Shoulder Pain Treatment & Chiropractic Care

What Are the Most Common Causes of Shoulder Pain?

The shoulder is one of the most mobile joints in the body. That mobility allows us to reach, lift, throw and perform complex movements, but it also means that several different structures must work together effectively.

Common causes of shoulder pain include:

• Rotator cuff-related shoulder pain
• Rotator cuff tears
• Frozen shoulder
• Calcific tendinopathy
• Acromioclavicular joint injuries
• Shoulder instability or dislocation
• Labral injuries
• Shoulder arthritis
• Biceps tendon problems
• Pain referred from the neck

The diagnosis matters because treatment that is appropriate for one shoulder condition may not be appropriate for another.

What Is Rotator Cuff-Related Shoulder Pain?

Rotator cuff-related shoulder pain is one of the most common presentations involving the shoulder.

The rotator cuff is a group of muscles and tendons that helps control and stabilise the shoulder during movement.

Symptoms often include pain when lifting the arm, reaching overhead or behind the back, lying on the affected shoulder or performing repeated lifting activities.

Terms such as rotator cuff tendinopathy, subacromial pain and shoulder impingement have historically been used to describe overlapping presentations.

Read more about rotator cuff-related shoulder pain →

Can a Rotator Cuff Tear Cause Shoulder Pain?

Yes. Rotator cuff tears range from relatively small partial tears to larger full-thickness tears.

Some tears cause pain and weakness, while others may be present on imaging without producing significant symptoms.

Assessment therefore considers both the clinical findings and, where appropriate, imaging rather than assuming that a tear seen on a scan is necessarily the sole cause of pain.

Read more about rotator cuff tears →

What Is Frozen Shoulder?

Frozen shoulder, or adhesive capsulitis, causes progressive pain and marked restriction of shoulder movement.

Both active and passive movement usually become restricted, often making everyday tasks such as dressing, reaching behind the back or sleeping on the affected side difficult.

Frozen shoulder can improve with time, but recovery may be slow and treatment should be matched to the stage and severity of the condition.

Read more about frozen shoulder →

What Is Calcific Tendinopathy?

Calcific tendinopathy occurs when calcium deposits develop within one of the rotator cuff tendons.

Some people have calcium deposits without symptoms, while others develop significant shoulder pain and restricted movement.

The appropriate treatment depends on the symptoms, examination findings and size and location of the deposit.

Read more about calcific tendinopathy →

Can Neck Problems and Posture Affect the Shoulder?

Yes. The neck, upper back, shoulder blade and shoulder work together as part of the same movement system.

Problems in the cervical spine can sometimes refer pain directly into the shoulder, while irritation of a cervical nerve can produce shoulder or arm pain together with tingling, numbness or weakness.

Even where the primary problem is within the shoulder itself, reduced movement of the neck or upper back and altered movement of the shoulder blade can influence how the shoulder is loaded and how comfortably it moves.

Posture can also affect shoulder mechanics. Sustained positions, particularly where the upper back is rounded and the shoulders are held forward for long periods, can alter the position and movement of the shoulder blade and may contribute to symptoms in susceptible people.

This does not mean that poor posture is the cause of every shoulder problem. It means that assessing the shoulder in isolation can sometimes miss factors in the neck, upper back and shoulder blade that may be contributing to the problem.

At Isis Chiropractic Centres, our assessment therefore considers the shoulder, cervical spine, upper back and shoulder-blade mechanics where relevant.

Read more about neck pain →

How Is Shoulder Pain Assessed?

Assessment begins with the history of the problem, including when it started, whether there was an injury, which activities aggravate it and whether there is weakness, stiffness or pain at night.

The examination may include:

• Active and passive shoulder movement
• Strength testing
• Rotator cuff testing
• Assessment of the acromioclavicular joint
• Shoulder stability
• Neck examination
• Neurological testing where appropriate
• Assessment of movement and rehabilitation needs

The aim is to determine the most likely source of the symptoms and whether conservative treatment is appropriate.

Do I Need an X-Ray or MRI for Shoulder Pain?

Imaging is not necessary for every shoulder problem.

An X-ray may be useful where arthritis, fracture, significant trauma or calcification is suspected.

Ultrasound or MRI may sometimes be appropriate where a significant tendon tear, labral injury or another soft-tissue problem is suspected and the result is likely to affect management.

At Isis Chiropractic Centres, imaging or referral is arranged where the clinical findings indicate that it is appropriate.

What Is the Best Treatment for Shoulder Pain?

The best treatment depends on the diagnosis, the tissues involved, the stage of the problem and what you need your shoulder to be able to do.

At Isis Chiropractic Centres, treatment may combine:

• Advice and appropriate modification of aggravating activities
• Progressive shoulder strengthening and rehabilitation
• Manual treatment of the shoulder where appropriate
• Treatment of contributing neck and upper-back dysfunction
• Work on shoulder-blade movement and control
• Low Level Laser Therapy or TECAR therapy where appropriate
• Shockwave therapy for selected tendon conditions, particularly calcific tendinopathy
• Gradual return to work, exercise and sport

The objective is not simply to reduce pain. It is to improve the capacity of the shoulder and address the mechanical and tissue factors that may be contributing to the problem.

Where the assessment suggests that medication, injection therapy, further imaging or specialist surgical opinion would be more appropriate, we will explain this and recommend the appropriate referral.

Do Anti-Inflammatory Drugs Affect Tendon Healing?

Anti-inflammatory medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) can be useful for reducing pain in some musculoskeletal conditions, but inflammation is also part of the body’s normal healing response.

Laboratory and animal research has shown that suppressing inflammatory pathways can affect processes involved in tendon and tendon-to-bone healing, including collagen formation and tissue remodelling. Some studies have raised particular concerns about prolonged use and selective COX-2 anti-inflammatory drugs.

Human research is less conclusive, and short-term use of some non-selective NSAIDs has not consistently been shown to impair healing. For this reason, it would be inappropriate to suggest that everybody with shoulder pain should avoid anti-inflammatory medication.

However, medication should not be regarded as a substitute for identifying the underlying problem and restoring the strength, mobility and load tolerance of the injured tissues.

If medication is required, this should be discussed with your GP, pharmacist or prescribing clinician, particularly if it is being used regularly or for prolonged periods.

Can Chiropractic Treatment Help Shoulder Pain?

Chiropractic care may be appropriate for some musculoskeletal causes of shoulder pain.

Rather than treating every painful shoulder in the same way, our chiropractors assess the shoulder, neck and surrounding movement patterns before recommending treatment.

Where appropriate, management may include manual therapy alongside exercise and rehabilitation.

Manual therapy should not replace progressive exercise where strengthening and rehabilitation are required, and some shoulder conditions are more appropriately managed through another healthcare pathway.

Read more about chiropractic treatment →

What Does the Research Say About Shoulder Rehabilitation?

Exercise and progressive rehabilitation are central components of conservative treatment for many common shoulder problems, particularly rotator cuff-related shoulder pain.

Systematic reviews have found that exercise can improve pain and function. Research into adding manual therapy to exercise has produced mixed results, with some studies suggesting benefit and others finding little additional improvement compared with exercise alone.

This is why we regard manual treatment as one possible component of care rather than the whole treatment programme.

Research:
Manual therapy and exercise versus exercise alone for rotator cuff-related shoulder pain
Exercise therapy for rotator cuff-related shoulder pain: systematic review and meta-analysis

Can Shockwave Therapy Help Shoulder Tendon Problems?

Shockwave therapy can be particularly useful for selected chronic tendon problems and is one of the treatment options available at Isis Chiropractic Centres.

Extracorporeal shockwave therapy delivers mechanical energy into the affected tissue. Research suggests that this can stimulate biological responses involved in tissue remodelling, including changes in blood-vessel formation, cell activity and collagen organisation.

Shockwave may also influence areas of fibrotic or poorly organised tissue. Rather than simply “breaking up scar tissue”, a more accurate description is that it may stimulate remodelling of abnormal or fibrotic tissue as part of the healing response.

Shockwave Therapy for Calcific Tendinopathy

One of the clearest applications in the shoulder is calcific rotator cuff tendinopathy, where calcium deposits develop within a rotator cuff tendon.

Clinical trials and systematic reviews have shown that extracorporeal shockwave therapy can reduce pain and improve function in people with calcific tendinopathy and can also promote partial or complete reduction of the calcium deposit in some patients.

Higher-energy and focused shockwave treatments have been particularly studied for calcific tendinopathy, although treatment choice should depend on the size and location of the deposit, symptoms and previous response to conservative care.

Read more about calcific tendinopathy →

Can Laser and TECAR Therapy Support Soft-Tissue Recovery?

At Isis Chiropractic Centres, Low Level Laser Therapy (photobiomodulation) and TECAR therapy may be used alongside exercise and rehabilitation for selected shoulder conditions.

Photobiomodulation uses specific wavelengths of light to influence biological processes within tissues. Research has reported effects on cellular activity, inflammation and collagen organisation, and clinical studies have found improvements in pain and function in a number of shoulder conditions.

TECAR therapy uses radiofrequency energy to produce physiological effects within tissues and may help reduce pain and improve function in musculoskeletal conditions.

These treatments are used as adjuncts to rehabilitation. They do not replace progressive loading, strengthening or correction of the mechanical factors contributing to the shoulder problem.

When Should Shoulder Pain Be Assessed Urgently?

Seek urgent medical assessment if shoulder pain is associated with:

• A significant injury with obvious deformity
• Inability to move the arm following trauma
• Severe swelling or rapidly increasing bruising
• A hot, red or markedly swollen joint with fever or feeling unwell
• Sudden unexplained weakness or loss of sensation
• Chest pain, breathlessness, sweating or other symptoms that could indicate a medical emergency

Not all pain felt around the shoulder originates from the shoulder itself, so unusual or unexplained symptoms should be assessed appropriately.

Shoulder Pain Treatment Near You

Milton Keynes

Our Milton Keynes clinic provides assessment, treatment and rehabilitation for shoulder pain, with on-site X-ray facilities where clinically indicated and rehabilitation facilities to support progressive recovery.

Northampton

Our Northampton clinic provides assessment, treatment and rehabilitation for shoulder pain, with on-site X-ray facilities where clinically indicated and rehabilitation facilities to support progressive recovery.

Aylesbury

Our Aylesbury clinic provides assessment and treatment for shoulder pain, with on-site X-ray facilities where clinically indicated.

Frequently Asked Questions About Shoulder Pain

Why does my shoulder hurt when I lift my arm?

Pain when lifting the arm can occur with several conditions, including rotator cuff-related shoulder pain, tendon problems, frozen shoulder and joint problems. The pattern of movement and examination findings help distinguish between them.

Why does my shoulder hurt at night?

Night pain is common with several shoulder conditions, including rotator cuff-related pain and frozen shoulder. Persistent night pain should be considered together with your other symptoms and examination findings rather than used alone to make a diagnosis.

Should I rest a painful shoulder?

Some temporary modification of painful activities may help, but prolonged complete rest is rarely the goal for uncomplicated musculoskeletal shoulder pain. Gradual movement and progressive exercise are often important parts of recovery.

Can shoulder pain be caused by a trapped nerve?

Yes. A cervical nerve problem can sometimes produce pain around the shoulder and arm, particularly when accompanied by tingling, numbness or weakness.

Do all rotator cuff tears need surgery?

No. Management depends on factors such as the type of tear, severity of weakness, age, activity requirements and response to conservative treatment. Some tears can be managed without surgery while others benefit from specialist assessment.

Start by Finding the Cause of Your Shoulder Pain

There are many reasons why a shoulder can become painful, and symptoms alone do not always reveal which structure is responsible.

Our first step is to assess the shoulder properly, explain what we find and recommend the most appropriate treatment, rehabilitation or referral pathway.