Shoulder pain is one of the most common reasons adults over 40 seek treatment at our clinics. Whether it’s that persistent dull ache while lifting your arm, a sharp pain when reaching overhead, or stiffness when trying to sleep, shoulder pain can significantly disrupt your daily life.
At our clinic, we often see patients who don’t realize how much shoulder physiotherapy can help—both to relieve pain and prevent long-term issues. Usually, people will come in for help once it starts to affect their sports and physical activity, or when they can no longer perform every day tasks like reaching a high shelf or putting on a jacket. Shoulder pain is treatable, even if it is has been there for months. However, we always recommend coming in as early as possible to have the highest chance of resolving your issue in the shortest amount of time possible. In this blog, we’ll break down why shoulder problems are so common, the most frequent causes of shoulder pain, and how shoulder physiotherapy can help you recover and stay active.
How does the shoulder joint work?
First, a brief anatomy lesson to help you understand where problems can come from. Importantly, the design of the shoulder joint, (ball and socket joint) makes it the most mobile joint in your body. However, this mobility comes with a cost. It’s greatest strength is also its weakness, since its huge range of motion translates to large amounts of instability in the joint.
Next, at the center of shoulder function is the rotator cuff, a group of four muscles and tendons that keep your shoulder joint in its socket generates joint movements. The rotator cuff includes:
- Supraspinatus (most commonly injured)
- Infraspinatus
- Teres minor
- Subscapularis
These muscles work together to help you lift, rotate, and control your arm. They also support your shoulder during everyday activities like reaching, pushing, or pulling. Proper shoulder kinematics, the way your bones, muscles, and joints move together, is essential for pain-free function. When part of this system is injured or weakened, it often leads to shoulder pain and limited movement.
What are common causes of shoulder pain in adults over 40?
If you’re over 40, you’re more likely to experience shoulder pain due to natural wear and tear, previous injuries, or changes in lifestyle. Some of the most common causes include:
1. Rotator cuff tendinopathy and tears
These refer to the four muscles we talked about in the previous section. Over time, the rotator cuff tendons can weaken, leading to inflammation (tendinopathy) or tears. This is one of the leading causes of shoulder pain in adults over 40, and one of the diagnoses we make most often in our clinics. This condition can develop acutely (from a specific injury or a moment in time), or slowly over time, usually from overuse.
2. Biceps tendon tendinitis/tears
The biceps tendon, which runs through the front of the shoulder, can become inflamed or torn, contributing to shoulder pain, especially with lifting or carrying. Due to its proximity to the rotator cuff tendons, issues may appear in both areas at the same time.
3. Frozen shoulder (adhesive capsulitis)
Still with a widely unknown cause, frozen shoulder causes the joint capsule to stiffen, leading to severe restriction of motion and ongoing shoulder pain. This condition has been thought to have autoimmune involvement, but research is ongoing. Frozen shoulder follows a very predictable pattern of stages known as the freezing, frozen, and numbing stages, each usually lasting several months.
4. Shoulder osteoarthritis
Age and activity-related cartilage and joint surface degeneration can lead to osteoarthritis, resulting in stiffness, loss of range of motion, and joint pain. Usually rare for it to happen in the 40’s, if you have had a previous history of traumatic shoulder injuries or surgeries, you are at greater risk.
5. Calcific tendinitis
Calcium deposits in the rotator cuff tendons can cause sudden, intense shoulder pain, often limiting movement. Common and highly effective treatment for this condition is shockwave therapy to break down the deposits.
6. Bursitis
Bursae are like little cushions in our body that sit in areas where there is a lot of friction or pressure. Usually, they sit under or between tendons to help them glide and offset the friction. During arm movements, they can sometimes be pinched or with repetitive activities they can become irritated and inflamed. Thus, bursitis, or inflammation of a bursa. Oftentimes, people will report pain with overhead movements in this condition.
7. Fracture, dislocations, and separations
These are more severe injuries that usually occur from traumatic, high speed or force accidents such as a sports injury or car collisions. Shoulder fractures happen frequently in the humerus or clavicle (collar bone). Dislocations may happen between the humerus and scapula, where the head of the humerus gets hit out of the socket. Separations occur at the clavicle when the ligaments that normally hold it down are torn.
Why is shoulder pain more common in adults over 40?
Several factors make shoulder pain more common as we age:
- Age-related wear and tear: Tendons naturally lose elasticity over time, increasing the risk of injury
- Repetitive overuse: Years of overhead work, sports, or manual labor can lead to chronic shoulder problems
- Poor posture: Slouching or rounded shoulders can change how the shoulder joint moves, leading to strain and discomfort
- Previous injuries: Old injuries can lead to compensation patterns due to lost strength and mobility
- Comorbidities: Diabetes, thyroid disease, and other conditions which increase in likelihood with age are linked to frozen shoulder and tendon problems.
How can physiotherapy help my shoulder pain?
Whether you’re dealing with an existing injury or trying to prevent shoulder pain, shoulder physiotherapy is one of the most effective treatments available.
Preventative shoulder physiotherapy or prehabilitation:
Prehabilitation is a newer term used to describe a proactive approach of preparing for physical activity. This involves improving overall fitness with the goal of minimizing the risk of injury while optimizing performance. Your physiotherapist will do a detailed assessment to determine the areas you need to work on. The treatment may include things like:
- Posture correction: Improving shoulder and overall body alignment to reduce strain on the shoulder
- Rotator cuff prehab: Building a stronger rotator cuff and shoulder blade muscles to stabilize the joint
- Stretching and mobility: Maintaining or restoring full range of motion for daily life or sport, to prevent compensation patterns
- Ergonomic advice: Learning how to avoid repetitive stressors at work, during daily activities
- Technique corrections: Sport specific or exercise corrections to form to reduce injury risk and improve muscle performance
Rehabilitative shoulder physiotherapy:
This form of physiotherapy is usually more familiar to individuals, and happens after a pain or injury has happened. The goal is to restore normal strength, movement, and function the the shoulder, so the individual can continue their normal work, physical activities, and hobbies. The treatment may include things like:
- Pain management techniques: Using manual therapy, massage, electrotherapy, ice/heat, and specific exercises to reduce shoulder pain
- Guided exercise programs: Safely rebuilding strength and mobility under professional supervision
- Movement retraining: Addressing faulty movement patterns to protect the joint during recovery
- Education and long-term care: Learn how to keep your shoulders healthy with maintenance protocols and prevent future injurie
Ready to get started?
Look for PhysioNow! We have many expert shoulder physiotherapists that are ready to get you started no matter what your goal is. Don’t let your shoulder trouble you any more! With 10 locations across the GTA from Burlington, Oakville, Mississauga, and Etobicoke, our team is ready to serve you. Book with PhysioNow today for your first assessment and treatment!
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