Part 2: Common Shoulder Conditions Treated By Physical Therapists

For the next installment of our post series, we’re focusing on shoulder pain, which can be extremely disabling. Whether or not you realize it, you use your shoulder almost constantly, as it permits practically any movement that involves your arms. This is why any issue that causes pain and prevents your shoulder from moving normally can be a major burden to your daily life.

After the back and neck, the shoulder ranks as the third most common site in the body for musculoskeletal pain, as about 67% of people will deal with it at least once in their lives. The primary reason is that the shoulder is the most flexible and mobile of all joints—and the only joint that can rotate a full 360°—but this extreme flexibility also makes it vulnerable to numerous injuries. Below is a summary of the most common shoulder–related conditions, many of which involve the rotator cuff, a group of four muscles and tendons that form a “cuff” and support the head of the upper arm bone:

• Shoulder impingement syndrome: involves any of the rotator tendons or other structures being trapped (or impinged) by two bones, which leads to shoulder pain, weakness, and difficulty reaching up behind the back
• Rotator cuff tendinitis (shoulder tendinitis): results from irritation or inflammation of a rotator cuff tendon, leading to pain and swelling in the front of the shoulder and side of the arm; most common cause of shoulder pain
• Rotator cuff tear: results when a rotator cuff tendon detaches from the bone, either partially or completely; can occur either traumatically or gradually, which is usually the case in older patients
• Shoulder bursitis: inflammation of a fluid–filled sac in the shoulder called the bursa, which occurs from regularly performing too many overhead activities; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
• Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, which causes the shoulder capsule to thicken and tighten around the shoulder joint; symptoms include pain and stiffness that makes it difficult to move the shoulder

Physical therapists use various interventions to facilitate recovery from shoulder pain

Regardless of what shoulder condition is present, in most cases, the best course of action is a comprehensive course of physical therapy. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with an exercise–based approach. They accomplish this by first identifying the source of pain and any associated impairments and then by designing a personalized treatment program that targets these areas of weakness and teaches patients how to regain their abilities through movement.

Most treatment programs will involve some combination of pain–relieving interventions, stretching and strengthening exercises, manual (hands–on) techniques administered by the physical therapist, and education on how to avoid future shoulder issues. But the specific approach used will vary depending on the condition present, its severity, and the patient’s abilities and goals.

There is no shortage of research supporting physical therapy as effective solution for many shoulder–related disorders. One powerful study called a systematic review found that stretching exercises, strengthening exercises, and other physical therapy techniques reduced pain and improved range of motion in patients with frozen shoulder. Another systematic review published in 2018 identified moderately strong evidence to support exercise therapy for rotator cuff tears, while a long–term study found that surgery was no better than nonsurgical treatment for patients aged 55 and older with a rotator cuff tear up to five years later. Results from yet another systematic review and meta–analysis published in 2022 showed that exercises—both on their own and as part of a program—improved range of motion, function, disability, and pain in patients with frozen shoulder.

In our next post, we’ll look at the injuries and conditions involving the knee.