Shoulder Pain: Common Causes, Treatment, and When to Get Help

Shoulder pain can make everything from reaching overhead to lifting weights, sleeping, throwing, or simply putting on a shirt uncomfortable. It is also easy to assume that pain means something in the shoulder is damaged and needs to be “fixed.”

The reality is usually more complicated.

Shoulder pain can come from several different structures and is influenced by factors such as training load, strength, movement, previous injury, age, recovery, and the demands you place on your shoulder. Imaging findings such as rotator cuff tears, arthritis, bursitis, and other changes also don’t always tell us exactly why someone hurts.

At Peak Form Health Center in San Diego, our goal isn’t simply to identify a painful structure. We want to understand why your shoulder is struggling with the activities you are asking it to perform and what we can do to improve its capacity.

For many people, that means combining hands-on treatment with progressive exercise and a thoughtful return to the activities they want to do.

Why Does My Shoulder Hurt?

The shoulder is designed to move.

Unlike joints that rely heavily on bony structure for stability, the shoulder allows an enormous amount of movement. Muscles surrounding the shoulder blade and rotator cuff continually work together to control the arm as you reach, lift, push, pull, throw, swim, or perform other activities.

That mobility is incredibly useful, but it also means the shoulder has to adapt to whatever demands you place on it.

Problems can develop when those demands exceed the shoulder’s current capacity.

For example, shoulder pain might appear after:

• Increasing your lifting volume
• Starting a new exercise program
• Returning to swimming or throwing
• Increasing tennis or pickleball
• Repetitive overhead work
• A fall or traumatic injury
• A period of inactivity followed by increased activity
• Changes in strength or conditioning
• Continuing to train despite gradually increasing symptoms

Sometimes there is an obvious event that started the problem. Other times, shoulder pain develops gradually without a specific injury.

Common Causes of Shoulder Pain

“Shoulder pain” is a symptom rather than a diagnosis. Several conditions can produce similar symptoms, which is why determining the likely source of pain requires more than simply identifying where it hurts.

Rotator Cuff-Related Shoulder Pain

Rotator cuff-related shoulder pain is one of the most common presentations we see.

The rotator cuff is a group of four muscles and their tendons that help control and stabilize the shoulder. Symptoms often include pain when reaching overhead, lifting away from the body, reaching behind the back, or lying on the affected shoulder.

People may also describe weakness or pain during pressing, throwing, swimming, or other overhead activities.

Importantly, rotator cuff pain does not automatically mean that the tendon is torn.

Tendon irritation, changes in load tolerance, weakness, and sensitivity can all contribute to symptoms.

Rotator Cuff Tendinopathy

Tendinopathy occurs when a tendon becomes painful and less able to tolerate the loads being placed upon it.

This can happen after repetitive activity or when training demands increase faster than the tendon can adapt.

Rest may temporarily decrease symptoms, but complete rest doesn’t necessarily restore the tendon’s ability to tolerate activity.

That is why progressive loading and strengthening are often central parts of rotator cuff rehabilitation.

Rotator Cuff Tears

Rotator cuff tears become increasingly common with age and can range from relatively small partial tears to larger full-thickness tears.

A tear on an MRI doesn’t automatically tell us how much pain or disability someone should have.

Some people with rotator cuff tears have substantial symptoms, while others have few or no symptoms.

The important question is not simply:

“Is there a tear?”

It is:

“Does this imaging finding help explain this person’s symptoms and function?”

Treatment decisions should consider the examination, strength, function, mechanism of injury, goals, age, symptoms, and imaging together.

Shoulder Bursitis

A bursa is a small fluid-filled structure that helps tissues move smoothly past one another.

The subacromial bursa can become sensitive and contribute to shoulder pain, particularly with reaching or overhead movement.

Bursitis frequently occurs alongside rotator cuff-related shoulder pain rather than existing as a completely separate problem.

Shoulder Impingement

Many people have been told that they have “shoulder impingement” because a tendon is being pinched when they raise their arm.

The term is still commonly used, but our understanding of shoulder pain has evolved.

Shoulder pain during elevation is not necessarily evidence that tissues are being repeatedly damaged or mechanically pinched every time the arm moves overhead.

This distinction matters.

If someone believes every painful movement is damaging their shoulder, they may understandably become afraid to move it. Instead, we often modify painful activities temporarily while gradually rebuilding the shoulder’s ability to tolerate them.

Calcific Rotator Cuff Tendinopathy

Calcific tendinopathy occurs when calcium deposits develop within a rotator cuff tendon.

For some people, this produces significant pain and difficulty moving the shoulder.

This is one shoulder condition where shockwave therapy can be particularly useful as part of conservative treatment. Shockwave applies acoustic pressure waves to the affected area and may help reduce pain and support changes within the calcific deposit and tendon.

We frequently combine shockwave with progressive rehabilitation rather than viewing it as a stand-alone solution.

Shoulder Arthritis

Arthritic changes within the shoulder can cause pain, stiffness, and reduced motion.

But, as with many imaging findings, the amount of arthritis visible on an X-ray doesn’t always perfectly match the amount of pain someone experiences.

For active adults with shoulder arthritis, maintaining mobility and developing strength around the shoulder can help improve function and increase the amount of activity the joint can tolerate.

Shoulder Instability

Some shoulders have difficulty maintaining adequate control during movement.

This may happen following a dislocation or traumatic injury, but instability can also occur without a major injury.

Someone may describe the shoulder as loose, unstable, weak, or as though it might “slip.”

Treatment often emphasizes strengthening the rotator cuff and muscles controlling the shoulder blade while gradually exposing the shoulder to increasingly challenging positions.

Does Shoulder Pain Mean Something Is Damaged?

Not necessarily.

Pain is important information, but it isn’t a direct measurement of tissue damage.

A painful shoulder may be irritated, overloaded, sensitive, injured, or simply struggling to tolerate its current demands.

This is one reason we don’t want to evaluate shoulder pain based only on an MRI or X-ray.

Imaging can be extremely useful when it is clinically indicated, particularly after significant trauma, major loss of strength, suspected fracture, dislocation, or when symptoms aren’t progressing as expected.

But imaging is one piece of the puzzle.

Do You Need an MRI for Shoulder Pain?

Usually, an MRI isn’t the first step for every episode of shoulder pain.

A good shoulder evaluation can provide considerable information about what is happening.

We look at factors such as:

• How the problem started
• Where the pain occurs
• Which movements reproduce symptoms
• Shoulder range of motion
• Rotator cuff strength
• Shoulder blade control
• Neck involvement
• Previous injuries
• Training and activity demands
• Changes in workload
• Your goals

If the examination suggests imaging would change the treatment plan, an X-ray, ultrasound, or MRI may be appropriate.

The goal isn’t to avoid imaging. It’s to use imaging when the information is likely to be useful.

How We Treat Shoulder Pain at Peak Form Health Center

There isn’t one treatment that works for every shoulder.

Your treatment should depend on what we find during the evaluation and what you are trying to return to.

Our approach commonly combines several strategies.

Hands-On Treatment

Manual therapy may include techniques such as Active Release Techniques (ART), soft tissue treatment, joint manipulation or mobilization, and other approaches designed to reduce pain and improve movement.

This can be particularly helpful when pain or guarding makes movement difficult.

But feeling better after treatment is only part of the process.

We want to use that improvement to help you move and train more effectively.

Progressive Shoulder Strengthening

Strength is one of the most important components of shoulder rehabilitation.

Depending on the individual, rehabilitation may include:

• Rotator cuff strengthening
• Rows and pulling exercises
• Pressing progressions
• Shoulder blade strengthening
• Isometric exercises
• Overhead strengthening
• Carrying exercises
• Eccentric or slow resistance training
• Sport-specific movements

We don’t necessarily want to protect the shoulder forever.

We want to gradually make it capable of handling more.

Shockwave Therapy

Shockwave therapy can be useful for selected shoulder tendon conditions, especially calcific rotator cuff tendinopathy.

At Peak Form Health Center, shockwave is performed by the treating provider and incorporated into the overall rehabilitation plan when appropriate.

Treatment may help reduce pain and improve the local tendon environment, but the ultimate goal remains restoring the shoulder’s ability to tolerate activity.

Activity Modification

You don’t always need to completely stop exercising because your shoulder hurts.

Instead, we can often change variables such as:

• Weight
• Range of motion
• Exercise selection
• Repetitions
• Training frequency
• Tempo
• Grip
• Volume

For example, someone who has pain with a heavy overhead press may tolerate a landmine press or lighter dumbbell variation.

That’s not necessarily avoiding the problem.

It can be a way to keep training while gradually rebuilding capacity.

Can You Exercise With Shoulder Pain?

Often, yes.

The appropriate amount depends on the condition and severity of symptoms.

We generally don’t expect every rehabilitation exercise to be completely symptom-free. Mild discomfort can sometimes be acceptable if symptoms remain manageable during exercise and settle afterward.

What matters is how the shoulder responds.

If symptoms progressively increase during training, remain significantly worse afterward, or continue worsening the following day, the workload may need to be adjusted.

The goal is to find the amount of loading that stimulates adaptation without continually overwhelming the shoulder.

When Should You Get Shoulder Pain Evaluated?

Consider getting your shoulder evaluated if pain:

• Persists for several weeks
• Continues getting worse
• Frequently interrupts sleep
• Prevents you from exercising or participating in your sport
• Causes significant weakness
• Limits your ability to raise your arm
• Began after a significant fall or injury
• Keeps returning whenever you resume activity

Sudden severe pain, obvious deformity, inability to move the arm after trauma, unexplained swelling or redness, fever, chest pain, or other concerning symptoms warrant more immediate medical evaluation.

The Goal Isn’t Just to Make Your Shoulder Stop Hurting

Pain relief matters.

But if your shoulder hurts every time you return to lifting, swimming, tennis, pickleball, throwing, work, or another activity you enjoy, simply reducing pain isn’t enough.

We want to understand what your shoulder needs to do and progressively prepare it to do that again.

That may mean improving strength.

It may mean modifying training temporarily.

It may mean restoring confidence with overhead movement.

And it often means gradually exposing the shoulder to greater loads rather than avoiding them indefinitely.

At Peak Form Health Center in San Diego, we combine sports chiropractic treatment, rehabilitation, exercise, and shockwave therapy when appropriate to help active adults move beyond shoulder pain and return to the activities that matter to them.

The shoulder is adaptable.

Our job is to determine where its current capacity is, then help you build from there.