Physio assessment and treatment in Miranda and the Sutherland Shire
Shoulder pain can be frustrating because it affects so many everyday things – Activities of Daily Living (ADLs), as we like to call them. Getting dressed, reaching overhead, sleeping on your side, lifting at work, training at the gym, and even simply turning the wheel while driving, can flare it up.
The good news is that most shoulder pain improves with the right plan. The tricky part is determining what is driving it and what your shoulder needs right now, so you do not inadvertently make it worse by doing too much or too little.
This page will help you understand the most common shoulder pain patterns, what they usually mean, what helps in the early stages, and when it is worth getting it assessed.
Quick summary
- Most shoulder pain is related to irritation of the rotator cuff and surrounding tissues, stiffness, or load sensitivity. It often settles with the right mix of movement, strength work, and smart modifications.
- If your shoulder pain is worse at night, hurts with reaching overhead, or feels weak, this does not necessarily mean a tear. It indicates your shoulder requires a calmer and more structured approach.
- Seek urgent medical care if you have a major trauma, obvious deformity, sudden severe weakness, pins and needles with loss of function, fever, unexplained swelling or redness, or chest pain.
Contents
- Common shoulder pain symptoms
- Common causes of shoulder pain
- When shoulder pain should be checked urgently
- What to do now
- How we assess shoulder pain at PhysioCentral
- Treatment approach: Mobility, Flexibility, Strength
- How long does shoulder pain take to improve?
- Shoulder pain FAQ
- Shoulder pain physio in Miranda and the Sutherland Shire
Common shoulder pain symptoms
Shoulder pain is not one single condition. The joint and its mechanics are far too complicated. The pattern of signs and symptoms matter.
You might notice:
- Pain when lifting your arm to the side or overhead, sometimes called a painful arc
- Pain at night, especially when lying on the sore side
- Pain when reaching behind your back, like putting on a bra or tucking in a shirt
- A sharp pinch at the front of the shoulder when pushing, pressing, or reaching forward
- A top of shoulder ache after the gym, carrying a bag, or doing push-ups
- Clicking, cracking, or grinding with movement
- A sense of weakness, or feeling that the shoulder will give way
Those patterns guide us toward the most likely causes and the best first steps.
Common causes of shoulder pain
Below are the most common causes we see at PhysioCentral. This is not a diagnosis, but it helps you make sense of what may be happening.
1) Rotator cuff related shoulder pain
This is the most common group. The rotator cuff is a set of muscles and tendons that help hold the ball of the joint snugly in its socket and control the movement of the shoulder as you lift, reach, and rotate.
This pain often:
- Feels worse with overhead work, reaching, or lifting away from the body
- Flares after doing more than your shoulder is ready for
- Can be worse at night
- Can feel sharp in certain ranges, then settle when you lower your arm
It is common for this to be labelled tendinopathy, bursitis, or impingement. The label matters less than the plan. Most of the time, the shoulder is sensitive to loading and requires a graded strength-building program.
We can also perform a few simple tests to determine whether you have a tear, which may require imaging, or a specialist referral, with a high degree of accuracy.
2) Frozen shoulder
Although extremely painful, Frozen shoulder is mostly about stiffness and loss of movement, not just pain.
It often:
- Develops gradually, sometimes after a small injury, and sometimes for no obvious reason at all
- Makes it hard to reach overhead or behind your back
- Causes pain at night and a deep ache
- Feels like the shoulder is blocked or stuck
Frozen shoulder tends to move through phases and can take months to fully settle. The key is using the right type of exercise at the right phase.
3) AC joint irritation (top of shoulder pain)
The AC joint sits at the top of the shoulder where the collarbone meets the shoulder blade.
This often:
- Feels sore on the very top of the shoulder
- Is aggravated by bench press, push-ups, dips, side sleeping, or reaching across the body
- Can be tender to touch at the top of the shoulder
4) Shoulder instability and dislocation history
Some shoulders feel loose, unstable, or have a history of dislocation or subluxation.
This often:
- Feels like the shoulder might slip, pop, or clunk
- Flares with certain positions, especially arm back and out to the side
- Creates a protective guarding feeling
- Causes you to avoid certain movements because it feels unsafe
- common in adolescents and the under 25’s
Rehab is usually very effective here, but it needs to be targeted to control, stability, and confidence.
We can show you what to do.
5) Referred pain from the neck or upper back
Sometimes the shoulder is not the main source. Neck joints, nerves, and upper back stiffness can refer pain into the shoulder and upper arm.
And most commonly occurs together with a shoulder issue.
Clues include:
- Neck stiffness or headaches alongside shoulder pain
- Pins and needles, burning pain, or pain that travels below the elbow
- Pain that changes a lot with neck position
- Shoulder tests that do not fully reproduce your symptoms
That is why a good shoulder assessment often includes a quick neck screen at the very least.
When shoulder pain should be checked urgently
Most shoulder pain is not dangerous, but some situations need prompt medical assessment.
Seek urgent medical care if you have:
- A major fall, crash, or sudden trauma and you cannot lift the arm
- A visible deformity, suspected dislocation, or severe swelling after injury
- Sudden severe weakness that is new, especially after trauma
- Numbness, tingling, or loss of hand or arm function that is worsening
- Fever, redness, warmth, and increasing pain that feels unwell
- Chest pain, shortness of breath, or pain that feels like it is not coming from the shoulder
If you are unsure, it is always better to get it checked.
What to do now
The aim early on is to calm irritation while keeping the shoulder moving enough to prevent unnecessary stiffness.
1) Modify the aggravators, not everything
Try to reduce the positions that spike pain:
- Overhead lifting
- Heavy pressing
- Long reaching away from the body
- Carrying heavy loads on the sore side
- Sleeping on the sore side
You usually do not need to stop all activity. You just need to reduce the load to a level the shoulder can tolerate, then build back up. Decrease load for 3 days – the inflammatory period, before gradually increasing activity again.
2) Keep gentle movement in the shoulder
A stiff shoulder is rarely a happy shoulder. In most cases, small comfortable movements help settle initial pain.
Examples:
- Pendulum swings – bent forward slightly, and swing the arm back and forth
- Wall slides – rest your hand against the wall to take some weight off the arm and gently slide up and down
- Gentle movements within a comfortable range
If movement is sharply painful, reduce the range, slow down, or change the exercise. A mild ache that settles quickly is usually acceptable. Sharp pain that lingers is a sign to back off.
3) Fix sleep setup early
Night pain is one of the biggest frustrations with shoulder problems.
Try:
- If you sleep on your back, place a pillow under the arm so the shoulder is supported
- If you sleep on the other side, hug a pillow so the sore arm is supported in front of you
- Avoid sleeping with the sore arm pinned under your body
- Avoid letting the arm hang over the side of the bed unsupported
Even a small improvement in sleep often speeds up recovery.
4) Ice or heat
Both can help. Choose what feels best:
- Ice is often helpful for sharper, more irritated acute flare-ups. Best if recently injured
- Heat can help if you feel stiff and guarded. Best with more chronic shoulder problems
Neither is a cure, but both can reduce sensitivity so you can move more comfortably.
How we assess shoulder pain at PhysioCentral
A good shoulder assessment is not just “does it hurt when I push here?”
We look at:
- Your history and the pattern of pain, including night pain and load triggers
- Shoulder range of motion, including behind the back and overhead
- Strength and control, including the rotator cuff and shoulder blade muscles
- Functional tests related to your work, sport, and gym routine
- A quick neck screen when needed
- Any red flags that suggest referral or imaging is appropriate
The goal is to make the plan clear and realistic, not vague.
Treatment approach: Mobility, Flexibility, Strength
Most shoulder pain responds best when rehab is structured and progressed in stages.
Stage 1: Mobility
Early goals:
- Reduce irritation
- Restore comfortable motion
- Improve sleep tolerance
- Find your safe window of movement
This usually involves gentle hands on treatment to ease protective muscle spasm, mobility work, education around flare-ups, and small changes to how you load the shoulder day to day.
Stage 2: Flexibility
If stiffness is part of your picture, we focus on restoring the ranges you need:
- Overhead reach
- Behind the back reach
- External rotation, often limited in rotator cuff issues and frozen shoulder
This stage is guided closely because stretching too hard, too early can flare some shoulders.
Stage 3: Strength
This is where most long-term wins happen. We build:
- Rotator cuff strength and endurance
- Shoulder blade control
- Gradual tolerance to lifting, pushing, pulling, and overhead work
- Work, sport, and gym specific progressions
If you have instability, we add control and stability work early and progress it carefully.
As strength goes up – pain goes down.
Shoulders are prone to recurrent aggravation – improving strength is crucial.
How long does shoulder pain take to improve?
This depends on the cause and how long it has been there, but typical ranges are:
- Rotator cuff-related pain: settles in about 6-8 weeks. Full strength can take up to 12 weeks. 6+ months if torn and requiring surgery. And these timelines only occur with consistency of rehab
- Frozen shoulder: can take several months to a year as it progresses through its phases of Inflammation and tightening
- AC joint irritation: often improves over 4 to 10 weeks depending on loads
- Instability related pain: often improves over 6-8 weeks, with full return of strength taking 16 weeks
Flare-ups during recovery are common; they don’t mean you are back to square 1. It usually means the shoulder needs a small adjustment, not a complete restart. 3 steps forward. 1 or 2 back.
Shoulder pain FAQ
Why is my shoulder worse at night?
Night pain often happens because irritated shoulder tissues do not love certain positions, especially compression on the sore side.
People also move less during sleep, so the shoulder stiffens, then complains when you roll onto it. Protective muscle spasm also tightens during periods of inactivity. Tendons (like the 4 rotator cuff) hate inactivity, and are soothed with movement.
Even if you get the arm in a perfectly comfortable position, the shoulder will simply become stiff and painful through lack of movement. A better sleep setup often helps but may not prevent night pain.
If you’re having trouble sleeping, even with the use of pain meds, you’re best to get up and do some gentle mobility work for 5-10 minutes to calm it down, so you can get back to sleep.
Do I need a scan?
Not always. Many shoulder findings on scans are common even in people with no pain. A good assessment can often guide treatment without imaging. Scans can be useful when there is significant trauma, suspected major tear, dislocation, fracture, or when progress is not matching expectations. We know what to do once we’ve fully assessed them.
How do I know if I have torn my rotator cuff?
A tear is more likely after a clear trauma, with sudden loss of function or significant weakness. Many people with painful shoulders do not have a major tear. If you are worried, we can assess strength and function and advise if imaging is appropriate.
Should I rest it completely?
Unless you’ve suffered a fracture or dislocation, usually not. Complete rest often leads to stiffness and reduced tissue strength. Most shoulders benefit from reduced aggravation and a graded return to movement and strength.
Is clicking or cracking a bad sign?
Not always. Many shoulders click harmlessly. Clicking matters more if it is painful, associated with instability, or followed by a sharp catch. There are a lot of moving parts in there, and they sometimes make a bit of noise.
Could my neck be causing shoulder pain?
Yes. That is why we screen the neck, especially if pain travels down the arm, you have pins and needles, or shoulder movement is not the main trigger.
Shoulder pain physio in Miranda and the Sutherland Shire
At PhysioCentral, we assess and treat shoulder pain for people in Miranda and across the Sutherland Shire. Whether your goal is sleeping comfortably again, lifting at work, getting back to the gym, or returning to sport, we will guide you with a clear plan and steady progressions.
If you would like help, book an appointment, and we’ll work out what is driving your shoulder pain and what to do next.
Related guides
- Rotator cuff related shoulder pain (coming soon)
- Frozen shoulder (coming soon)
- Physiotherapy in Miranda and the Sutherland Shire: https://physiocentral.net.au/service/physiotherapy-miranda-sutherland-shire/
- Injury recovery process: https://physiocentral.net.au/injury-recovery-process-healing-phases-treatment-timing/