Shoulder pain is the 3rd most common musculoskeletal complaint seen in clinical practice, with 70% of patients still experiencing symptoms 6 weeks after their initial presentation, and 50% developing chronic symptoms (Ottenheijm et al 2011). There are a number of structures in the shoulder which can cause pain, including the sub-acromial bursitis and tendons of the rotator cuff.

What are the most common causes of shoulder pain?

  • Sudden overload to the rotator cuff resulting in a muscle tear
  • Sub optimal movement of the scapula causing compression on the bursa and rotator cuff tendons which lie in the sub-acromial space (right).

What is the aim of treatment?

1 . Increase strength of the rotator cuff Research has consistently shown that exercise is the most important intervention for patients with shoulder pain, regardless of their age, duration of symptoms, or severity of symptoms (Littlewood et al 2016). The following points should be considered in any exercise program:

  • Exercises may result in some level of discomfort
  • Higher repetitions with lower resistance appear more beneficial than heavier loads
  • Completing 3 sets of a given exercise will infer the greatest benefits
  • Exercises which target scapula mechanics are important to reduce the compression on the rotator cuff tendons or bursitis

2 . Increase sub-acromial space to reduce pressure on the rotator cuff and bursitis

  • The scapula (shoulder blade) should upwardly rotate as the patient lifts up their arm (left). If the scapula doesn’t upwardly rotate this can reduce the sub-acromial space and irritate the rotator cuff tendons and bursitis. Tension in the muscles which oppose this movement may be responsible for this abnormal movement and cause pain. Manual therapy addressing these muscles can often help improve the scapula movement and reduce the pain during exercise