Shoulder pain is extremely common, whether you’re an athlete, a gym-goer, or just someone who lifts things (or kids!) every day. In fact, shoulder pain is one of the most frequent musculoskeletal complaints reported in both the general and sporting populations (Brukner et al., 2017).
But why does it happen, and what can you do about it?
Let’s break it down simply — with some support from current research.
Common Causes of Shoulder Pain
Shoulder pain can result from:
- Overuse or repetitive movement, especially in sports like swimming, tennis, or gym-based overhead lifting
- Poor posture or technique, which changes how your shoulder blades move
- Imbalances in strength or flexibility, particularly between the front and back of the shoulder
- Previous injury, which increases your likelihood of pain recurrence by up to 11 times (Hill et al., 2015)
One study specifically looked at swimmers and found that reduced internal rotation and increased external rotation (often due to tightness at the back of the shoulder and stretching at the front) were linked to a greater risk of injury (Hill et al., 2015). In simple terms any movement deficits at the shoulder can increase your chance of shoulder injury significantly
Increased external rotation may result from anterior capsule laxity, while reduced internal rotation may be due to tightness in the posterior capsule — both of which affect how smoothly the shoulder joint moves (Ebraheim, 2017; Internal Impingement of the Shoulder, 2021). In simple terms, any stiffness or instability at the shoulder will effect how well you can use your shoulder
Rotator Cuff Injuries: A Common Culprit
Rotator cuff injuries — where one or more of the small muscles that stabilise the shoulder becomes irritated or torn — are particularly common with age. Over 50? Your chances go up significantly (Merolla et al., 2011). But even young athletes are not immune, especially those with poor technique or high training loads.
Muscle weakness, particularly of the rotator cuff, has been shown to contribute to shoulder pain. A study by Hill et al. (2015) found that swimmers with weaker internal rotation torque had higher rates of pain and dysfunction.
What About Surgery?
Surgery is typically reserved for more severe cases, or if conservative treatment hasn’t worked. But outcomes vary.
- Patients over 63 years old tend to have poorer surgical outcomes (Merolla et al., 2011)
- Partial tears generally respond well to conservative treatment
- Older patients may report better satisfaction post-surgery due to lower functional demands (Pécora et al., 2015)
Importantly, a high reinjury rate after surgery has led many clinicians to favour exercise-based rehab first.
What Does the Research Say About Physiotherapy?
Exercise therapy — particularly strengthening the rotator cuff and shoulder stabilisers — is strongly supported in the literature. In fact, patients who completed strength training had significantly lower incidence of shoulder pain than those who didn’t (Hill et al., 2015).
Manual therapy, posture retraining, scapular control, and motor pattern corrections are all common parts of a physio’s toolkit.
In contrast, corticosteroid injections, once popular, are no longer routinely recommended due to poorer long-term outcomes (Brukner et al., 2017).
How Can Physiotherapists Help?
A physiotherapist will assess:
- Your shoulder mobility and strength
- Scapular (shoulder blade) movement
- Any technique issues related to your sport or occupation
- Underlying issues like poor posture, thoracic stiffness, or core weakness
Then, they’ll prescribe a personalised rehab plan that might include:
- Strengthening exercises
- Stretching tight structures
- Postural corrections
- Movement retraining
- Return-to-activity planning
Takeaway
Shoulder pain, particularly related to rotator cuff dysfunction, doesn’t have to be a life sentence. The right rehab — backed by research — can often prevent surgery and get you back to doing what you love.
If your shoulder is slowing you down, don’t wait. Reach out to a physio who can guide you through a safe and science-supported recovery.
References
Brukner, P., Brukner, P., Bahr, R., McCrory, P., & Khan, K. (2017). Brukner & Khan’s clinical sports medicine. Volume 1, Injuries (5th ed.). McGraw-Hill Education (Australia).
Hill, L., Collins, M., Posthumus, M., & Schwellnus, M. P. (2015). Risk factors for shoulder pain and injury in swimmers: a critical review. Physical Therapy in Sport, 16(1), 96–102.
Internal Impingement of the Shoulder. (2021). Physiopedia. Retrieved from https://www.physio-pedia.com/Internal_Impingement_of_the_Shoulder
Linaker, C. H., & Walker-Bone, K. (2015). Shoulder disorders and occupation. Best Practice & Research Clinical Rheumatology, 29(3), 405–423.
Merolla, G., Paladini, P., Ciaramella, G., & Porcellini, G. (2011). Surgical versus conservative management of rotator cuff tears: a review. Muscles, Ligaments and Tendons Journal, 1(2), 70–73.
Pécora, J. R., Fagotti, L., Santana, G. C., de Andrade, M. S., & Cohen, M. (2015). Clinical and functional outcomes of rotator cuff repair in patients aged 70 years and over. Acta Ortopédica Brasileira, 23(6), 303–306.
