Physiotherapy for Shoulder Pain and Rotator Cuff Problems at Megazee.com

It is almost always the sleep that brings people in. During the day the shoulder is a nuisance: sharp getting a coat on, awkward reaching into the back seat, a twinge putting a mug on the top shelf. Then you roll onto it at two in the morning and it wakes you properly. Four nights of that and a shoulder stops being something you can wait out.

This page covers what is likely to be going on, how to tell a rotator cuff problem from a frozen shoulder, and what physiotherapy for shoulder pain at Megazee.com changes. It sits alongside the other problems we treat at our Manchester clinic. The urgent section comes first, because one sort of shoulder pain is not a shoulder problem at all.

Shoulder pain that needs a doctor today, not a physiotherapist

• 999 now. Shoulder or arm pain with chest tightness or pressure, breathlessness, sweating, nausea, or pain spreading to the jaw. Left shoulder pain can come from the heart, and it does not always announce itself as chest pain.
• A&E. The shoulder looks deformed or out of place, you cannot lift the arm at all after a fall or dislocation, or there was significant force and severe pain. Also shoulder-tip pain after a blow to the abdomen.
• Same-day medical care. A hot, red, swollen shoulder with a fever or feeling generally unwell. That can be an infected joint.
• Urgent GP. An unexplained lump or swelling around the shoulder or collarbone; persistent pain around the shoulder blade in a smoker, particularly with hand weakness or a drooping eyelid; unexplained weight loss; night pain that is severe and unrelieved in every position; or sudden loss of arm strength with no injury at all.

That list is not exhaustive and none of it is a diagnosis. If you are unsure, ring NHS 111. Our medical disclaimer sets out what a website can and cannot tell you.

“I can’t lie on that side”

It is the most common sentence we hear about shoulders, and it is not a sign that something is badly damaged. Upright and awake, the muscles around the joint share the load constantly and your arm hangs clear of everything. Lying down removes both of those. On the bad side you compress an irritable tendon against the bone above it. On the good side the arm drops forward across your body and hangs off the very tissue that hurts.

Three things help most people while the shoulder is settling. Sleep half-propped rather than flat for a week or two. Put a pillow under the sore arm so it rests level rather than dangling. And do not sleep with the arm overhead or under the pillow, which is the position that most reliably ruins the second half of the night.

Rotator cuff, frozen shoulder, or something else

Rotator cuff related pain is the common one. An ache on the outside of the upper arm, often halfway down towards the elbow, and a painful band roughly between shoulder height and overhead. Lowering the arm can hurt more than lifting it. The range is usually still there, and it is the strength and the tolerance that have gone.

A frozen shoulder behaves differently. Movement disappears in every direction, including when someone else moves the arm for you, and turning the forearm outwards with the elbow tucked in is the first thing to go. It is most common between about forty and sixty, sometimes after a period of immobility, and it is more frequent in people with diabetes. It runs as a painful phase followed by a stiff phase, and the stiff phase is far less distressing than the first.

Impingement is a word, not a diagnosis. It describes a pattern of pain on lifting, not a structure that has gone wrong.

Instability is a different reader again: younger, usually with a dislocation behind them, describing a shoulder that feels like it might come out.

How we assess a shoulder at Megazee.com

We start with what you have stopped doing, not where it hurts. Fastening a bra, tucking a shirt in, reaching the seatbelt, lifting a full kettle, the back seat of the car. One of those becomes the thing we retest against.

Then we use a landmark rather than a vague sense of progress. Thumb up your back to the back pocket, the belt, the lower ribs, the opposite shoulder blade. A shoulder that reaches the pocket and a shoulder that reaches the blade are different problems, and moving one landmark is what a good fortnight looks like.

Next we move the arm ourselves, because the gap between what you can do and what the joint will allow is the single most useful finding in a shoulder. We test strength in the positions that actually hurt, check the neck, and retest your chosen movement before you leave so you know on the day whether anything shifted.

What treatment involves

Loading does most of the work. If the shoulder is very irritable we start with holds rather than movement: pressing the forearm outwards into a doorframe for thirty to forty-five seconds, five times, twice a day. That often takes the edge off the nights within a week or two, which buys the room to start strengthening properly.

From there it becomes a graded programme: rows and external rotation with a band, then weight, then reaching overhead once the painful band has quietened. Two or three exercises, done most days, beats eight done for a fortnight. The soreness rule at Megazee.com is the same for every joint we treat: sore during, settled within an hour, no worse the next morning.

Hands-on work earns its place when a shoulder is genuinely stiff rather than sore, and restoring shoulder range with hands-on work is used to create enough movement to load the joint in the same session, never on its own.

For throwers, swimmers, racket players and anyone lifting overhead, the programme runs longer and finishes with progressive loading for the rotator cuff at the speeds and angles your sport actually demands.

If you have had surgery, your surgeon’s protocol governs the early weeks whatever the shoulder feels like, and rehabilitation after cuff repair is staged around it. Bring the operation note to the first appointment.

How long shoulder problems take

Honest shapes rather than dates. Tendon and muscle adapt slowly, and shoulders are the part of the body where people most often stop just before it works.

• Cuff related pain. Night pain typically settles first. Strength and comfortable overhead reach lag behind, commonly by a couple of months, and the programme is judged at around twelve weeks rather than at appointment three.
• Frozen shoulder. Measured in months, sometimes well over a year, and it does not respond to being forced. Treatment aims at pain, sleep and holding onto the range you have while the natural course runs.
• After a dislocation or a repair. Timelines come from the surgical protocol first and the shoulder second.

Nobody can promise you a date, and any clinic that offers one is guessing.

Booking physiotherapy for shoulder pain at Megazee.com

You do not need a GP referral to be seen privately. Every physiotherapist at Megazee.com is registered with the Health and Care Professions Council and chartered with the Chartered Society of Physiotherapy, and the NHS overview of what physiotherapy involves is a reasonable place to start if you have never seen one. Our fees and funding section sets out costs and how insurance works.

Bring something sleeveless: a shoulder cannot be assessed through a jumper. Book a shoulder assessment at our Manchester clinic, or speak to a physiotherapist before you book if you would rather describe it first. If the nights have gone, that is usually reason enough.