time.

How do you know if physical therapy is working? ›

Of course, each treatment program is tailor to each person's need, so your results will be unique. But generally, after each appointment, you should notice improvements in movement and a reduction in pain. If you do not feel you're progressing, tell your therapist about your concerns.

Can physical therapy do more harm than good? ›

“No.” “No” is the simple answer. Physical therapy patients often fear that their discomfort will worsen as a result of their treatment. But, as long you and your physical therapist agree, there should never be any painful or incontinental treatment.

How do I get the most out of physical therapy? ›

Tips to get the most out of physical therapy
  1. Be a good historian. ...
  2. Set goals. ...
  3. Commit to your appointments. ...
  4. Do the homework. ...
  5. Find a dedicated space to do the work. ...
  6. Don't skip. ...
  7. Speak up and ask questions. ...
  8. Stick to the topic.
30 Oct 2018

Can I take a break from physical therapy? ›

Sessions are scheduled with rest days in between to allow you to regain strength and relax outside of physical therapy. Use this time to unwind and do activities that make you feel better and relaxed. Physical therapy will be a waste if you don't supplement it with sufficient rest.

What time of day is best for physical therapy? ›

Morning: the early bird gets the workout done

Early sessions are great for a few reasons. Many people feel stiff when they get out of bed. Doing your session right when you wake up can help get your blood pumping, help you feel more nimble, and get you ready to face the day.

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 you do PT 2 days in a row? ›

But for the average person, aim to train the same muscle group no more than twice a week, leaving at least 48 hours between each, recommends Pire. So, no, you probably shouldn't strength train the same muscle group two days in a row.

When is it too late for rotator cuff surgery? ›

Delaying surgery for 12 months or more after a rotator cuff tear diagnosis is associated with almost twice the odds of needing a subsequent revision surgery compared to having surgery between six weeks and one year after diagnosis, according to a retrospective study of records from thousands of patients across the ...

Can physical therapy help a full thickness rotator cuff tear? ›

Non-operative treatment using this physical therapy protocol is effective for treating atraumatic full thickness rotator cuff tears in approximately 75% of patients followed for two years.

How much physical therapy is needed after shoulder surgery? ›

After shoulder surgery, your doctor and physical therapist will typically recommend rehabilitation activities like exercising and/or stretching for 10 to 15 minutes, two to three times per day.

What is the next step if physical therapy doesn't work? ›

Worse, when traditional physical therapy does fail, most people go back to their doctors hoping for a different solution. Many times, the next step for these folks involves unwanted procedures or surgery.

What can you not do in physical therapy? ›

Physical therapy never includes sex. It also never includes verbal sexual advances or any other kind of sexual contact or behavior. Sexual contact of any kind in the course of a physical therapy treatment is illegal and unethical.

Why am I in so much pain after physical therapy? ›

This is because your muscles are being used to move your bones, and when you use your muscle to move your body, the injured muscle activates the pain fibers in the injured area, and you have pain.

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