The shoulder is the most mobile joint in the body, often described as a golf ball sitting on a tee. Many things have to work properly in order for the shoulder to function well. Physiotherapists are capable of assessing and diagnosing shoulder pathology, and providing a treatment plan that when followed, will help to optimize outcomes. When studying the shoulder, physiotherapists learn how to perform special tests. These tests are meant to be specific and sensitive enough to allow us to effectively diagnose what part of the shoulder is injured. However, there are problems with these tests in that many of them aren’t overly specific or sensitive, and thus it is difficult to develop an accurate working diagnosis.


Because of this, leading experts in shoulder rehabilitation now classify shoulder pain in to 4 categories. These categories include neck related shoulder pain, the unstable shoulder, the painful and stiff shoulder, and the painful and weak shoulder. Determining which categories the client is in guides an appropriate plan of care. Below are descriptions of each category:

Neck related shoulder pain – roughly 20% of all shoulder cases will have neck involvement. Signs of neck involvement are pain and stiffness in the neck, pain radiating past the elbow, pain when sitting, and/or numbness/tingling in the arm. If there is neck involvement with shoulder pain, the neck must be addressed in the early phases of treatment to maximize outcomes.

The unstable shoulder – Often times, a client with an unstable shoulder presents with a history of trauma resulting in a trip to the emergency room. Examples would be a dislocated shoulder or a separated shoulder. In non-traumatic cases, there is a history of joint laxity. Conservative treatment in a traumatic event would consist of bracing the shoulder, then focusing on improving range of motion and joint stability.

The painful and stiff shoulder – A stiff shoulder presents with restriction of movement in the shoulder, both when you try to move your arm actively, and when we try to move it passively. Stiff shoulders can be a result of many things, including tight muscles, osteoarthritis, inflammation of the joint capsule (frozen shoulder), calcification of tendons, bursitis, and stiffness in the thoracic spine/neck. Treatment is focused on improving mobility with manual therapy, stretching, and eccentric strengthening.

The painful and weak shoulder – A weak shoulder presents with weakness and often pain with active and/or resisted movements of the shoulder. Examples include rotator cuff tendinopathy/tearing and long head of biceps tendinopathy/tearing. Treatment consists of progressive strengthening and stabilization exercises of the shoulder.


Evidence supports that if you have shoulder pain now and don’t do anything about it, it will likely still be present in 6 months. There is also evidence that supports if you have pain for 3 months or less and of non-traumatic nature, it will take up to 3 months to maximize your recovery. If you have had pain for greater than 6 months or have had a traumatic injury, it will take up to 6 months to maximize your recovery. Treatment also must consist of education and progressive exercise for best outcomes, and clients who do best are active participants in their plan of care, being consistent with attending their appointments and following their home exercise program.