Shoulder pain can develop from a microtrauma (a rather benign, repetitive activity) performed over a long period of time that gradually wears down the tendons in the shoulder until they become inflamed. It can also be caused by a macrotrauma (a more significant event or activity that can easily be identified as the source of the shoulder pain). This could be a fall onto the shoulder or onto the outstretched arm. Regardless of the cause of the pain the treatment is often similar from case to case with some individual variations.

Treatment of the shoulder can encompass several different areas. Conservative measures include medication such as anti-inflammatories or pain medications, rest, cortisone injections, and or physical therapy. One aspect of care is often not enough to heal a rotator cuff injury. A combination of treatments is usually most effective in helping to relieve pain in the shoulder.

Often times when you present to your medical doctor with complaints of shoulder pain they will prescribe some medication as described above. It is easy to recommend that a person rest the painful shoulder but it may be difficult to do depending on their occupation or responsibilities at home. Injections for the painful shoulder are sometimes given right away depending on your medical doctor's philosophy. Some MD's would rather you attend physical therapy before considering injecting the painful shoulder. Injections are not the end all beat all and they do not offer relief to all patients that receive them. Often times a well rounded physical therapy program can alleviate shoulder pain and you won't have to consider having an injection.

Physical therapy treatment can consist of the following interventions:

1. Therapeutic exercises: this will consist of range of motion, conditioning, and strengthening exercises. The goal here is to maximize and restore any loss of range of motion, improve the overall endurance of the shoulder blade and shoulder muscles and to improve the strength of these same muscles. Adequate strength of the shoulder blade muscles is just as important as having strong rotator cuff muscles. These two groups must work together in order to restore normal biomechanics and to prevent further injury.

2. Manual therapy: this will consist of hands on treatment that the physical therapist would perform on you. This might consist of joint mobilization (i.e. techniques designed to improve joint motion and relieve pain), or soft tissue massage (i.e. techniques designed to improve muscle and connective tissue flexibility and to relieve pain).

3. Modalities: this consists of machines that the physical therapist may apply to your painful shoulder to assist in pain relief and healing along with the other treatments mentioned above. Some of these machines are ultrasound, electrical stimulation, TENS, or iontophoresis.

All of these interventions can be used in the treatment of a painful shoulder. It is common in clinical practice to use a combination of these interventions. It has been my experience in treating hundreds of shoulder patients over the years that therapeutic exercise is an absolute in the treatment of the painful shoulder. Treatment of a rotator cuff injury or pain in the shoulder should always include exercises that strengthen the shoulder blade and shoulder muscles. A painful shoulder can persist for years. With the right education you won't have to suffer any longer!