Month: September 2025

Shoulder pain is one of the most common complaints I hear as a physical therapist. But few things are as frustrating as persistent pain in the back of the shoulder. This type of pain can interfere with reaching, lifting, sleeping, and even simple daily tasks like putting on a shirt. Sometimes the pain is a dull, constant ache. Other times, it radiates, pinches, or worsens with certain movements. No matter how it shows up, one thing is clear: it can affect your quality of life.

It’s important to pay attention to when pain starts. Especially if it worsens or is accompanied by other symptoms, as this can help determine when to seek further evaluation.

In this blog, I’ll walk you through the most common causes of pain in the back of shoulder, highlight related conditions, and provide actionable physical therapy and self-care strategies. My goal is to help you better understand your pain and empower you with knowledge to take control of your recovery.

Introduction

Shoulder pain is a widespread issue that affects millions of people every year, often disrupting daily life and limiting activity. Because the shoulder joint is one of the most mobile and complex joints in the body, it’s especially vulnerable to injury and strain. Common causes of shoulder pain include rotator cuff tears, shoulder blade pain, and referred pain from other areas of the body. Whether the pain is sharp, dull, or radiates down the arm, it can stem from a variety of sources—ranging from overuse and poor posture to acute injuries or underlying medical conditions.

Recognizing the root cause is crucial for effective treatment and long-term relief. If you experience severe pain, numbness, or tingling in your shoulder or arm, it’s important to seek medical attention promptly, as these symptoms may indicate a more serious problem. In this guide, we’ll explore the most common causes of shoulder pain and provide strategies to help you manage and overcome discomfort.

Understanding Shoulder Anatomy

The shoulder joint, or glenohumeral joint, is a remarkable ball-and-socket joint formed by three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). This unique structure allows for a wide range of motion, making it possible to reach, lift, and rotate your arm in almost any direction. Surrounding the joint are layers of soft tissues—muscles, tendons, and ligaments—that provide stability and support. The rotator cuff, a group of four muscles and their tendons, is especially important for keeping the upper arm bone securely in the shoulder socket and enabling smooth, controlled movement.

However, the very flexibility that makes the shoulder so functional also makes it prone to problems. Overuse injuries, poor posture, and wear-and-tear arthritis can place excessive strain on the surrounding muscles and soft tissues, leading to pain and limited mobility. Conditions like frozen shoulder, bulging or ruptured discs in the neck, and even heart attacks can also cause pain that radiates to the shoulder area. Understanding how the three bones, the rotator cuff, and the supporting structures work together is key to identifying the source of your pain and developing an effective treatment plan. By appreciating the complexity of the shoulder joint, you’ll be better equipped to protect it, maintain good posture, and restore a healthy range of motion.

Pain in the Back of the Shoulder

It is often linked to musculoskeletal issues like muscle strain, rotator cuff irritation, frozen shoulder, or acute injury. It can also arise from spinal problems or even internal conditions that “refer” pain to the area. The sensation may be sharp, dull, burning, or radiating—and knowing the difference helps narrow down the cause.

Localized pain in the back of the shoulder may indicate specific shoulder problems that require targeted evaluation, especially if the pain worsens over time or interferes with daily activities.

Shoulder Blade Discomfort

Pain in the back of the shoulder is often felt around or under the shoulder blade (scapula). This is because the shoulder blade serves as a foundation for many muscles that stabilize and move the shoulder joint. Inflammation of the bursa, a fluid-filled sac that cushions the joint, can also cause pain and restrict shoulder motion in this area. When the joint is stiff or dysfunctional, the scapular muscles overcompensate, leading to tightness and soreness.

Relieve Shoulder Blade Pain

As a PT, I often prescribe gentle, posture-friendly exercises to relieve shoulder blade pain:

• Shoulder blade squeezes: Sit tall, pull your shoulder blades back and down, hold for 5 seconds, and relax.
• Wall angels: With your back against a wall, slowly raise and lower your arms like making a snow angel.
• Child’s pose stretch: Kneel on the floor, reach arms forward, and let the upper back open up.
• Heat or warm shower: Loosens tight muscles and makes stretching more effective.

These simple movements, done consistently, can help reduce strain and restore balance in the upper back.

Referred Pain

Not all shoulder pain originates in the shoulder. This phenomenon is called referred pain, which refers to pain felt in the shoulder that actually originates from another structure or area. For example, issues in the neck, spine, or even internal organs can radiate into the back of the shoulder. Distinguishing called referred pain from local shoulder dysfunction is critical in developing the right treatment plan.

Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is one of the most restrictive conditions I see. It occurs when the capsule around the shoulder joint thickens and tightens, causing stiffness and limited range of motion. Patients often describe difficulty lifting the arm overhead, fastening a bra, or reaching into a back pocket.

Stages of frozen shoulder:

1. Freezing: Painful and gradually stiffening (6 weeks–9 months).
2. Frozen: Less pain, but severe restriction (4–6 months).
3. Thawing: Motion slowly returns (6 months–2 years).

Physical therapy focuses on gentle mobility exercises, joint mobilizations, and progressive stretching to shorten recovery time and reduce pain in the back of shoulder.

Poor Posture

Posture plays a huge role in shoulder health. Hours of sitting slouched, leaning forward at a desk, or scrolling on a phone contribute to poor posture, which strains the muscles around the back of the shoulder. Over time, this creates imbalances and chronic pain.

PT tip: Strengthening the upper back and core, while stretching the chest, can dramatically improve posture and relieve shoulder blade pain. Make it a habit to practice good posture as part of your daily routine to prevent back and shoulder pain. Small habits—like keeping screens at eye level and using a supportive chair—go a long way.

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When Shoulder Pain Could Be a Heart Attack

While most pain in the back of the shoulder is musculoskeletal, sometimes it can be a warning sign of something more serious. Heart attacks can cause pain that radiates into the left shoulder, jaw, or arm. If you notice sudden shoulder pain along with chest pressure, shortness of breath, nausea, or dizziness, seek prompt medical attention immediately. It’s always better to be cautious.

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Cervical Herniated Disc

The neck (cervical spine) can be a hidden culprit for back-of-shoulder pain. A cervical herniated disc is a type of bulging or ruptured disc, where the cushioning discs between the vertebrae bulge or rupture, pressing on nearby nerves. This can cause radiating pain that spreads from the neck into the shoulder blade, arm, or even fingers. Symptoms often include tingling, numbness, or weakness.

Physical therapy treatments may include posture training, traction, nerve glides, and gentle strengthening exercises to reduce pressure and improve stability.

Causes of Shoulder Pain

Pain in the back of shoulder can come from many sources. Common causes include:

• Frozen shoulder
• Rotator cuff strain or tear
• Rotator cuff tendon injury
• Cervical herniated disc
• Compression fracture
• Dislocated rib
• Shoulder dislocations
• Poor posture
• Referred pain from internal organs (like the heart)

Because the shoulder is a complex joint, pinpointing the exact shoulder condition often requires a detailed evaluation from a PT or physician.

Compression Fracture

A compression fracture in the spine—often due to osteoporosis—can cause back and shoulder pain. When a vertebra collapses, it alters spinal alignment and strains nearby muscles, sometimes felt as pain in the back of the shoulder. Medical imaging and consultation are necessary here, as treatment may involve bracing or medical management in addition to physical therapy.

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Dislocated Rib

A dislocated rib can mimic shoulder blade pain. When a rib slips out of alignment, it can affect the rib cage and surrounding muscles, irritating nerves and creating sharp pain with deep breaths, lifting, or twisting. Manual therapy, breathing exercises, and gentle mobilization are common PT strategies to restore rib alignment and reduce pain.

The Role of Physical Therapy

As a PT, I view physical therapy as the cornerstone of recovery for shoulder pain, especially when dealing with pain in the back of the shoulder. Physical therapy is a key component of pain management for shoulder issues, providing specialized interventions to reduce pain and improve quality of life. While rest or medication may provide temporary relief, PT targets the underlying causes—whether that’s stiff joints, weak muscles, poor posture, or nerve irritation. The goal is not only to reduce pain but also to restore strength, range of motion, and confidence in your daily movements.

Depending on the cause, treatment may include:

• Gentle stretching: Movements such as pendulum swings, towel stretches, wall climbs, and cross-body reaches help restore mobility gradually. We start slowly, working within your comfort zone, and progressively expand your range as the shoulder adapts.
• Strengthening: Building strength in the rotator cuff, scapular stabilizers, and postural muscles provides the foundation for healthy shoulder mechanics. This often includes resistance band exercises, light weights, and bodyweight drills that retrain your shoulder to function smoothly and safely.
• Postural training: Poor posture is one of the most common contributors to pain in the back of shoulder. As PTs, we focus on postural awareness, ergonomic corrections, and exercises to open the chest and strengthen the upper back. This improves alignment and reduces unnecessary strain on your shoulders.
• Manual therapy: Hands-on techniques like joint mobilization, soft tissue release, myofascial release, and gentle stretching can help relieve stiffness, improve circulation, and restore normal joint mechanics. Many patients notice immediate relief and improved mobility after these sessions.
• Modalities: Depending on your needs, we may use heat, ultrasound, cold therapy, or electrical stimulation. These tools don’t fix the root cause but create the right environment for healing by calming inflammation and easing discomfort.

What makes PT unique is personalization. No two patients experience pain in the back of the shoulder in the same way.

Prompt Medical Attention

There are situations where shoulder pain requires urgent care:

• Sudden severe pain after an accident (possible fracture or dislocation)
• Numbness, tingling, or weakness spreading into the arm or hand
• Shoulder pain with chest pain, dizziness, or difficulty breathing (possible heart attack)

Never ignore these red flags, and seek treatment from a healthcare professional immediately if you experience any of them.

Herniated Disc vs. Frozen Shoulder

It’s easy to confuse herniated disc pain with frozen shoulder. Here’s a quick breakdown:

• Frozen shoulder: Dull ache, stiffness, loss of range in all directions.
• Herniated disc: Sharp, shooting pain, sometimes described as stabbing pain due to nerve involvement, often worsens with neck movement, sometimes with numbness.

A PT assessment can determine the root cause and guide you toward the right care.

Final Thoughts

Pain in the back of shoulder can be overwhelming, but it’s treatable with the right combination of self-care, physical therapy, and lifestyle changes. Whether your pain stems from frozen shoulder, posture, a disc issue, or even something more serious, understanding the source is the first step toward relief.

With time, patience, and consistent effort, most people regain mobility and return to pain-free living. Don’t ignore your symptoms—get evaluated, start treatment, and take control of your recovery.

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Take the Next Step with Pelvis NYC

If you’re dealing with persistent pain in the back of the shoulder, don’t wait. At Pelvis NYC, our expert physical therapists provide personalized, hands-on care to address the root cause of your pain. From posture training to targeted exercises, we’ll help you move better and feel better.

👉 Book your appointment with Pelvis NYC today and start your journey to recovery.

Suppose you’re struggling with frozen shoulder (also called adhesive capsulitis). In that case, you know how frustrating it can be when simple tasks like reaching overhead, putting on a jacket, or sleeping comfortably become nearly impossible. As a physical therapist, I often hear patients ask: “Is there anything I can do at home for frozen shoulder self-care?”

The shoulder is a ball-and-socket joint, where the upper arm bone (humerus) fits into the shoulder socket (glenoid cavity). This structure allows for a wide range of motion, but also makes the shoulder susceptible to conditions like frozen shoulder.

The good news: Yes. With the right combination of frozen shoulder treatment, shoulder exercises, and self-care strategies, you can gradually restore movement, reduce stiffness, and find pain relief.

This guide covers everything you need to know about frozen shoulder self-care—from recognizing symptoms to managing risk factors and integrating PT-based solutions.

What is Frozen Shoulder (Adhesive Capsulitis)?

Frozen shoulder happens when the capsule surrounding your shoulder joint thickens and tightens, limiting motion. This condition occurs when the shoulder capsule becomes inflamed and adhesions form, leading to restricted motion. The exact cause of frozen shoulder remains unknown, though certain risk factors increase susceptibility. This leads to pain, stiffness, and difficulty moving your arm.

It typically develops slowly and goes through three stages:

1. Freezing stage – Increasing shoulder pain and limited motion.
2. Frozen stage – Frozen shoulder occurs as the capsule thickens and synovial fluid decreases, resulting in pain and stiffness. Pain may lessen, but stiffness peaks.
3. Thawing stage – Mobility gradually returns.

Pain and stiffness are hallmark symptoms, and restricted motion and loss of the shoulder’s range are key features. Reduced synovial fluid in the joint contributes to shoulder stiffness and limited shoulder movement.

You might be interested in reading Pain in the Back of Shoulder Explained!

Frozen Shoulder Symptoms

Common symptoms of frozen shoulder include:

• Persistent shoulder pain, especially at night
• Pain that can radiate from the shoulder to the upper arm
• Stiffness that makes everyday tasks hard
• Limited range of motion in all directions
• Difficulty lifting, reaching, or rotating the arm

Frozen shoulder affects about 2-5% of the general population, most commonly adults between 40 and 60 years old.

If you notice these signs, especially combined with risk factors, you may be starting to develop frozen shoulder.

Risk Factors for Frozen Shoulder

Not everyone gets adhesive capsulitis, but some people are more at risk. Key risk factors include:

• Age (most common between 40–60 years old)
• Diabetes or thyroid conditions
• Shoulder immobilization (from injury, fracture, or surgery)
• Previous rotator cuff injury
• Sedentary lifestyle or lack of mobility

Frozen Shoulder Treatment: The Role of Physical Therapy

While frozen shoulder can sometimes resolve on its own, physical therapy treatment helps speed recovery and prevent long-term stiffness. The primary goals of treatment are to restore motion and reduce pain. As a PT, I typically use:

• Manual therapy to mobilize the joint capsule, helping regain motion and improve shoulder movement
• Shoulder exercises for flexibility and strengthening, which also help regain motion and improve shoulder movement
• Heat or ice therapy for pain relief
• Education on posture, movement, and self-care at home

Simple treatments like heat, ice, and gentle stretching are often effective for most patients. Symptoms may slowly improve over time, and full recovery can take several months to years, depending on the individual.

Combining in-clinic treatment with a structured self-care routine offers the best results.

Shoulder Treatment Options Beyond Physical Therapy

While physical therapy is often the cornerstone of frozen shoulder treatment, there are additional options available for those who need further relief or whose symptoms persist. One commonly used intervention is a steroid injection into the shoulder joint. This can help decrease pain and inflammation, making it easier to participate in a range of motion exercises and daily activities. Steroid injections are especially helpful during the early, painful stages of adhesive capsulitis.

For some patients, if physical therapy and injections do not provide enough improvement, a procedure called manipulation under anesthesia may be considered. During this treatment, a healthcare provider gently moves the affected shoulder through its full range of motion while the patient is under anesthesia, helping to break up tight portions of the shoulder capsule and improve mobility.

In rare cases where severe stiffness and pain remain despite other treatments, arthroscopic surgery may be recommended. This minimally invasive procedure involves making small incisions in the shoulder and using a camera to guide the release of the tight shoulder capsule and removal of any scar tissue that may be restricting movement. Surgery is typically reserved for those with persistent frozen shoulder symptoms that do not respond to less invasive treatments.

It’s important to discuss all available shoulder treatment options with your healthcare provider. Together, you can determine the best approach to decrease pain, restore range of motion, and help you return to your normal activities.

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Frozen Shoulder Self-Care: What You Can Do at Home

Here’s how you can actively participate in your recovery:

Some people find that with consistent self-care, such as gentle stretching and following recommended exercises, pain and mobility may begin to improve within six weeks, although full recovery can take longer.

Additionally, some individuals consider dietary supplements to support joint health, but it is important to consult your healthcare provider before starting any new supplement.

1. Gentle Shoulder Exercises

Safe, consistent motion prevents worsening stiffness. Try these PT-approved frozen shoulder exercises:

• Pendulum swings – Let your arm hang and make small circles.
• Towel stretch – Hold a towel behind your back and gently pull upward.
• Wall walks – Use your fingers to climb a wall, gradually lifting your arm higher.

Once your range of motion improves, adding strengthening exercises can help support your shoulder and prevent future problems.

2. Heat Before Stretching

Apply heat for 10–15 minutes before exercises to relax tight tissues and ease pain. Taking a warm shower before stretching can also help relax the shoulder muscles and prepare them for exercise.

3. Ice After Activity

If your shoulder feels sore, use ice to calm irritation.

4. Maintain Good Posture

Avoid slouching or guarding your arm too much—gentle movement throughout the day supports recovery.

The Rotator Cuff and Frozen Shoulder

Although adhesive capsulitis mainly affects the joint capsule, your rotator cuff muscles often weaken from lack of use. Rotator cuff tears are another common shoulder problem, and sometimes imaging tests like MRI are needed to distinguish between a rotator cuff tear and frozen shoulder. Strengthening these muscles is a key part of long-term shoulder treatment and preventing re-injury.

Pain Relief Tips for Frozen Shoulder

In addition to self-care exercises and therapy, patients often find relief with:

• Over-the-counter anti-inflammatory medication (if cleared by your doctor)
• Gentle stretching routines
• Prioritizing sleep positions that reduce pressure on the affected shoulder

If pain persists or the diagnosis is unclear, a healthcare provider may recommend a physical exam and imaging tests, such as X-rays or MRI, to rule out other causes of shoulder pain. A thorough physical examination is important to assess shoulder mobility and identify the underlying problem.

Preventing Future Episodes of Frozen Shoulder

Once you’ve recovered from frozen shoulder, taking steps to prevent it from returning is essential for long-term shoulder health. Regular shoulder exercises that maintain flexibility and strength in the shoulder joint are key to preserving your range of motion and reducing the risk of developing frozen shoulder again. Working with a physical therapist can help you learn the right exercises and stretches tailored to your needs.

Managing underlying risk factors is also crucial. Conditions like diabetes, thyroid disease, and heart disease can increase your chances of developing adhesive capsulitis, so keeping these medical problems under control with the help of your healthcare provider is important. Maintaining a healthy weight, eating a balanced diet, and avoiding smoking all contribute to better joint health.

If you’ve had a recent shoulder injury or surgery, early movement and gentle rehabilitation exercises can help prevent the shoulder capsule from tightening. Don’t wait for stiffness to set in—consult a physical therapist soon after any shoulder issue to get personalized guidance on safe, effective exercises.

By staying proactive with your shoulder care, you can help ensure your shoulders remain healthy, mobile, and pain-free for years to come.

Final Thoughts on Frozen Shoulder Self-Care

Recovering from frozen shoulder takes patience—but with the right plan, you don’t have to live in pain. A mix of physical therapy treatment and frozen shoulder self-care strategies can help restore movement, reduce stiffness, and give you back your daily function.

If you’re struggling with shoulder pain or think you may have adhesive capsulitis, consider visiting a physical therapist. Together, we can create a plan for pain relief, mobility, and long-term shoulder health.

Take the Next Step with Pelvis NYC

Ready to take the next step in your frozen shoulder recovery? At Pelvis NYC, our expert physical therapists specialize in shoulder treatment, pain relief, and restoring mobility. Don’t let adhesive capsulitis hold you back—book your appointment with Pelvis NYC today

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FAQs

1. Can frozen shoulder heal on its own?
Yes, but recovery can take months to years. Physical therapy treatment and self-care exercises can significantly speed up healing.

2. What is the fastest way to relieve frozen shoulder pain?
Gentle shoulder exercises, heat before stretching, and ice afterward can provide immediate pain relief.

3. Is frozen shoulder the same as a rotator cuff injury?
No. Frozen shoulder involves the joint capsule tightening, while rotator cuff injuries affect the shoulder muscles and tendons. However, the two can overlap.

4. When should I see a physical therapist for frozen shoulder?
If shoulder pain or stiffness lasts more than a few weeks, see a PT. Early treatment prevents long-term disability.

Related Blog: Left Shoulder Pain: Causes, Symptoms, and Proven Treatment Options