When is shoulder pain abnormal? Your FAQs, answered

1. What are the most common causes of shoulder pain?

Shoulder pain can stem from a variety of causes. Common causes include repetitive reaching or lifting, such as painting, throwing, or pressing; heavy lifting; or taking a fall on your shoulder. Physical therapy can help address a broad spectrum of pain and mobility issues.

If you feel pain while lifting your arm, have weakness, or have trouble sleeping on the side of your sore arm, you might have a rotator cuff irritation. The rotator cuff is a group of small muscles that stabilize your shoulder and can get irritated easily; rest and physical therapy can help reduce inflammation. If the pain is sharp and happens when you lift your arm overhead, you might have an impingement, which means structures in your arm are getting compressed, or “pinched.” Posture can also be a factor: if you sit a lot in your daily life, your shoulders round forward, which can lead to an achy feeling while lifting or tightness in the front of the shoulder or chest.

2. Can physical therapy help with shoulder pain?

Yes, physical therapy can be very effective for treating shoulder pain. Whether your discomfort is caused by injury, overuse, or conditions like rotator cuff tendinopathy or frozen shoulder, a physical therapist can assess the root cause and develop a personalized plan. Treatment may include exercises, manual therapy, and movement education to reduce pain and restore function. Physical therapists can treat a wide variety of conditions, including sports injuries from throwing, post-surgery recovery, chronic shoulder pain, and neck-related shoulder pain.

3. Can therapy reduce pain from shoulder impingement?

Yes, physical therapy can reduce pain from shoulder impingement, or subacromial pain syndrome. Physical therapy can improve postural awareness and strength, joint mobility and stability, and general flexibility, which promotes overall healing and strengthening of the shoulder. Physical therapists can also provide instruction for better body mechanics for daily exercise and modifications for activities.

4. What are the symptoms of a rotator cuff tear and will rehab help?

Physical therapy can help address symptoms of a rotator cuff tear. The rotator cuff is made up of four different muscles that help the shoulder perform different movements. A complete or incomplete tear in any of these muscles can cause difficulty and diminished strength in lifting your arm over your head, and pain in the middle of your range of motion as you lift your arm. Physical therapy can help remedy these symptoms by restoring range of motion and improving strength and shoulder function. Even with a complete tear, physical therapy can provide relief by strengthening the surrounding muscles to improve overall shoulder function and reduce pain. If surgery is needed, physical therapy before surgery can improve surgical outcomes by increasing strength and proactively restoring range of motion.

5. Will physical therapy help a frozen shoulder?

Yes, physical therapy will improve a frozen shoulder and is crucial for restoring motion and function in the frozen and thawing stages. After an initial evaluation, your physical therapist will devise an individualized treatment plan based on the stage of frozen shoulder. Treatment plans often include manual therapy, therapeutic exercises and modalities, and an at-home exercise program that promotes long-term healing. The most effective approach to resolving a frozen shoulder focuses on consistently improving range of motion, without causing more pain or discomfort. Physical therapy can also help with pain management and prevent further stiffness in the pre-freezing and freezing stages.

6. Can shoulder pain go away on its own?

It depends. Shoulder pain can sometimes go away on its own, especially if it’s caused by acute inflammation from doing too much of a new activity—think, playing pickleball for the first time, or playing catch for a few hours with your kids. If you experience shoulder pain that only occurs with specific movements, it can be worth seeing a physical therapist to reduce the pain even if it’s not limiting your daily activities. Pain that persists for longer than one to two weeks means it’s time to see a physical therapist. Typically, the earlier you come to physical therapy, the sooner a physical therapist can resolve your pain.

7. Should I rest or exercise when my shoulder hurts?

Rest and exercise can both be appropriate at certain times. If your pain is worsening with exercise, then you should rest your shoulder but plan to slowly reintegrate exercise, so that you can return to your normal activities. Shoulder pain stems from a variety of reasons and can result in range of motion restrictions or strength deficits. Guided exercise can help address those motion restrictions. A physical therapist can help you determine if rest or exercise is best for your condition and can develop a targeted treatment routine to get you back to your daily life without pain.

8. Why is my shoulder hurting after exercise?

Shoulder pain after exercise can happen for a variety of reasons. You might feel sore 12-48 hours after a workout, as your muscles adjust to a new movement and experience tiny, microscopic tears; this is a normal part of getting stronger. Immediate or lingering soreness might indicate that you’ve overused your shoulder. A sharp, pinching pain or pain with certain movements could suggest that you’re exercising with incorrect form and mechanics, which can cause stress to build up in the shoulder.

So, when is pain not normal? Pay attention to your pain if it’s sharp and stabbing, doesn’t improve after a few days, you have weakness or inability to lift the arm, or you have night pain that wakes you up. These signs mean it’s time to get checked out. A physical therapist can help diagnose your issue and adjust your exercise program, build shoulder strength, stability, and improve joint mobility, and rehabilitate an injury.

9. How do I treat shoulder pain at home? 

For new and undiagnosed shoulder pain, avoid activities and movements that cause pain. For new injuries, consider ice, while heat may feel better for tight muscles or an arthritic shoulder. If sleep is painful, try sleeping on your back or on the opposite side, with a body pillow supporting the painful shoulder. As your symptoms improve, resume gentle activity. This could include gentle stretching for the neck and upper back, doorway stretches, pendulum arm swings, and an external shoulder rotation with a TheraBand or light dumbbell. If your pain levels remain low or disappear entirely, gradually return to full activity. Be mindful to maintain an efficient posture of the head, neck, and shoulders; as you lift heavy weights, modify your form to keep the load close to your body. If the pain lasts for one to two weeks, it’s time to check in with a physical therapist for an evaluation.

10. When should I worry about shoulder pain?

If your shoulder pain is not relieved by rest, or is not correlated with certain positions or activities, you should seek care. Other warning signs include difficulty performing everyday tasks, failure of symptoms to improve after modifying your activities for one to two weeks, or new symptoms that radiate down your arm. If you have prolonged pain, call one of our offices today to get checked out.

11. What does physical therapy for the shoulder involve?

Physical therapy for the shoulder is individualized for every patient and their specific impairment and goals. Most shoulder-focused physical therapy regimes center around restoring range of motion. Generally, treatment plans involve exercises to strengthen and increase mobility in the shoulder, cervical spine, and thoracic spine, in addition to rotator cuff stability. Physical therapists can also provide manual therapy based on the specific shoulder condition. If you’re receiving physical therapy to recover from surgery, your treatment plan will be coordinated with your surgeon.

12. Do I need a referral to start physical therapy for shoulder pain?

No, you do not need a referral to make a physical therapy appointment for your shoulder pain. Under Direct Access, a law in Pennsylvania and New Jersey, you can see a Direct Access certified physical therapist immediately without a prescription from your doctor. Most health insurances cover physical therapy obtained by using Direct Access, but if yours does not, our staff will help you get what you need from your doctor to be covered.

13. Is physical therapy better than surgery for shoulder injuries?

Depending on your shoulder injury, physical therapy might be more effective or preferable to surgical intervention. With shoulder dysfunction, there’s usually an underlying mechanical problem that alters joint mechanics and leads to pain. While surgery can correct damage to shoulder anatomy, it doesn’t correct deficits in range of motion, strength, or mechanics; these issues often have to be addressed in post-surgical physical therapy. Surgery also involves a host of potential complications, including infection and nerve injury, and typically costs more than a standard six-to-eight-week schedule of physical therapy. For some common shoulder conditions, such as subacromial pain syndrome, research has demonstrated that there is no statistically significant difference in outcome between patients who undergo surgery versus physical therapy. Basically, surgery may be required for your shoulder, depending on the extent of your injury and your functional needs, but physical therapy can be used as a first-line intervention to address your pain non-invasively.

14. Why do I have numbness or tingling in my arm?

Numbness or tingling in the arm is often related to nerve irritation. Nerves are like electrical cords that run from your neck, through your shoulder, and down your arm. If they’re irritated, stretched, or compressed anywhere along that path, you may feel symptoms such as tingling, “pins and needles,” numbness, or weakness. Nerve irritation is often caused by neck or shoulder stiffness, as tight joints or muscles reduce space around nerves; poor posture or positioning, inflammation or arthritis, and repetitive or overhead activities. Physical therapy can reduce nerve irritation by improving posture and joint mobility, stretching tight tissues that may be compressing nerves, strengthening muscles to better support the neck and shoulder, and providing positions and movements to reduce pain. Many patients notice that as mobility and posture improve, numbness and tingling become less frequent or less intense.

Tell your therapist or provider right away if your numbness or tingling is getting worse or constant, is accompanied by significant weakness, spreads rapidly or affects your balance, or is associated with sudden pain, loss of coordination, or changes in bladder/bowel control. These signs may require further medical evaluation. Physical therapists will adjust treatment based on how your body responds.