Shoulder Pain: 4 Causes, Symptoms and Treatment

Shoulder pain often starts as a small twinge, but it can quickly turn into a daily ache that makes simple things—like getting dressed or working out—uncomfortable.

It’s one of the most common reasons people come to see me for physiotherapy in Sandton, and research shows that up to 26% of people will experience it at some point in their lives¹.

This article will help you understand what causes shoulder pain, the most common symptoms, and how the right shoulder pain physiotherapy approach can relieve discomfort and get you moving again—safely and pain-free.

---

What is Shoulder Pain?

Shoulder pain happens when you feel discomfort in or around your shoulder joint. This pain can come from different parts of the shoulder, like the muscles, tendons, ligaments, bones, or even nerves.

The shoulder is the most flexible joint in your body, allowing you to move your arm in many directions, but this also makes it more likely to get hurt or wear out over time.

How Common is Shoulder Pain?

Shoulder pain is very common—studies show that up to 26% of people experience it at some point in their lives¹. If you’re feeling it now, you’re not alone.

It’s especially common in:

• Adults over 40 – wear and tear in the shoulder joints and tendons becomes more likely with age².
• Athletes – especially those who play sports like tennis, swimming, or baseball, where the shoulder is used repeatedly.
• People with physical jobs – such as construction workers, factory workers, or anyone doing frequent heavy lifting or overhead work³.

Repeated stress or overuse can slowly build up, causing pain that sticks around or worsens over time—especially without the right physiotherapy for shoulder pain.

What Are Common Symptoms of Shoulder Pain?

1. Aching Pain in the Shoulder: A dull, constant ache that seems to sit deep in the shoulder joint, especially noticeable when at rest or after using the arm for a while.
2. Sharp Pain When Moving the Arm: A sudden, sharp pain that occurs when lifting the arm overhead, reaching behind your back, or performing certain movements like throwing or pushing.
3. Stiffness: Difficulty moving your shoulder freely, often feeling like your shoulder is “frozen” or “stuck,” making it hard to reach for objects or put on a shirt.
4. Weakness in the Arm: A sense of weakness or lack of strength in your shoulder and arm, making it challenging to lift even light objects or do everyday tasks.
5. Clicking or Popping Sounds: Hearing or feeling a clicking, popping, or grinding sensation in the shoulder when you move it, often accompanied by discomfort.
6. Pain When Sleeping: Discomfort that gets worse when lying on the affected shoulder, making it hard to find a comfortable sleeping position and causing disturbed sleep.
7. Tenderness to the Touch: Sensitivity or pain when you press on certain areas of the shoulder, like on the front or top of the shoulder joint.
8. Swelling or Warmth: Visible swelling around the shoulder or a warm sensation in the area, indicating inflammation or injury.

Why Does Shoulder Pain Happen?

Wear and Tear Over Time

One of the most common reasons people seek shoulder pain relief is from gradual wear and tear. Everyday movements—especially repeated overhead reaching or lifting—can put stress on the shoulder joint.

Over time, this leads to small injuries in the muscles, tendons, or joints that build up and cause ongoing discomfort.

Inflammation and Swelling

When your shoulder is overused or irritated, the tissues can become inflamed. This swelling makes the joint feel tight and painful, and even simple movements can start to hurt.

It’s a common reason people come in for physiotherapy for shoulder injury.

Muscle and Tendon Damage

The muscles and tendons around your shoulder play a big role in keeping it stable and moving smoothly. When these structures are strained—either from overuse or sudden injury—they can become painful, weak, or inflamed.

This kind of damage often builds up from repetitive shoulder movements or poor posture over time.

Joint Instability

The shoulder is a very mobile joint, but that mobility makes it more prone to instability.

When the ligaments or support structures weaken, the joint can feel loose, wobbly, or painful—especially during lifting or overhead motions.

If left untreated, instability can lead to repeated injuries.

Conditions That Cause Shoulder Pain

1. Rotator Cuff Tendinitis: Inflammation or irritation of the rotator cuff tendons, often due to overuse or repetitive motions. This is the most common cause of shoulder pain and usually affects the Supraspinatus tendon.
2. Shoulder Impingement Syndrome: Occurs when the rotator cuff tendons are pinched during shoulder movements, leading to pain, especially when lifting the arm.
3. Biceps Tendinopathy: Occurs when the long head of the biceps tendon becomes irritated or inflamed from overuse, causing pain in the front of the shoulder, especially during lifting or overhead movements.
4. Rotator Cuff Tear: A tear in one or more of the rotator cuff tendons—often the supraspinatus—can result from a sudden injury or gradual wear over time. It commonly leads to pain and weakness, especially when lifting or rotating the arm, as seen in a Supraspinatus Tear.
5. Frozen Shoulder (Adhesive Capsulitis): A condition characterized by stiffness and restricted movement, usually developing gradually and often without an obvious cause.
6. Bursitis: Inflammation of the bursa (fluid-filled sacs) that cushion the shoulder joint, typically caused by repetitive motion or prolonged pressure.
7. Shoulder Arthritis: Degeneration of the shoulder joint cartilage, leading to pain, stiffness, and swelling, commonly due to osteoarthritis or rheumatoid arthritis.
8. Labral Tear: A tear in the ring of cartilage (labrum) surrounding the shoulder socket, often caused by injury, repetitive overhead motions, or degeneration.
9. Shoulder Instability: Occurs when the head of the upper arm bone is forced out of the shoulder socket, leading to pain, weakness, and repeated dislocations.
10. Shoulder Dislocation: A condition where the upper arm bone pops out of the shoulder socket, typically due to a fall or trauma, causing intense pain and immobility.
11. Calcific Tendinitis: A buildup of calcium deposits within the rotator cuff tendons, leading to sudden, severe shoulder pain, especially when lifting the arm.
12. Fractures: Breaks or cracks in the bones of the shoulder, usually due to trauma or falls, causing sharp pain, swelling, and limited movement.
13. Nerve Impingement (Brachial Plexus Injury): Compression or injury of the nerves that run from the neck to the shoulder, causing pain, tingling, or numbness.
14. Referred Pain from Neck (Cervical Radiculopathy): Pain that radiates from the neck to the shoulder due to compressed or irritated nerves, often mistaken for shoulder pain.

Common Mistakes People Make When They Have Shoulder Pain

Ignoring the Pain

One of the most common mistakes is simply ignoring the pain, hoping it will go away on its own.

Shoulder pain often starts off mild and intermittent, but if left unchecked, it can progress to more severe and constant discomfort.

Self-Diagnosing and Self-Treating:

Another pitfall is trying to diagnose and treat the problem yourself without consulting a healthcare professional.

While rest and over-the-counter pain relievers might provide temporary relief, they don’t address the underlying cause of the pain. Misdiagnosing your condition could lead to ineffective treatments that allow the problem to worsen.

Pushing Through the Pain

Many people, especially athletes and active individuals, make the mistake of pushing through the pain, continuing their activities despite discomfort.

This can lead to further injury, increased inflammation, and longer recovery times.

Delaying Treatment

Some people delay seeking professional help, thinking that the pain isn’t serious enough to warrant a visit to the Healthcare Professional.

However, early intervention is key to preventing further damage. Delaying treatment can result in the condition becoming more complicated and harder to treat, requiring more intensive interventions later on.

Inadequate Rehabilitation

After an initial diagnosis and treatment, some individuals fail to complete their rehabilitation program.

Skipping physical therapy sessions or not following through with prescribed exercises can hinder recovery and increase the risk of re-injury.

Proper rehabilitation is important for restoring strength, flexibility, and function to the shoulder.

What Happens if Shoulder Pain is Left Untreated?

Chronic Pain

What might start as occasional discomfort can turn into chronic pain if left untreated. Chronic shoulder pain can become a daily issue, making it difficult to perform routine tasks and severely impacting your quality of life.

Loss of Mobility

As shoulder pain progresses, you might find it increasingly difficult to move your shoulder. Conditions like frozen shoulder can develop, leading to significant stiffness and a loss of range of motion. This can make it challenging to perform even basic activities like reaching overhead or dressing.

Muscle Weakness and Atrophy

Without proper treatment, the muscles around the shoulder can weaken over time. This is especially true if pain causes you to avoid using the affected arm. Muscle weakness can lead to further instability in the shoulder joint and increase the risk of additional injuries.

Joint Damage

Conditions like arthritis can worsen without treatment, leading to the breakdown of cartilage in the shoulder joint. This degeneration can result in increased pain, stiffness, and eventually, the need for surgical intervention, such as joint replacement.

Permanent Damage

In severe cases, neglecting shoulder pain can lead to permanent damage. Torn tendons, damaged cartilage, and other structural issues can become irreversible if not addressed promptly. This could result in long-term disability or the inability to use the shoulder normally.

What Can You Expect With Shoulder Pain?

With the right diagnosis and treatment, most shoulder injuries can be managed effectively—often without surgery. Conditions like rotator cuff tears, bursitis, or tendinitis usually respond well to physiotherapy for shoulder injury, relative rest, and activity modification.

More serious cases—such as large tears or advanced arthritis—may need surgical care for long-term relief and function.

If shoulder pain is ignored or treated incorrectly, the risk of chronic pain, stiffness, and permanent joint damage goes up.

But even in advanced cases, options like rehab and surgical treatment can still improve your movement and reduce pain.

Treatment Options

Myofascial Release

Myofascial release is a hands-on technique that helps relieve tension in the muscles and the connective tissues (fascia) around them.

By applying gentle pressure, I can help loosen up tight areas, reduce pain, and improve your shoulder’s mobility. This treatment is especially helpful if your shoulder pain is related to muscle tightness or knots.⁴

Orthopedic Manual Therapy

Orthopedic manual therapy includes techniques where I use my hands to move your joints, stretch your muscles, and improve your shoulder’s function. This might include:

• Joint Mobilization: Gentle movements of the shoulder joint to improve its range of motion.
• Soft Tissue Massage: Massaging the muscles and tendons around the shoulder to reduce tension and improve blood flow.

These hands-on treatments can help reduce pain, improve mobility, and speed up your recovery¹.

Exercises for Shoulder Pain

Exercises are one of the best ways to treat shoulder pain. A personalized exercise plan can help you get stronger, more flexible, and improve your shoulder’s movement. Some key exercises include:

• Stretching Exercises: These help loosen up your shoulder, reduce stiffness, and improve your range of motion.
• Strengthening Exercises: These focus on the muscles around your shoulder joint, like the rotator cuff, to make your shoulder stronger and more stable.
• Posture Exercises: Good posture can prevent shoulder pain. Exercises that improve your posture can reduce strain on your shoulder and help prevent future problems.⁶

Dry Needling

Dry needling involves using thin needles to target tight muscles or trigger points that cause pain. This treatment can help release muscle tension, reduce pain, and improve your shoulder’s movement.

It’s similar to acupuncture, but it focuses on muscle pain and dysfunction. Dry needling can be an effective way to treat shoulder pain that is caused by muscle tightness or spasms³.

Laser Therapy

Laser therapy uses low-level lasers to reduce pain and inflammation in the shoulder. This treatment can help speed up healing by increasing blood flow and reducing swelling. Laser therapy is a painless and non-invasive way to treat shoulder pain, especially for conditions like tendinitis or bursitis⁵.

Taping and Bracing

Sometimes, taping or bracing your shoulder can help support it and reduce pain during activities. Taping, like using kinesiology tape, can help stabilize your shoulder and relieve pressure on injured areas.

A shoulder brace might be recommended if you have instability or are at risk of dislocation. This can help you stay active while protecting your shoulder from further injury. ⁶

Education and Self-Care

Understanding your condition is key to managing shoulder pain. I’ll teach you about proper body mechanics, how to perform exercises safely, and what activities to avoid or adjust to prevent further injury.

We’ll work together to develop a self-care plan that fits your lifestyle and keeps you on the path to recovery¹.

Once your shoulder starts to feel better, it’s important to gradually return to your normal activities. I’ll guide you on how to safely increase your activity levels without risking re-injury.

Conclusion

As a physiotherapist, I want you to know that shoulder pain doesn’t have to be a lifelong struggle. With the right steps and a little patience, you can feel strong, mobile, and pain-free again.

I see people every day who feel limited by their shoulder pain—but I also see how effective the right physiotherapy for shoulder injury can be.

Whether it’s discomfort from training, work, or everyday tasks, you don’t have to push through it alone.

If you ever need help or support, just reach out. Let’s get your shoulder moving the way it should.

About the Author

Daniel da Cruz is a licensed physiotherapist in Sandton, Johannesburg, with extensive experience treating shoulder-related conditions such as rotator cuff injuries and impingement syndrome.

He uses a combination of exercise-based rehabilitation, manual therapy, and patient education to restore shoulder strength, mobility, and function. Daniel’s goal is to help patients recover safely, reduce their risk of future injury, and return to their sport, work, or daily life pain-free.

---

References

1. Røe, Y., Soberg, H.L., Bautz-Holter, E., and Ostensjø, S., 2013. A systematic review of measures of shoulder pain and functioning using the International classification of functioning, disability and health (ICF). BMC Musculoskeletal Disorders, 14(1), p.73. Available at: https://doi.org/10.1186/1471-2474-14-73
2. Garving, C., Jakob, S., Bauer, I., Nadjar, R., and Brunner, U., 2017. Impingement Syndrome of the Shoulder. Deutsches Ärzteblatt International, 114(45), pp.765-776. Available at: https://doi.org/10.3238/arztebl.2017.0765
3. Yu, H., Côté, P., Shearer, H., Wong, J., Sutton, D., Randhawa, K., Abdulla, S., Southerst, D., Mior, S., Ameis, A., Stupar, M., Nordin, M., van der Velde, G.M., Carroll, L., Jacobs, C.L., Taylor-Vaisey, A., and Shergill, Y., 2014. Effectiveness of Passive Physical Modalities for Shoulder Pain: Systematic Review by the Ontario Protocol for Traffic Injury Management Collaboration. Physical Therapy, 95(3), pp.306-318. Available at: https://doi.org/10.2522/ptj.20140361
4. Brantingham, J., Cassa, T., Bonnefin, D., Jensen, M., Globe, G.A., Hicks, M., and Korporaal, C., 2011. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. Journal of Manipulative and Physiological Therapeutics, 34(5), pp.314-346. Available at: https://doi.org/10.1016/j.jmpt.2011.04.002
5. Chang, K.V., Mezian, K., Naňka, O., Wu, W.T., Lin, C.P., and Özçakar, L., 2018. Ultrasound-guided interventions for painful shoulder: from anatomy to evidence. Journal of Pain Research, 11, pp.2311-2322. Available at: https://doi.org/10.2147/JPR.S169434
6. Pieters, L., Lewis, J.S., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., and Struyf, F., 2019. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physiotherapy Interventions for Subacromial Shoulder Pain. The Journal of Orthopaedic and Sports Physical Therapy, Epub 15 Nov 2019. Available at: https://doi.org/10.2519/jospt.2020.8498