Physical Therapy for Shoulder Pain: An Essential Step

Shoulder pain is a common problem that affects millions of people worldwide. It can be caused by various factors, including injury, arthritis, and overuse. One of the most effective treatments for shoulder pain is physical therapy.

Physical therapy uses various techniques to reduce shoulder pain and improve function. It can help patients recover from shoulder injuries, manage chronic pain, and prevent future injuries.

We'll examine some of the most common ways physical therapy treatment can help with shoulder pain. We'll also explore some exercises that can help with pain and improve your shoulder function.

How Does Physical Therapy Help With Shoulder Pain And Shoulder Injuries

The primary goal of physical therapy for shoulder pain and injuries is to:

• Manage your pain
• Improve your range of motion
• Strengthen the surrounding muscles to avoid future injuries.

Shoulder pain and shoulder injuries can be debilitating. It affects our daily routine and limits our mobility. It also impairs our ability to perform basic functions like brushing teeth, eating, and dressing. And since the shoulder is a complex joint, it requires careful treatment.

Physical therapy may include various exercises and treatments tailored to meet your needs. The rehabilitation process may vary depending on the severity of your shoulder injury.

What Are Common Shoulder Injuries That May Need Physical Therapy?

Here are some common conditions affecting the shoulder that may require physical therapy:

• Rotator cuff tears

The rotator cuff comprises four muscles surrounding the shoulder joint. They work together to allow the arm to move in different directions.

A rotator cuff tear is a common injury that occurs when one of these muscles or tendons is torn. It's often caused by trauma, repetitive motions, or aging.

• Frozen shoulder

Frozen shoulder, or adhesive capsulitis, causes stiffness and pain in the shoulder. This condition can cause extreme shoulder pain, making it difficult to move. It can occur spontaneously, post-surgery, or after an injury.

• Shoulder impingement syndrome

Shoulder impingement syndrome occurs when the rotator cuff or sac of the joint gets pinched, especially when the arm is lifted overhead.

It's common in athletes who train in overhead activities such as volleyball and tennis.

• Bursitis

Bursitis is an inflammation of the bursa, a small sac that cushions and lubricates joints. In the shoulder, bursitis can be caused by overuse, injury, or infection.

• Shoulder dislocation

A shoulder dislocation occurs when the upper arm bone pops out of its socket in the shoulder blade. It can be caused by a fall, a blow to the shoulder, or a sudden twist.

What Should I Expect From A Physical Therapy Appointment?

It’s normal to feel unsure or anxious about your first physical therapy appointment. But don’t worry. Here’s a quick picture of what to expect from your first visit to the physical therapist.

You can expect to undergo an evaluation to assess your shoulder during your first physical therapy appointment. The physical therapist may also identify other areas causing your pain.

Your physical therapist may ask you questions about the following:

• Your medical history
• Lifestyle habits
• Any exercises or activities that may be causing or alleviating your pain.

This evaluation may also include a physical examination of your shoulder. We have a more in-depth article on shoulder pain evaluation here.

Once your physical therapist has identified the root cause of your pain, they will work with you to develop a customized treatment plan. This treatment plan may include various interventions (which we’ll discuss later).

Throughout your appointments, your therapist will closely monitor your progress. They will also adjust your treatment plan as needed.

And if you're worried you won't be able to keep up, they will also provide you with guidance and support, helping you to stay motivated and on track. Physical therapy is not just about your body. Your mindset and other psychological factors can significantly impact your progress, too.  

According to a study, patients with higher expectations of recovering well due to physiotherapy tend to have better outcomes. Additionally, the following patient characteristics seem also to yield better results:

• Higher confidence in their ability to manage their pain
• Lower levels of pain when they are resting
• Currently employed or in education

Do I Need A Referral For Physical Therapy? 

Most of the time, people are referred to physical therapists by their healthcare providers. But you can actually see a physical therapist without a referral from a healthcare provider. This is known as "direct access" to physical therapy.

Direct access allows patients to seek physical therapy more quickly and without the additional costs of a referral. You can learn more about direct access through American Physical Therapy Association. They can also help you find a physical therapist near you.

Direct access does not impact your progress. In fact, it may even improve outcomes and decrease healthcare costs.

However, it's important to note that some insurance plans may still require a referral for physical therapy coverage. Yes, even in states with direct access laws. It's a good idea to check with your insurance provider and the physical therapy clinic to determine if a referral is needed for coverage.

What Are The Best Physical Therapy Methods For Treating Shoulder Pain And Injuries?

Several physical therapy methods can be effective for treating shoulder pain and injuries. Here are some of the most common ones:

• Range of motion exercises

These exercises can help improve flexibility and reduce stiffness in the shoulder joint.

• Strengthening exercises

Targeted exercises can help strengthen the muscles around the shoulder joint. This can help improve stability and reduce the risk of further injury.

• Manual therapy

This can include techniques like massage and joint mobilization. They help reduce pain and improve mobility in the shoulder.

• Ultrasound

A physical therapist may use an ultrasound machine on the injured area to help promote healing and reduce pain.

• Electrical stimulation

Sometimes a physical therapist may also use electric stimulation on your nerves or muscles to help them recover.

• Taping

A physical therapist may use special tape to support your shoulder or help it move more easily.

• Posture correction

Improving poor posture can help reduce stress on the shoulder and improve shoulder function.

• Workplace ergonomics

Your physical therapist may suggest changes to your workstation. This will help you sit and work in a more comfortable and supportive way.

• Home exercise program

Your physical therapist will also give you exercises to do at home. This will help you maintain the progress you've made in physical therapy.

• Activity modification

Avoiding physical activities that aggravate the shoulder can help reduce pain and promote healing. A physical therapist may also recommend modifications to your daily activities.

What Are Physical Therapy Exercises For Shoulder Pain?

There are many physical therapy exercises that can help alleviate shoulder pain. However, the specific exercises prescribed will depend on the cause and severity of the pain. Below are some exercises that may be recommended for shoulder pain:

• Pendulum exercise

1. Stand up straight and gently lean forward. Support your weight with your non-injured arm on a table or chair.
2. Let your injured arm hang down straight toward the floor.
3. Slowly swing your injured arm in a circular motion. Start with small circles and gradually increase the size of the circles.
4. After 10-15 circles in one direction, switch to the opposite direction and repeat.
5. Repeat the exercise 2-3 times per day. Gradually increase the number and size of the circles as your shoulder pain improves.

• Shoulder blade squeeze

1. Sit or stand up straight with your arms at your sides.
2. Squeeze your shoulder blades together and hold the squeeze for 5-10 seconds.
3. Release the squeeze and relax your shoulders.
4. Repeat the exercise for 10-15 repetitions. Gradually increase the duration of the squeeze as your shoulder muscles strengthen.
5. You can also perform this exercise using a resistance band for added resistance.

• Doorway Stretch

1. Stand in a doorway with your feet shoulder-width apart.
2. Place your hands on the door frame at shoulder height, with your palms facing forward.
3. Take a step forward with one foot, keeping your body upright and your arms straight.
4. You should feel a stretch in your chest and shoulders.
5. Hold the stretch for 20-30 seconds, then return to the starting position.
6. Repeat the stretch with your other foot forward.

• Shoulder circles

1. Stand or sit with your arms hanging by your sides.
2. Slowly lift your shoulders towards your ears as high as you can.
3. Roll your shoulders back in a circular motion. Squeeze your shoulder blades together as you move them.
4. Continue the circular motion. Bring your shoulders down and forward until they are back in their starting position.
5. Repeat the circular motion in the opposite direction. Start by bringing your shoulders up and forward and then rolling them back and down.
6. Repeat the exercise for 10-15 repetitions in each direction.

• Internal rotation

1. Bend your elbows and keep them close to your side.
2. While keeping your elbows close to your body, bring your forearm across your body.
3. Slowly return your back to the starting position and repeat.

• External rotation

1. Like internal rotation, bend your elbows and keep them close to your side.
2. Rotate your arm outwards while keeping it close to your side.
3. Slowly return your arm to starting position and repeat.
4. Once you’re strong enough, you can also use a resistance band attached to a door knob or stable object.

• Cross arm stretch

1. Relax your shoulders and stand with your feet shoulder-width apart.
2. Pull one arm across your chest, and use your opposite hand to hold onto the upper arm. You should feel a stretch.
3. Hold for 30 seconds before switching sides.

Exercises that target your neck and upper back can also help with shoulder pain. We have a great list of these exercises here.

When Should I Start Physical Therapy For Shoulder Pain?

The answer to this question is complex and dependent on individual factors such as

• The type and severity of the pain
• Any underlying medical conditions
• The cause of the pain.

However, you can reduce the chances of developing chronic pain if you start earlier. Here are a few instances when you should consider starting physical therapy:

• After an injury

Shoulder injuries like rotator cuff tears or dislocations need immediate attention. If you've injured your shoulder, starting physical therapy as soon as possible is advisable. Early intervention can help promote healing, limit pain, and restore range of motion.

• After surgery

If you've had shoulder surgery, your surgeon will prescribe physical therapy as part of your rehabilitation plan. Typically, physical therapy starts a few weeks after surgery. The physical therapist will help with the following:

• Control pain
• Restore mobility and strength
• Prevent the development of scar tissue.
  
  After a rotator cuff repair surgery, for example, active physical therapy is recommended to start 4-6 weeks after the procedure. If you want more detail about how a rehabilitation program usually goes, here’s a brief overview:
  
• First Phase (Weeks 0-6)
  • The focus is to increase the range of motion (ROM) gradually. 
  • Strict immobilization for the first two weeks, during which time you can perform hand and wrist exercises.
  • Starting passive ROM exercises from weeks 2-4 while continuing hand and wrist exercises. You can also elbow and shoulder blade exercises.
  • From weeks 4-6, the patient can progress to active-assisted ROM exercises with a physical therapist. 
    
• Second Phase (Weeks 7-11)
  • The focus is improving ROM and progressing to active ROM exercises.
  • Aggressive stretching is avoided
  • Exercises to improve strength and stability are slowly introduced.
    
• Third Phase (Week 12 and beyond)
  • The focus shifts to unrestricted ROM and strengthening exercises. 
  • Various exercises are introduced to improve the strength and function of the rotator cuff muscles and other shoulder muscles.
    
    
• When other non-invasive treatments fail

If you've tried conservative treatments like rest, ice, or painkillers, and your pain persists, it's time to consider physical therapy.

• For preventative care

Physical therapy can be a preventative measure if you're at risk of developing shoulder pain. This is especially true regarding sports injuries.

A physical therapist can help you identify any muscle imbalances or postural issues that could lead to shoulder pain.

How Long Is Physical Therapy For Shoulder Pain?

The duration of physical therapy for shoulder pain varies from person to person. Factors include: 

• The cause of the shoulder pain
• The severity of the shoulder injury
• Response to treatment

According to one study, the average length of physical therapy sessions for a frozen shoulder is 3-4 weeks. Meanwhile, patients with rotator cuff injuries may experience improvement after 6-12 weeks of therapy.

It's essential to follow the entire course of physical therapy, even if you begin to feel better. Discontinuing physical therapy too early may cause your pain to return.

How Many Times A Week Should I Do Physical Therapy?

Generally, most people with shoulder pain benefit from at least two to three physical therapy sessions per week. However, it really depends on the following factors:

• The stage and severity of your condition

The frequency of physical therapy sessions can vary depending on the condition. For example, if you have acute shoulder pain, you may require more frequent sessions to ensure proper recovery.

On the other hand, if you have chronic shoulder pain, you may require less frequent visits to maintain your range of motion and strength.

• Your overall health status

If you have other medical conditions, you may require more or less physical therapy. This depends on your ability to tolerate exercise and your risk of complications. Your physical therapist can work with your physician to determine the right number of visits based on your medical history.

• Your goal for physical therapy

If you have a specific goal, such as returning to work or sports, you may require more frequent therapy sessions to achieve your desired outcome.

Your physical therapist may recommend specific exercises or activities to perform in-between sessions.

• Access to care

If you live in a remote area or have limited insurance coverage, you may only be able to attend physical therapy once per week.

However, your physical therapist can provide home exercises and techniques to supplement your in-person sessions. This can allow you to continue to progress toward your goals.

Is Physical Therapy Worth It For Shoulder Pain?

The answer is a resounding YES. Physical therapy is worth it for shoulder pain. Physical therapy is a non-invasive and effective way to treat shoulder pain.

One of the main benefits of physical therapy is that it can help reduce the need for surgery or medication. In many cases, physical therapy can be just as effective as surgery, without the added risks or recovery time. It can also reduce the need for pain medications, which can have unpleasant side effects.

Additional studies further support this. A 2013 study examined the outcomes of 452 patients with rotator cuff tears treated with a standardized physical therapy program. The study found that after two years of follow-up, 75% of the patients reported being satisfied with their treatment.

Another benefit of physical therapy for shoulder pain is that it's personalized. Your physical therapist will work with you to develop a tailored treatment plan. This personalized approach means you're more likely to see results faster and have long-term benefits.

It's important to note that physical therapy for shoulder pain may not be a quick fix. It can take time and effort to see results. You may need to commit to ongoing physical therapy sessions. 

However, the benefits of physical therapy can be well worth the investment, both physically and financially.  Physical therapy can provide long-term benefits even after the pain is gone. 

Is It Normal For My Shoulder To Hurt After Physical Therapy?

Some people may experience pain or soreness after a physical therapy session.  This can lead to confusion and concern. So, is it normal for your shoulder to hurt after physical therapy?

The short answer is yes. It's normal to experience some discomfort after a physical therapy session. This discomfort can take many forms, including soreness or a dull ache.

It can be frustrating to experience pain after a treatment meant to alleviate pain. However, physical therapy is an active form of treatment. It involves manipulating the shoulder joint and muscles. So it's natural for there to be some response from the body.

That being said, there is a difference between normal discomfort and pain indicative of a problem. You should talk with your physical therapist if you experience:

• Sharp pain
• Swelling
• A sudden increase in pain after a physical therapy session

The intensity and duration of post-physical therapy discomfort can vary based on several factors. These include:

• The severity of the initial shoulder injury
• The type and intensity of physical therapy performed
• The frequency of physical therapy sessions
• Your overall health and pain tolerance

How Do I Relieve Post-Physical Therapy Pain?

There are a few steps you can take to manage post-physical therapy pain. First, communicate openly with your physical therapist about any discomfort you're experiencing. They can modify treatment or suggest complementary therapies to help alleviate pain.

Secondly, don't be afraid to rest and take it easy after a physical therapy session. Your body needs time to recover and heal, so avoid unnecessary strain or movements that may exacerbate pain.

Finally, consider incorporating pain management techniques into your routine. This can include:

• Ice or heat therapy
• Massage
• Over-the-counter pain relievers.

These can help manage discomfort and promote healing. If you’re looking for a heating pad that can help you relieve pain, we have a great one filled with aromatic herbs to help you relax!

Can Physical Therapy Make a Shoulder Tear Worse?

Physical therapy does not make a shoulder tear worse. In fact, physical therapy can be incredibly beneficial for shoulder rehabilitation and strengthening.

Physical therapy is often prescribed as part of the recovery process for those who had a surgical repair for a shoulder tear. In these cases, physical therapy is crucial to rehabilitating the shoulder.

Physical therapists are trained to carefully evaluate shoulder injuries. It’s important to work with a qualified physical therapist and follow their prescribed plan closely. Remember, pushing yourself too hard or performing exercises incorrectly can lead to setbacks.

What If Physical Therapy Doesn't Work for Shoulder Pain?

Physical therapy is a common treatment for shoulder pain. However, even with proper diagnosis and treatment, you may still experience pain or find that physical therapy doesn't work. You should always communicate with your physical therapist if that is the case. This allows them to reevaluate your condition and make adjustments to your treatment.

One possible reason could be that the origins of the pain are not related to the shoulder joint. In some cases, shoulder pain can be caused by referred pain from other parts of the body.

Another reason could be that the underlying condition causing the shoulder pain is more complex. It may take longer to address the issues and get results from treatment.

It's also important to note that physical therapy is not a one size fits all solution. Different individuals may require different treatment approaches.

How Can I Tell If Physical Therapy Is Not Working for My Shoulder?

Physical therapy may not always work for everyone. Knowing if physical therapy is not working for your shoulder is essential in such cases.

Here are some telltale signs that physical therapy may not be doing its job:

• Persistent or worsening pain
• No improvement in the range of motion

This may indicate that the therapy is ineffective for your particular situation or that you might not be doing the exercises correctly.

Ultimately, trusting your instincts and listening to your body is important. Be honest and open with your physical therapist and work together to find the best treatment plan for your shoulder pain.

Takeaway

Physical therapy is a safe and effective treatment option for shoulder pain. It helps to reduce pain and stiffness, improve the range of motion, and restore function to the joint.

A skilled physical therapist can work with you to develop a personalized treatment plan. They can help address your specific needs and goals. With proper care and attention, you can return to your normal everyday activities and enjoy a full, pain-free life.