Conservative Management
of Shoulder Pain

Physical therapy can help you decrease your shoulder pain and restore the range of motion, strength and function of the shoulder. A good physical therapy approach will be exercise-based and include a home exercise program so that frequent appointments are not necessary. The therapist may use modalities and manual therapy treatment to facilitate your patient’s recovery in addition to their exercise program. The physical therapist should incorporate these principles as the foundation for treatment.

1. Manage pain

• Activity modification – education related to do’s and don’ts e.g. what activities and positions to avoid.
• Work on shoulder positioning to help with pain at rest and at night.
• Use Adjunctive treatments such as heat or ice may be helpful and taught for home use.

2. Improve/maintain shoulder mobility

The physical therapist should give your patient joint and soft tissue mobility exercises to maintain or improve their range of motion. This may include the use of a cane/stick, pulleys or stretches using the patient’s “good” arm to assist moving their affected shoulder.

3. Establish a strong, stable base of support for the arm to work from

The shoulder is a ball and socket joint. The socket, or glenoid, is part of the shoulder blade, or scapula. Many patients with shoulder pain have poor posture and poor positioning of their shoulder blades on their rib cage. This results in weakness of the muscles (scapular stabilizers) that attach the shoulder blades to the spine and move the scapula when you move your shoulder. Abnormal movement patterns of the shoulder blade are referred to as scapular dyskinesis. This abnormal movement may contribute to shoulder pain. Shoulder rehabilitation should ALWAYS include posture education and strengthening of scapular stabilizers.

In addition, spinal posture is important and directly impacts how your patient moves their shoulders. Posture correction related to the entire spine and core/lower abdominal strengthening is essential. Optimal posture and stability (using the core and scapular stabilizers) should be incorporated into all of their shoulder exercises.

4. Strengthening of the rotator cuff

The rotator cuff muscles compress and centre the ball of the shoulder in the socket during movement, providing stability to the shoulder joint. The rotator cuff initiates movement when we lift our arm, gives the ability to lift the arm above shoulder height and rotates the shoulder to reach behind our back (to tuck in a shirt or do up a bra) or up behind our head (to comb or wash our hair or pull a shirt off overhead). In addition, the rotator cuff is crucial in providing strength at shoulder height and overhead.