Struggling with Shoulder Pain? 

Shoulder pain is a common injury,  particularly for people who work out in the gym or who play sports.

Many weightlifting exercises require the use of the shoulder muscles, which can easily become strained or injured if not done correctly. 

Additionally, poor sleeping posture can also contribute to shoulder pain. People who sleep on their side may experience joint compression or pinching of the nerves, which can lead to pain and discomfort.

It is essential to address shoulder pain to prevent it from becoming a chronic problem.

Old advice like rest, ice, compress and elevate does not often solve the issue leaving people in pain and wanting to know how they can become pain-free.

Have a read of John’s story below.

Shoulder Pain Liverpool Case Study

John, a keep weightlifter from Liverpool was suffering from pain in his shoulder.

He felt stiffness and swelling at the front of his shoulder in the mornings and it got worse after exercise even just light weights.

He'd been to the NHS who gave him a quick massage and some generic exercises but nothing changed. 

His shoulder got so painful that he could not lift a bottle of water without severe pain. 

So he typed treatment for shoulder pain into Google and found my clinic FM Physio in Liverpool.

He wanted to get back to weightlifting and this was his main goal.

With the right treatment shoulder symptoms can resolve quickly.

In 6 weeks his pain had fully resolved and he's back in the gym doing what he loves again.

Right assessment = right treatment = right result.

Here is an explanation of what was wrong and what I did to help his shoulder heal.

What causes most shoulder pain?

At FM Physio in Liverpool City Centre, I see a lot of shoulder pain and most of this is usually due to poor muscle coordination.

What do I mean by this? 

When you pick something up e.g. a cup of tea or a weight in the gym, the first area or muscles that need to work is the hand and wrist (otherwise we would not be able to pick it up).

Then we need to be able to transfer the weight from the wrist to the elbow, then from the elbow to the shoulder and chest muscles.

This is how we successfully pick up an object without pain. Usually, this is done without you even thinking.

However, with most painful shoulders, what often happens is that all of the stress is going through the shoulder joint causing pain.

As discussed this is usually due to weakness in the hand, wrist, elbow or chest muscles.

See the picture below that explains. 

On the left side, all the weight is transferred evenly through each joint (25% wrist, elbow, chest & shoulder) so the body does not have any pain when doing any movements like picking up a weight.

Whereas, on the right, the wrist, elbow and chest are not doing enough work (5%) so all the weight is going through the shoulder (85%) and the body is interpreting that as pain. 

Until this imbalance is corrected then the pain will remain.

What should I do if I have shoulder pain?

So the first thing you need to do is to improve the coordination between all your muscles so that you take the load off the shoulder joint. 

This is done with specific exercises targeted at improving your muscles coordination, if you've been given strengthening exercises before by your GP or physio, these will not specifically target your coordination and sometimes will exacerbate the issue. 

Now there is a time and a place for strengthening, but not at the start.

At FM Physio in Liverpool, I focus on the 80/20 rule, which is 80% focusing on improving the coordination of the muscles in your arm so they work as one unit and 20% on desensitising the area with hands-on treatment. 

Once all your muscles are activating in the correct pattern, then we can start strengthening it.

If you strengthen it too early, your shoulder will just get more painful as you will further overwork your shoulder that’s already overworked.

If you've been to a physio and most of their treatment was hands-on then this will have only helped short term as it never got to the root cause of your problem. 

It’s easy to get a massage or have acupuncture but if you really want to get back to your sport or in the gym, it’s the exercises that will make the biggest difference.

How can I arrange a physiotherapy assessment for shoulder pain?

If you suffer from shoulder pain then you have 2 options, 1) book a 30-minute strategy call to see if FM Physio is the right fit for you and we can delve deeper into what I’ve discussed and get you a plan together with clear milestones or if you are ready to pull the trigger, book in for a face to face assessment in my Liverpool City Centre clinic.

Link to book free strategy call HERE

Link to book an assessment at FM Physio in Liverpool HERE

If you’re still unsure, keep reading…

What would a physiotherapy assessment for shoulder pain involve?

The first thing that I do is find out what your goals are and what your shoulder pain is holding you back from doing as this is very important.

If I don't know what the end goal is then I won't be able to set you clear milestones so that you know you are progressing in the right direction. 

If you have a clear plan and you can tick off each milestone then you will continue to do the work and see the results. I will also go through your injury history, medical history etc as sometimes this has a few clues to why your shoulder is painful.

Once this is done, I will get into the physical assessment.

This starts with a general movement assessment to see if you have any obvious issues and then I will progress into doing a thorough shoulder assessment with a key focus on your muscle coordination.

What conditions are related to shoulder pain?

Shoulder pain can be caused by a variety of conditions that affect the joint, muscles, tendons, and ligaments of the shoulder. One common cause of shoulder pain is rotator cuff tendinitis, which occurs when the tendons that attach the rotator cuff muscles to the shoulder bones become inflamed and irritated.

Another common cause is shoulder impingement syndrome, which results from the pinching of the tendons or bursa in the shoulder joint.

Bursitis, a condition in which the bursae (small fluid-filled sacs) become inflamed, can lead to shoulder pain as well. A shoulder fracture or dislocation, which can occur from a traumatic injury or fall, may also cause shoulder pain.

Finally, shoulder pain can be associated with conditions such as frozen shoulder, biceps tendinitis, and adhesive capsulitis. 

The main thing to note is most of the shoulder issues that did not have a clear mechanism of injury like a fracture are often due to an imbalance and that's where completing a thorough shoulder assessment comes in. 

Pain, inflammation, lack of movement, weakness etc are usually a symptom of the cause, find the cause and these will go away usually within 6 weeks or less. 

What diagnostics are related to shoulder pain?

9/10 these tests are not clinically necessary. 

Some doctors may recommend certain diagnostic tests. The first step is usually a physical examination of the joint followed by imaging tests like X-ray, MRI, or ultrasound. 

These tests help to visualise the bones, joints, and soft tissues around the shoulder to determine the extent of the injury or damage.

In some cases, doctors may also recommend an arthroscopy, which is an invasive procedure that involves inserting a small camera into the shoulder joint to identify problems. 

Just because you have had an X-ray, MRI, ultrasound or even an arthroscope does not mean that you have got to the root cause of the problem. 

Our medical system is built around finding a diagnosis but what if that inflamed tendon at the front of your shoulder was actually caused by your weak wrist that you fell over 5 years ago?  

What should I do if I have shoulder pain?

Don't waste time, if it's causing you pain and has been there for longer than 2-3 weeks, reach out to a physio. 

The NHS waiting lists are huge and they can take up to a year to see a physio for ongoing treatment. 

Even then the number of times I have heard someone just being given a sheet of generic exercises and then sent on their way again. 

I have successfully treated most shoulder pain in 6 weeks of less but getting the right treatment quickly is key because the longer you leave it, the longer it will take to heal.

When should I see a physiotherapist?

If your pain has not gone away in 2-3 weeks it's likely that you will need to do something to help your body heal the issue. 

If you ignore it and continue to go to the gym and lift weights or do your sport, it's likely that your problem will get worse and worse. 

Here is a free guide on shoulder pain but if you feel that you need a professional to look at your shoulder and you live in Liverpool then book in for an appointment here. 

I'm offering 10% off this spring so act fast as there are only a few openings each week BOOK HERE

Thanks for reading

Stuart Goldfinch - Founder FM Physio, Ex- UK SAS Trainer, Head Police Physio, Specialist NHS Lower Limb Team.