Shoulder pain can make everyday activities such as reaching overhead, getting dressed, lifting, or sleeping uncomfortable. Two common causes of shoulder pain are rotator cuff-related pain and what is often described as shoulder impingement.
Although shoulder pain can sometimes settle with time, persistent symptoms can affect your strength, movement, sleep, work, and ability to exercise. Understanding what may be contributing to your symptoms and knowing how to manage them can help you return to normal activities.
In this article, we’ll explore shoulder impingement and rotator cuff pain, common symptoms, potential causes, physiotherapy treatment options, and when you should consider seeing a physiotherapist.
Key Takeaways
- Shoulder pain can have several different causes, so an accurate assessment is important.
- Rotator cuff-related shoulder pain can cause pain with lifting, reaching, and other overhead activities.
- Shoulder impingement is a term commonly used to describe shoulder pain associated with certain movements and loads.
- Physiotherapy can help improve shoulder strength, movement, function, and confidence.
- Exercise-based rehabilitation is often an important part of managing persistent shoulder pain.
- You don’t necessarily need to avoid all painful movements, but activities may need to be modified while your shoulder recovers.
- Persistent, worsening, or significant shoulder pain should be assessed by a healthcare professional.
- A physiotherapist can develop an individualised treatment programme based on your symptoms, lifestyle, and goals.
What Is Shoulder Impingement?
Shoulder impingement is a term traditionally used to describe pain that occurs when structures around the shoulder become irritated during certain movements, particularly when raising the arm.
The shoulder is a highly mobile joint that relies on muscles, tendons, ligaments, and other tissues to provide movement and stability.
The rotator cuff is a group of four muscles and their tendons that help control movement of the shoulder and keep the head of the upper arm bone centred within the shoulder joint.
When the shoulder is repeatedly exposed to loads that exceed its current capacity, pain can develop.
The term “impingement” can sometimes suggest that a structure is simply being trapped or damaged. However, shoulder pain is often more complex than this, and symptoms can be influenced by factors such as:
- Muscle strength
- Shoulder movement
- Training or activity levels
- Repetitive loading
- Previous injury
- Sleep
- Stress and general health
- Changes in physical activity
This is why an individual assessment can be useful when shoulder pain persists.
What Is Rotator Cuff Pain?
The rotator cuff plays an important role in controlling shoulder movement.
Rotator cuff-related pain can develop when the tissues around the shoulder are exposed to more load than they are currently able to tolerate.
This may happen following:
- A sudden increase in exercise
- Repetitive overhead activity
- Changes in work demands
- Weight training
- Throwing or racket sports
- Returning to activity after a period of inactivity
- A sudden injury
Rotator cuff pain doesn’t necessarily mean that the tendon has been seriously damaged.
Symptoms can vary considerably between individuals, and the amount of pain does not always directly reflect the amount of tissue damage.
Common Symptoms of Shoulder Impingement and Rotator Cuff Pain
Shoulder symptoms can vary depending on the individual and the underlying cause.
Common symptoms may include:
- Pain when lifting the arm
- Pain reaching overhead
- Discomfort when reaching behind your back
- Pain when putting on or removing clothing
- Shoulder weakness
- Pain when lying on the affected side
- Difficulty lifting objects
- Pain during gym exercises
- Stiffness or reduced shoulder movement
- Discomfort during repetitive activities
Some people may also notice pain at night or difficulty finding a comfortable sleeping position.
If shoulder pain is affecting your sleep, work, exercise, or everyday activities, it may be worth having the problem assessed.
What Causes Rotator Cuff and Shoulder Pain?
There isn’t always one single cause of shoulder pain.
The shoulder can become painful when the demands placed on it change faster than the tissues have time to adapt.
For example, someone may develop symptoms after suddenly increasing:
- Weight training
- Swimming
- Tennis
- Throwing
- Manual work
- Overhead activity
- Repetitive lifting
Shoulder pain can also develop without an obvious injury.
Changes in strength, movement, activity levels, recovery, and other physical or lifestyle factors may all contribute to the development or persistence of symptoms.
How Is Shoulder Impingement Diagnosed?
A physiotherapist will usually begin by taking a detailed history of your symptoms.
This may include asking about:
- When your pain started
- Whether there was an injury
- What movements aggravate your symptoms
- Your work and daily activities
- Your exercise or sporting activities
- Previous shoulder problems
- Your current level of shoulder strength and movement
They may then assess your shoulder movement, strength, coordination, and functional ability.
Shoulder pain can have several possible causes, so the aim of an assessment is to understand the overall pattern of your symptoms rather than relying on one individual test.
In some cases, further medical assessment or imaging may be appropriate.
Physiotherapy Treatment for Shoulder Impingement
Physiotherapy treatment depends on your symptoms, physical examination, and goals.
There isn’t one exercise or treatment that is suitable for everyone.
Your physiotherapist may use a combination of:
- Exercise rehabilitation
- Strength training
- Movement retraining
- Activity modification
- Education and advice
- Manual therapy where appropriate
- Gradual return to sport or exercise
- Load management
The main aim is usually to help your shoulder become stronger and more tolerant of the activities you need or want to perform.
Exercise Therapy for Rotator Cuff Pain
Exercise is often an important part of rehabilitation for shoulder pain.
A physiotherapist may prescribe exercises designed to improve:
- Rotator cuff strength
- Shoulder control
- Upper-limb strength
- Scapular control
- Shoulder mobility
- Functional capacity
The exercises may initially be relatively simple before gradually becoming more challenging.
As your shoulder improves, your programme can be progressed to reflect the activities you need to return to.
Isometric Shoulder Exercises
Isometric exercises involve contracting a muscle without significant movement of the joint.
They can sometimes be useful during the earlier stages of rehabilitation when certain movements are uncomfortable.
Your physiotherapist can advise on the appropriate position, resistance, and duration based on your symptoms.
Resistance Band Exercises
Resistance bands can provide a convenient way of strengthening the shoulder.
Exercises may target the rotator cuff and other muscles involved in controlling the shoulder.
The resistance can be gradually increased as your strength and tolerance improve.
Shoulder Raises
Controlled shoulder raises can help improve strength and tolerance for lifting the arm.
These exercises can be progressed gradually depending on your symptoms and functional goals.
Scapular Strengthening
The muscles around the shoulder blade contribute to effective shoulder movement and control.
Exercises may therefore target the muscles that help control the position and movement of the shoulder blade.
The specific exercises should be selected according to your individual assessment rather than relying on a generic programme.
Should You Stop Exercising If Your Shoulder Hurts?
Not necessarily.
Complete rest may not always be the best approach for persistent shoulder pain.
Instead, your physiotherapist may recommend modifying activities that significantly aggravate your symptoms while maintaining as much comfortable movement and activity as possible.
For example, this could involve:
- Reducing the weight used during an exercise
- Performing fewer repetitions
- Temporarily reducing overhead activity
- Changing exercise technique
- Taking additional recovery time
- Choosing alternative exercises
- Gradually rebuilding your previous training volume
The aim is to find an appropriate level of activity that allows your shoulder to recover while continuing to build its capacity.
How Long Does Shoulder Impingement Take to Improve?
Recovery time varies considerably.
Some shoulder problems improve relatively quickly, while persistent symptoms may require a longer period of rehabilitation.
Factors that can influence recovery include:
- How long you’ve had symptoms
- The severity of your pain
- Your current shoulder strength
- Your activity levels
- The demands placed on your shoulder
- Previous shoulder injuries
- Sleep and recovery
- How consistently you complete your rehabilitation programme
Rather than focusing only on a specific number of weeks, it can be more useful to monitor improvements in pain, strength, movement, and your ability to perform everyday activities.
Managing Shoulder Pain at Home
There are several things you can do to help manage shoulder symptoms.
Keep Your Shoulder Moving
Avoiding all shoulder movement because it hurts can sometimes lead to increased stiffness and reduced confidence in using the arm.
Gentle, comfortable movement can often be maintained while more aggravating activities are temporarily modified.
Gradually Increase Activity
If your symptoms have developed after increasing your activity, consider whether your shoulder has had enough time to adapt.
Gradually rebuilding your activity can help improve the capacity of the muscles and tendons around the shoulder.
Consider Your Sleeping Position
Shoulder pain can make sleeping uncomfortable, particularly when lying directly on the affected side.
Changing your sleeping position or supporting the arm with a pillow may make it easier to find a comfortable position.
Don’t Ignore Persistent Symptoms
If shoulder pain continues despite modifying your activities, or is gradually getting worse, it may be appropriate to seek professional advice.
An assessment can help identify the factors contributing to your symptoms and provide a structured rehabilitation plan.
Warning Signs You Shouldn’t Ignore
Most shoulder pain is not an emergency, but some symptoms require prompt medical assessment.
You should seek medical advice if you experience:
- Severe or rapidly worsening pain
- Significant loss of shoulder movement following an injury
- A sudden inability to lift or move the arm
- Significant swelling or deformity
- Numbness or persistent weakness in the arm
- Shoulder pain following significant trauma
- Fever or feeling generally unwell alongside shoulder pain
- Chest pain, shortness of breath, or other symptoms that could indicate a non-musculoskeletal cause
If you are unsure about your symptoms, seek appropriate medical advice rather than assuming they are caused by shoulder impingement.
When Should You See a Physiotherapist?
You don’t have to wait until your shoulder pain becomes severe before seeking physiotherapy.
An assessment may be useful if you are:
- Experiencing persistent shoulder pain
- Struggling with overhead activities
- Finding exercise increasingly difficult
- Having difficulty sleeping because of shoulder pain
- Noticing weakness in the affected arm
- Returning to the gym or sport after an injury
- Experiencing recurring shoulder problems
- Unsure which exercises are appropriate
- Finding that your symptoms aren’t improving
A physiotherapist can assess your shoulder, identify contributing factors, and develop an appropriate rehabilitation programme.
Why Releaf’s Physiotherapy Approach Can Help
At Releaf, we understand that shoulder pain can affect much more than your ability to lift your arm.
Our physiotherapists take the time to understand your symptoms, lifestyle, work demands, exercise routine, and goals.
Depending on your individual needs, treatment may include:
- Physiotherapy assessment
- Shoulder strength assessment
- Exercise rehabilitation
- Rotator cuff strengthening
- Mobility exercises
- Activity modification
- Manual therapy where appropriate
- Return-to-sport rehabilitation
- Gym and exercise advice
- Load management
- Injury prevention strategies
Rather than simply treating the painful area, our aim is to understand what may be contributing to your symptoms and help you build the strength and capacity needed to return to the activities you enjoy. To view our price list please use this link: https://www.releafphysio.com/price-list/
Why Choose Releaf Physio?
Whether you’re dealing with a new shoulder problem or have been experiencing pain for several months, our experienced physiotherapists can provide personalised, evidence-informed care.
We can help you:
- Understand what’s contributing to your shoulder pain
- Improve shoulder strength and movement
- Manage symptoms during everyday activities
- Return to exercise and sport
- Build confidence using your shoulder again
- Reduce the risk of recurring problems
- Develop a rehabilitation programme suited to your goals
Your rehabilitation should be based on your individual symptoms, physical capacity, and lifestyle rather than a generic shoulder exercise programme. To book an appointment please use this link: https://www.releafphysio.com/book-online/
Frequently Asked Questions
Is shoulder impingement the same as a rotator cuff injury?
Not necessarily. Shoulder impingement is a term commonly used to describe shoulder pain associated with certain movements, while rotator cuff problems can involve pain or changes affecting the rotator cuff muscles and tendons.
Shoulder pain can have several different causes, so an assessment is useful when symptoms persist.
Can physiotherapy help shoulder impingement?
Yes. Physiotherapy can help many people with shoulder pain by addressing factors such as strength, movement, activity levels, and load tolerance.
Treatment is individualised and may include exercise rehabilitation, education, activity modification, and other appropriate physiotherapy techniques.
Should I stop going to the gym if I have shoulder pain?
Not necessarily. You may be able to continue exercising by modifying the exercises, weights, range of movement, or training volume.
Your physiotherapist can help identify which activities are appropriate and how to gradually return to your normal training.
How long does rotator cuff pain take to heal?
Recovery varies from person to person. Some symptoms improve over a relatively short period, while persistent shoulder pain may require a longer rehabilitation programme.
Your recovery will depend on factors such as the duration of your symptoms, activity demands, strength, and how your shoulder responds to rehabilitation.
Can I exercise with rotator cuff pain?
In many cases, yes, although the type and amount of exercise may need to be adjusted.
A physiotherapist can help you identify appropriate exercises and gradually increase the amount of load your shoulder can tolerate.
Should I have an MRI or scan for shoulder pain?
Not everyone with shoulder pain needs imaging.
A physiotherapy assessment can often help determine whether further investigation is necessary. If imaging or another medical assessment is appropriate, your physiotherapist can advise you on the next steps.
What should I do if my shoulder pain is getting worse?
If your symptoms are progressively worsening, consider reducing activities that significantly aggravate your shoulder and seek professional advice.
Persistent or worsening pain should not simply be ignored, particularly if you are also experiencing significant weakness, loss of movement, swelling, or symptoms following an injury.
Can physiotherapy prevent shoulder pain from coming back?
Physiotherapy can help address factors that may contribute to recurring symptoms, such as reduced strength, poor load tolerance, or sudden changes in activity.
Building your shoulder’s capacity and gradually returning to your normal activities can help you manage future increases in workload.
Conclusion
Shoulder impingement and rotator cuff-related pain can make everyday activities, work, exercise, and sleep difficult. However, shoulder pain doesn’t necessarily mean that you need to stop using your arm or give up the activities you enjoy.
A combination of appropriate activity modification, progressive strengthening, movement rehabilitation, and education can help many people improve their shoulder function and return to normal activities.
If you’ve been experiencing persistent shoulder pain, a physiotherapy assessment can help identify the factors contributing to your symptoms and provide an individualised treatment plan.
At Releaf, our goal is to help you understand your shoulder pain, build strength and confidence, and return to the activities that matter to you.
