Shoulder Injuries - Challenges and Solutions
By Daniel Hickey Physio at Rehab Rooms Physio Clinic
Introduction
Shoulder injuries are some of the most complex and disruptive issues I see in clinic. Whether it’s a gym-goer struggling with overhead presses, a GAA player hesitant to return to contact, or a desk-based worker unable to sleep on their side, shoulder pain can be relentless, frustrating, and deeply limiting.
The challenge with the shoulder isn’t just its mobility—it’s its vulnerability. And when that balance is disrupted, recovery requires more than a few basic exercises. It demands structure, strategy, and individualisation.
Last weekend, I attended the Complete Shoulder Symposium hosted by Sports MAP at UPMC Sports Surgery Clinic. With leaders in the field like Edel Fanning PhD, Ben Ashworth, Hamish Macauley, and Robbie Smyth presenting, the event focused on cutting-edge strategies in shoulder rehabilitation, assessment, and return to sport. But perhaps most importantly, it offered clinical tools that are just as valuable in private practice as they are in elite sport.
Here’s how I am integrating these insights into my approach to treating shoulder conditions in clinic — from complex post-op cases to everyday rotator cuff-related pain.
The Clinical Reality of Shoulder Pain
Rotator cuff-related pain, frozen shoulder, and instability are among the most common conditions we see in private practice. But despite being common, these injuries are anything but simple.
Take rotator cuff tendinopathy. It often begins as a dull ache, or pain lifting overhead. But over time, pain persists, strength declines, and patients become less confident using their arm. Many are told they have a tear or degeneration, but rarely are they told that the shoulder is adaptable, and that strength, control, and load management are the key to recovery.
Frozen shoulder is another condition where patients often feel left behind. They’re told to wait it out, or that it will “get better on its own”—but in reality, many suffer months of stiffness, poor sleep, and reduced function. The earlier we engage with guided movement and strength, the better the outcome.
Some shoulder issues aren’t caused by a single injury but rather by the shoulder struggling to stay stable during movement. These cases, often related to instability or hypermobility, can be trickier to spot—and are sometimes misunderstood or not fully addressed. For some people, it’s the result of a previous dislocation or trauma. For others, especially those who are naturally more flexible or do a lot of overhead activity (like swimming or gym training), the shoulder may simply lack the control it needs to feel strong and reliable.
When this type of issue isn’t managed properly, it can lead to hesitation, ongoing discomfort, or even repeated episodes of the shoulder giving way. That’s why we focus not just on building strength, but on helping the shoulder relearn how to move well under load—improving control, timing, and confidence. By starting with simple movements and gradually progressing to more challenging positions, we help patients feel strong, stable, and in control again—whether they’re reaching overhead, lifting weights, or just going about everyday life.
What Makes the Shoulder So Complex?
Unlike joints like the hip or knee, the shoulder relies on dynamic stability. Its strength comes not from bones or ligaments, but from coordinated muscle activation and control.
That means shoulder rehab must go beyond pain relief. We need to address:
Strength (particularly of the rotator cuff and scapular stabilisers)
Control under load
Range of motion, especially overhead
Fear of re-injury or hesitation using the arm
Functional return — not just in the clinic, but in daily life or sport
And we must look beyond the shoulder itself. Thoracic mobility, core strength, trunk rotation, and the kinetic chainall play critical roles in how the shoulder functions.
How I Approach Shoulder Rehab
I take a phased, person-centred approach, rooted in assessment, communication, and progressive loading. My rehab process is shaped by both current research and the practical frameworks shared at the Sports MAP symposium.
1. Understand the person and the problem
Every rehab journey begins with identifying what matters most to the individual—whether that’s sleeping through the night, lifting a child, or returning to training.
Assessment involves range of motion, pain triggers, strength testing (often using handheld dynamometry), and observing how the shoulder moves in real-world tasks. Most importantly, I explain everything in clear, supportive language so the patient understands what’s going on—and how we’re going to fix it.
2. Work with pain, not against it
In the early stages of recovery—whether it’s a frozen shoulder or a tendon issue—it’s important to keep the shoulder moving in a way that feels safe. That doesn’t mean pushing through sharp pain, but it also doesn’t mean total rest. We start with what your shoulder can handle—like gentle holds, light stretches, or supported band exercises—and build from there. The goal is to stay active, rebuild confidence, and make steady progress.
3. Build strength with purpose
As pain starts to ease, we begin focusing on real-life strength—not just isolated muscle work. We target the muscles that support and stabilise the joint (especially the rotator cuff) and use movements like single-arm carries, resistance band work, and controlled overhead lifts.
The aim isn’t just to reduce pain—it’s to help your shoulder feel strong, stable, and trustworthy again.
4. Restore confidence
It’s common to feel anxious about using your shoulder again—especially if you’ve had surgery or a traumatic injury. That’s why we use graded exposure to gradually reintroduce movements you might be avoiding, like reaching, lifting, or pressing. Progress is tracked closely so you can see and feel improvement, building trust in your shoulder and in your body again.
5. Progress with purpose
The goal isn’t just to improve strength or range—it’s to return to full, confident function. Whether that’s lifting in the gym, throwing in a match, or simply reaching into a high cupboard without thinking, rehab isn’t done until you feel ready and resilient in your day-to-day life.
Manual Therapy Matters — When Used with Purpose
While progressive exercise is the foundation of long-term recovery, we also place a strong emphasis on hands-on treatment in clinic.
Joint mobilisations, soft tissue release, and manual therapy are highly effective for reducing pain and improving range of motion—especially in stiff or sensitive shoulders. This is particularly helpful in cases like frozen shoulder or post-op recovery.
Manual therapy isn’t a replacement for exercise—it’s a complement. It helps create short-term change so that we can load more effectively, sooner, and get patients back to moving with less discomfort and more confidence.
Bringing Research Into Rehab
As part of my PhD at UCD, I’m currently researching how wearable technology can track meaningful recovery outcomes in post-operative patients. That research mindset shapes how I approach rehab day-to-day.
In our clinic, we use objective measures like handheld dynamometry to test strength, track progress, and inform return-to-activity decisions. This gives us:
Clear data to spot lingering weaknesses
Smarter planning for return to sport or work
Better communication with patients about progress
This approach benefits everyone—from the weekend warrior to the post-op patient. It’s not about guessing. It’s about precision, progress, and confidence.
To Anyone Dealing With Shoulder Pain
You don’t have to live with shoulder pain, or worry that your arm will never feel the same. The shoulder is one of the most adaptable joints in the body—with the right plan, you can regain strength, control, and trust in it again.
At Rehab Rooms, we don’t just treat the joint—we work with the person. Whether you’re newly injured, dealing with long-term pain, or rebuilding after surgery, we’ll guide you through a clear, structured plan that’s built around your life, your needs, and your goals.
What to Do Next
Take the First Step - If your shoulder is holding you back, let’s fix it—together. A stronger, more confident shoulder starts here!
At Rehab Rooms we believe that successful treatment is down to accurate diagnosis and assessment, which leads to successful treatment outcomes. With this in mind…why not book online by clicking here or call us at 01 430 5634 to schedule a time that works for you!