Physical Therapy for Shoulder Pain

Seeking physical therapy for shoulder pain is very common. People often seek physical therapy when they notice shoulder pain when sleeping, dressing, reaching, driving, lifting, and resting. Think of how many times you do those activities per day – shoulder pain can seriously disrupt your daily routine!

Pain can range in severity and can feel sharp, dull, achy, or pulling. Physical therapists commonly see patients with a new injury, a recurring ache, or a fresh surgery. Some issues solve quickly, and some take time to heal.

The shoulder joint is meant to be flexible, which means it needs a lot of muscular support to keep it stable. With so many components to the shoulder, it’s no wonder why it can seem so vulnerable.

At JACO, we provide a rare opportunity for you to be treated 1-on-1 by a physical therapist for over 50 minutes every session. We strive to empower you to manage your symptoms so that you can confidently discharge from our care. Interested in an appointment? Call us today!

Common Shoulder Injuries that Physical Therapists Treat


Physical therapists are experts at shoulder anatomy, and we treat a wide variety of shoulder injuries. This doesn’t include them all – reach out if your injury isn’t on the list!

  • Shoulder Impingement

This usually occurs with repetitive overhead reaching. Structures in the shoulder get irritated and “impinged” which provoke pain. If untreated, it can result in tendonitis, bursitis, or a rotator cuff tear.

  • Frozen Shoulder/Adhesive Capsulitis

Frozen shoulders time to resolve as the shoulder slowly loses mobility, sometimes over the course of several months. Physical therapy helps to accelerate mobility gains as you recover, but you have to be incredibly diligent in your stretching at home!

  • Rotator Cuff Tear – Nonsurgical vs Surgical

Nonsurgical: Conservative options are reserved for small or partial tears, sometimes degenerative, which don’t always need surgery to heal. Sometimes those tears become asymptomatic on their own or with the help of a physical therapist. In case of a more severely torn cuff, your physician will usually prescribe  Physical Therapy as even with those, many patients do heal without surgery.

Surgical: For larger or persistently painful tears, surgery may be necessary. If you have a rotator cuff repair, you cannot actively move your arm for up to 6 weeks, or you risk re-tearing the repair. A physical therapist can help you recover through your physician’s protocol by promoting passive range until it’s appropriate to start loading the muscles.

  • Shoulder Subluxation/Dislocation – Nonsurgical

Traumatic/nontraumatic shoulder subluxation or dislocation can be scary, but it’s usually best treated with a strengthening protocol. We can help guide you in the right direction and educate you on how to avoid dislocations in the future.

  • SLAP Tear – Nonsurgical vs Surgical

A SLAP tear stands for “superior labrum anterior posterior”. The tear occurs where the cartilage of the shoulder joint and the biceps tendon meet.

Nonsurgical: Some types of SLAP tears do very well conservatively and tend to scar down over time without surgery.

Surgical: Some types of SLAP tears are too large and painful. Surgery is needed to either anchor the biceps back onto the labrum or attach it lower on the bone ({biceps tenodesis}).

  • Bankart Lesion – Surgical

A Bankart lesion, sometimes associated with a Hill-Sachs lesion, can predispose you to recurring dislocations. Usually, surgical intervention is needed to stabilize the joint, followed by physical therapy.

  • Total Shoulder Replacement

This procedure replaces the shoulder joint to resolve pain caused by advanced arthritis. This is only if the rotator cuff is intact.

  • Reverse Total Shoulder Replacement

This procedure replaces the shoulder joint, but in reverse anatomy to preserve stability in the absence of healthy rotator cuff musculature.

  • Acromioclavicular Joint Pain (AC Joint)

The AC joint is a small joint in the shoulder that can be dislocated or sprained when falling directly on it. Although physical therapists cannot replace torn ligaments holding it in place, we can make the shoulder stronger to reinforce the joint’s anatomy.

  • Bicipital Tendonitis

This is usually caused by repetitive overhead reaching and shoulder impingement. A physical therapist can help you decrease irritating factors and strengthen the right areas to prevent return of symptoms.

What Causes Shoulder Pain?


Shoulder pain arises when something in the shoulder isn’t operating correctly. Pain generators include muscle, cartilage, and bursae. If symptoms can not be resolved conservatively, an MRI may be needed to determine the severity of the injury.

Tendinitis occurs when a muscle’s tendon is inflamed due to overload misuse or overuse. This can be the precursor to a tear, where the muscle or its tendon are disrupted partially or completely. In some cases, it can result in surgery.

The labrum, or cartilage inside the shoulder joint, can also become disrupted. This usually occurs when falling on your outstretched arm or subluxing/dislocating the shoulder from the socket. Sometimes this requires surgery, but both surgical and nonsurgical interventions require heavy emphasis on shoulder stabilization exercises to keep the joint strong.

Does Physical Therapy Help Shoulder Pain?


The short answer – yes! The long answer – yes, absolutely!

Your first physical therapy session will be spent understanding your shoulder’s pain patterns and movement/strength deficits. At JACO, we always check surrounding structures to rule out referred pain from another source.

If we suspect that your pain is originating from something other than the shoulder itself, we will work with your physician to request additional testing. There are serious conditions that mask themselves as shoulder pain, so make sure you tell your physical therapist and physician if you have underlying conditions that need to be considered such as heart and vascular problems.

Once we determine that you are appropriate for physical therapy, we give you a few exercises to perform at home so that you can get on the road to recovery! For best results, you need to stay consistent with your exercises at home.

Subsequent sessions will be used to check on your progress and see if exercises are being performed correctly. Your physical therapist may change your home exercises according to your shoulder’s presentation so that you may reach your goals!

Exercises are always chosen to specifically fit your needs and we will always follow your surgeon’s protocol to protect the surgery if you are coming in with a post surgical condition.

  • First 6 weeks into your rotator cuff repair? Passive range of motion ONLY! Don’t move it yourself. Seriously. Contact us.
  • Can’t do certain activities of daily living? Your shoulder may be missing certain range of motion range of motion. Let us help you with that… more specifically, let us help you get the reach so YOU can do that.
  • Traveling pain from shoulder to elbow? Could be shoulder, could also be neck. We’ll check it out to make sure you’re doing the right exercises.

Before doing any new exercises on your own, consult your physical therapist.

You may also gain insight into why your pain occurred in the first place. Do you have an underlying nerve impairment that affects the strength of your shoulder? Do your lifting mechanics need adjustment? You and your physical therapist can work together to figure it out.

Top 5 Frequently Asked Questions about Shoulder Injuries


1. What’s the best way to sleep with shoulder pain?

There’s no easy answer to this because everyone is different. However, most people find it uncomfortable to sleep on the affected shoulder. Most people find relief by sleeping on their unaffected side or laying on their back with their shoulder propped on a pillow.

It’s critical to get adequate sleep for recovery. If you’re having difficulty finding relief, talk to your physical therapist.

2. When should I get an MRI?

X-rays are helpful in ruling out bone issues, but they don’t show the full picture. Most insurance policies won’t approve an MRI until you’ve attempted conservative care for your shoulder. This may seem frustrating, but many of shoulder pain cases heal without surgery.

If your symptoms are persistent despite conservative care, it’s a sign that further intervention may be appropriate. In this case, findings in an MRI are more likely to be pain-generators. Therefore, an MRI may be necessary as a precursor to surgery. An MRI result doesn’t normally change the course of physical therapy unless there are many components to the injury that need clarification from imaging. But it does tell the surgeon the significance of the pathology.

At JACO Rehab, we give your symptoms 6-8 visits to respond. If there is no difference in your symptoms or functional status, we will coordinate care with your doctor for imaging or additional testing.

3. Should I feel pain after physical therapy for my shoulder?

Depending on the injury, some discomfort is to be expected. Some pain is gain, but not all pain. Sharp, constant pain is not an appropriate response and should be alerted to the therapist so that adjustments can be made. You should also tell your physical therapist if neck or elbow pain occurs.

Here are some examples of appropriate pain:

  • Muscle soreness from a workout, or delayed onset muscle soreness, which resolves with time
  • Achiness after stretching a frozen shoulder which resolves with heat
  • Slight achiness after passive ranging for a rotator cuff repair which resolves with ice/over-the-counter pain medication if medically appropriate
  • Intense pulling during a stretch for frozen shoulder that goes away when released
  • Tenderness in muscle during soft tissue manipulation which eases when released

 

4. How long does it take to recover from shoulder surgery?

Different protocols are used for different types of surgeries and are often surgeon-specific. Make sure you clarify what you can/can’t do right after surgery with your surgeon and physical therapist. You don’t want to get re-injured!

You need to hit certain milestones in your protocol before progressing forward. Some people progress slower than others, and that’s okay. If you are consistent with your home exercise program provided by your physical therapist, you’ll likely stay on-target for recovery.

As always, the timeline differs between surgeries. Most people don’t feel completely normal again until 6-12 months after the surgery because of remaining weakness. It takes 6 weeks to see initial strength gains, and muscles take a while to adapt. Loading muscles too quickly could cause problems. You can’t force it. So, you will need to continue strengthening even after physical therapy finishes. Learn everything you can from your therapist!

5. What should I wear for physical therapy?

You should always wear something that exposes the joint we’re working on. So, if we are treating your shoulder, a short-sleeve shirt or tank top would be most appropriate.

We ask that you please remove all lidocaine patches, kinesiotape, and ointments prior to physical therapy, so that we have direct access to the shoulder and all its raw glory.

If you’re fresh from surgery, you can leave surgical dressing alone. This includes steri-strips. Do not remove these unless otherwise directed. They help protect against infection and promote a healing environment for the incision sites.

Book an appointment with JACO Rehab today – be proactive and don’t wait for things to get worse.

Quick Tips for Injury Prevention

Three Stretches to Reduce Shoulder pain

Frozen Shoulder Self treatment

Prevent Shoulder Pain

Frozen Shoulder Self Help

Shoulder Exercises for Swimmers

Shoulder Strengthening Exercises

These videos are not a replacement for professional physical therapy but to help alleviate for minor injuries and aches.

Contact Jaco

Call: (808)381-8947

Send An Email: scheduling@jacorehab.com