SHOULDER PAIN

Shoulder pain can turn simple tasks like reaching for a shelf, putting on a jacket or sleeping on your side into a real ordeal. It's the third most common musculoskeletal complaint we see, after low back and neck pain, and it affects roughly 1 in 6 adults at any given time.

The most common conditions we treat include rotator cuff tendinopathy, subacromial pain syndrome (previously called impingement), frozen shoulder and referred pain from the neck or upper back. Each presents differently and needs a specific approach, which is why getting the right diagnosis matters.

Manual therapy combined with exercise has strong evidence for shoulder pain. A 2024 meta-analysis of 24 trials found this combination outperformed exercise alone, and the 2025 JOSPT clinical practice guideline recommends active rehabilitation with manual therapy as the initial approach for rotator cuff problems. For degenerative rotator cuff tears, multiple systematic reviews found no meaningful difference between surgery and structured rehab at one year, making conservative care a sensible first step.

Frozen shoulder is worth mentioning separately. The joint capsule thickens and tightens, moving through a painful 'freezing' phase, a stiff 'frozen' phase and a gradual 'thawing' phase. Without treatment this can take 12 to 24 months. Mobilisation techniques meaningfully speed up recovery and reduce pain along the way. A large JAMA Network Open meta-analysis of 65 studies confirmed that physiotherapy including mobilisation, when combined with other treatments, provides additional benefit for frozen shoulder recovery.

In practice, we always assess the shoulder, neck and upper back together. Many shoulder problems are driven by thoracic spine stiffness and poor scapular (shoulder blade) control, so treating the shoulder in isolation often misses the point. Treatment typically includes joint mobilisation, soft tissue work and a personalised rehab programme of stretching and strengthening.