Physiotherapy for Shoulder Pain

Pilates with the science of Physiotherapy


Shoulder physiotherapy is based on the type of injury and pain level. Your assessment will determine what type of injury you have. It will also tell us what structures are damaged and causing pain. We use specific clinical tests based on your history of injury. You may need a referral to your GP for an ultrasound or x-ray. Severe injures of a traumatic nature, with loss of movement should be seen in Emergency or by your GP.

Shoulder injuries can be grouped into three main groups, however, there is always variation for each patient. The grouping makes it easier for patients to understand the nature of the injury and the treatment approach. Read our blog here about how we treat shoulder injuries based on these groupings and why.

We provide a thorough assessment of your shoulder injury and treatment plan. Most treatment plans incorporate traditional manual therapy and Pilates-based rehab using the classic equipment. Pilates equipment is ideal for this joint as it needs strengthening and stability. It also needs mobility to do normal functional things.

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a boy jumping with a basketball


Rotator Cuff Injuries:

Rotator cuff injuries are very common with our Downtown Toronto patients and can affect both young and older patients. In the younger age groups, the muscle and tendon can become overloaded. Mild to moderate tears involve a period of rest and gradual exercises. Rotator cuff tendons can also be overloaded or have tears. An ultrasound will be the first imaging performed to confirm an injury.

Frozen Shoulder (Adhesive Capsulitis):

This injury or condition can occur after an inflammatory response in the shoulder joint. The shoulder joint becomes very stiff and painful. Corticosteroid injections may help to reduce pain so that you can start moving it again. The condition goes through different phases as it heals. The length of time can be six months or even up to a year in some patients.

Weak and Painful Shoulders:

Weakness in the shoulder muscles and shoulder blades can cause pain in the shoulder joint. If the mechanics are not correct the shoulder can pinch some of the soft tissue structures as you lift the arm up. Dislocation or partial dislocation can cause some instability if the shoulder is not strengthened again. Usually, the shoulder is not stiff. In this case, the muscle imbalances are not allowing the arm to clear the shoulder joint or the shoulder blades are not rotating with the arm sufficiently.

Other types of injuries we treat with shoulder physio:

  • Biceps tendinopathy
  • AC joint sprains (collar bone sprains)
  • Collar bone and upper arm fractures
  • Nerve entrapments (shoulder and neck)
  • Surgical repair/stabilization (dislocations)

Neck Pain Referred to the Shoulder

A common condition is nerve compression from the neck. This can refer pain down to the shoulder and arm. Sometimes the symptoms of numbness and tingling can be felt in the hand and fingers. It is important to assess your neck to see if the pain is coming from the nerves in the neck. The type of pain, how it is triggered and what movements cause the pain will tell us if your neck is the cause. The assessment is thorough so that we can rule in or out the neck. Some painful muscles in the neck can also refer pain to the shoulder regions.


  • Shoulder Strengthening Programs with the Classic Pilates Equipment:
    The classic Pilates equipment allows strength through a range of levels. This is important as the shoulder is a very mobile joint. It also needs strength in a variety of movements and positions. All these need to be incorporated into an effective rehabilitation program. We use resistance from the Pilates springs and pulleys. Elastic exercise bands and weights are also great.
    We incorporate the Reformer, Tower and Pilates props into the programs. Strength has to progress to functional rehabilitation for return to sport or normal activities.
  • Shoulder Mobility Programs:
    This program is suited to the stiff or ‘frozen shoulder’. The combination of manual therapy and exercise is very helpful. Frozen shoulders have to be treated gently as they can flare up if the treatment is too aggressive. Each stage of a frozen shoulder has to be treated differently. The early frozen stage is more acute and irritable. The later stage is less painful and stiffer. The shoulder will tolerate stronger stretches in the later stages.
  • Postural Programs for the Shoulder:
    Many shoulder injuries can be caused by poor upper back and neck posture. A common scenario we see is the stiff, rounded upper back with head forward posture. The shoulder can become involved when the stiff upper back limits shoulder mobility. The shoulder blades, upper arm and upper back (thoracic spine) all need to work together for correct shoulder mechanics. We use Pilates-based exercises to combine the upper back with shoulder mechanics. Many neck and shoulder conditions can be treated by integrating the upper back mobility into the program. Postural causes of shoulder pain are common with desk work or not enough variety in exercise programs.


Can I continue to lift weights with a painful shoulder?

The key is to reduce the amount of loading into the injured muscles or tendon. There has to be a reduction in lifting weights, otherwise, the injury will become chronic or more serious. Pain needs to be reduced so that the structure can heal. We can advise on safe exercises and alternatives.

What else can I do for pain?

Physiotherapists cannot suggest pain medication as this is outside our scope of practice. You can talk to your GP about pain medication. Some painful shoulder conditions may benefit from a corticosteroid injection, however, the long-term outcome from corticosteroid injections is not better than exercise-based treatments. Gentle movements and gradual strength will also reduce pain.

How long do shoulder injuries take to heal?

This depends on the type of injury. The first step is to reduce pain with the treatment, This can take up to 6 weeks. Once pain is reduced then you can increase the strengthening phase. The tendon or muscles may still be weak and fragile, so it can take another 3 to 6 months for full strength.

Frozen shoulder is a lot longer and has specific stages of recovery.