Think of all of the ways you use your hands and arms in daily life: reaching to lift something onto a high shelf, holding hands with your child who is slowly trailing behind, passing a ball - and even getting that itch in the centre of your back. To do all this and much more, your shoulder joint is acutely designed to be able to move freely and support weight in almost all directions, being one of the most mobile joints in the body.
Unfortunately, being one of the most used and versatile joints in the body also makes the shoulder vulnerable to a range of pains and problems, particularly around its stability and damage to the tissues and structures that comprise the joint. As a result, shoulder injuries are a very common problem that our physios see and treat, with causes ranging from something as simple as slicing bread (yep, that’s a real cause), to being overused in sports.
To help you understand what may be going on with your shoulder, here are four causes of shoulder pain that we often see and treat, why they occur, and what you should do about it.
Medically referred to as adhesive capsulitis, having a frozen shoulder means that your shoulder becomes stiff, painful and difficult to use like you used to. Unlike other conditions, a frozen shoulder can last for years, gradually worsening and progressing through a ‘freezing’ then ‘frozen’ phase, before entering a ‘thawing’ phase and regaining function.
The reason behind why a frozen shoulder develops isn’t well understood in research, but the process by which it occurs includes inflammation of the shoulder joint, perhaps after being injured and then immobilised, or when recovering from surgery. The tissues then thicken and contract, shrinking to make movement painful and uncomfortable.
Developing a frozen shoulder is one of the many reasons why physiotherapy treatment is highly recommended for shoulder injuries - as the risk of frozen shoulder increases when you don't complete exercise therapy after shoulder tendinitis or a shoulder injury, or when your shoulder is immobilised in a sling without regular stretching. Other risk factors include diabetes, thyroid disorders, cancers and more.
When it comes to helping manage a frozen shoulder, physiotherapy and manual mobilisation have been found to offer the most benefit in the adhesive phase of the injury.
Rotator Cuff Injury
Your rotator cuff is a group of four muscles that surround the shoulder and form a cuff around the head of the arm bone. They work together to help control, move and stabilise the shoulder joint. Given the high loads the shoulder is exposed to and its repetitive movement patterns, the rotator cuff can sustain a range of injuries, ranging in pain and severity. These can include tendinopathies, as well as rotator cuff tears.
Rotator cuff injuries can appear in two primary ways - as a result of a sudden or heavy load or impact, or from overuse that develops over weeks, months or years. This is often linked to age, with rotator cuff injuries becoming more common over the age of 50 years. In some cases, a rotator cuff can feel like a deep ache in or on top of the shoulder which may be accompanied by weakness, and it can make it difficult to reach behind your back. Other times, these injuries may have very mild or even no symptoms.
Physiotherapists work extensively to help treat rotator cuff injuries by helping restore your range of motion, muscle strength, and coordination, helping you get back to comfortably performing your daily activities. If the severity of your injury means that you need surgery, your physio will help you prepare for the procedure and recover afterwards, so you get the best results.
A shoulder impingement feels like pain in the shoulder when lifting the arm that may be accompanied by weakness or pins and needles. It occurs when the rotator cuff muscles or a small fluid-filled sac at the top of the shoulder become trapped and inflamed, and are painfully pinched each time the shoulder is lifted.
Shoulder impingements are often caused by muscle imbalances, particularly where there is some shoulder instability that leaves the rotator cuff muscles working overtime. It can also be caused by trauma or overusing the shoulder, especially through repetitive overhead movements.
Your physio will work with you to confirm your diagnosis, understand why it has occurred and what aggravates your shoulder, and then form a tailored treatment plan that will likely involve hands-on therapy, home exercises, and education all designed to reduce your symptoms and help prevent them from recurring.
Cervical radiculopathy is better known as a pinched nerve in the neck, and is often an unsuspecting cause of shoulder pain, given the pain refers down towards the shoulder, shoulder blade and arm. It occurs when one of the nerves coming off the spinal cord becomes compressed, which can occur for a number of reasons such as herniated disc, degeneration such as arthritic changes, trauma, and more.
Physiotherapy can completely resolve the symptoms of cervical radiculopathy in many cases, working to help you manage your pain, using manual techniques to relieve pressure in the neck region such as gentle massage, providing education on posture, and moving you through strengthening and range-of-motion exercises when you’re ready to comfortably return to normal function.
Experiencing Shoulder Pain? Our Physios Can Help
We work with clients to help with a wide range of shoulder pains and problems, from the pains we’ve mentioned to others like shoulder instability, which can result from shoulder weakness, repeated dislocations and more. In all areas, our team's approach aims to restore pain-free movement in your shoulder joint, optimise strength and function, and help you regain normal motor control of your shoulder.
We have three clinics available in Hong Kong Central and Wong Chuk Hang, alongside our own Pilates studio to best support your rehabilitation. Book your appointment online or call us on +852 2801.4801