You don’t have to be involved with sports to suffer a shoulder injury. I’ve recently been treating someone who developed a rotator cuff injury from just siting at a computer all day!

In this blog I am going to talk about how shoulder injuries can be simplified into three broad categories. I will also discuss the treatment for each group. Unfortunately in the physiotherapy world we tend to complicate things for patients and the shoulder is an example where simplicity can be just as effective. There are some difficulties with the shoulder, but this is the same as any other injury. With most shoulder rehabilitation the process just takes time. A lot of shoulder injuries do not need surgery and do well with the right rehabilitation.

Traumatic shoulder injuries:

I am not going to go into detail on these types of injuries as they deserve a separate blog. Fractures, large muscle or tendon tears need to be seen by an orthopaedic surgeon. X-rays and MRI may be necessary. Significant loss of movement and the mechanism of injury will determine the right care. Any traumatic injury should be investigated for possible fracture, tendon rupture and large soft tissue tears. A dislocation is a severe trauma and should be seen in emergency, so the shoulder can be repositioned in the joint.

Most shoulder injuries that can be treated in the physiotherapy clinic can be grouped into the three categories below:

  1. Weak and Painful

  2. Stiff and Painful

  3. Weak and Unstable

I have borrowed these groups from a British physiotherapist (Adam Meakins) who does a great job in simplifying how we approach shoulder injuries. It makes much more sense to group shoulder injuries by their primary movement problem. It’s very difficult to determine in the clinic which specific structures are causing pain. By determining the primary movement problem, I can be more effective with the treatment options.

The Weak and Painful Shoulder:

In this group I include rotator cuff strains. These are the small stabilizing muscles in the shoulder joint. In the younger population this could be caused by lifting weights. If these muscles are overloaded beyond their strength they can tear. Degenerative rotator cuff problems start in the 50’s age group. They are caused by weakening in the muscle-tendon unit. In the clinic the shoulder will test weak with pain as the damaged tissues are stressed. Rotator cuff tears can be caused by repetitive use or a sudden overload into the muscle-tendon unit.

Most of these muscle-tendon injuries need strengthening. The rotator cuff gets activated with lots of different movements so there are plenty of options. When pain is high, I find ways to strengthen around this. Resistance bands and light weights are good for starters. In the gym setting, pulleys are ideal. The pulley rope can be adjusted so that the rotator cuff muscles can be worked in different positions. Keeping it functional is key, so that the exercises mimic normal movement patterns.

Shoulder injuries from lifting weights usually involve a tear or strain of the rotator cuff. Overloading the shoulder is the main cause. Gym goers really have to pull back on the weights and build up again. The rotator muscles and their tendons need to be reloaded again with lighter resistance.

The Stiff and Painful Shoulder:

In this scenario there are obvious limitations with movement and pain. The two common conditions in this category are the arthritic shoulder and frozen shoulder. The arthritic shoulder is one where there are limitations of movement due to joint degeneration. Sometimes the soft tissues around the joint become tight. There may some pain moving into the stiffness.

The frozen shoulder is another entity. This is where there is severe loss of movement in all directions and a lot of pain. There will be pain at night and with movement. We don’t know why a frozen shoulder occurs in some people. Sometimes it is caused by an underlying initial injury that produces inflammation.

For the stiff arthritic shoulder the treatment is to mobilize the joint using manual therapy and mobility exercises. The soft tissue restrictions can be mobilized with a general program of strengthening. Every shoulder is different depending on how stiff they are.

For a frozen shoulder, the treatment may last at least six months. It is important not to be too aggressive initally to avoid aggravating it and causing more pain. It is one of the most challenging shoulder injuries to manage as the pain is quite high. I tend to use a mix bag of treatment techniques as each shoulder will respond differently.

The Weak and Unstable Shoulder:

These shoulders tend to be the result of repeated dislocations. If dislocation becomes chronic then surgery is usually indicated. Regular dislocations tend to occur in contact sports. If surgery is not indicated then rehabilitation is aimed at strengthening the stabilizing muscles of the shoulder joint. Certain movements have to be avoided to reduce the risk of further dislocations. The treatment program should be progressed from basic strengthening to stabilizing exercises.

Shoulder Gym Workouts: What Exercises Should I Do?

EMG studies show that the rotator cuff muscles are activated with general shoulder movements. General pushing and pulling exercises will activate both sides of the rotator cuff. Arm raises to the the side activate both. I still think it is a good idea to do some specific rotator cuff exercises as well as compound movements. Pulleys and elastic bands are good for targeting these muscles. Whatever level you are in the gym, the key is to build up slowly so to not cause injury.

If you have any questions about this blog you can email me at the address below. If you need specific advice about an injury it is best to seek advice from a physiotherapist. You can also contact me for advice about incorporating shoulder exercises into your workouts.

About the Author

Damian Wyard trained is a Registered Physiotherapist and Stott Pilates Rehabilitation Instructor with 20 years experience in his field. He is the owner of Pilates4Physio in Toronto. You can reach him privately at, or at his Pilates studio