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Shoulder Pain: What You Need to Know and When to Get Help 

Shoulder pain is extremely common and can affect most of us at some point in our lives. The good news is that, in most cases, it is not serious and will improve with time, appropriate exercise and some simple changes to your daily activities. As a UK physiotherapist working in Nerja, I regularly see people from across the Málaga and Axarquía area with shoulder pain. One of the most important things to understand is that different shoulder problems require different approaches to treatment. Knowing what may be causing your symptoms can help you decide when to manage things yourself and when to seek professional advice. 

Why does my shoulder hurt? The shoulder is a complex joint that allows a very large range of movement. This flexibility is useful, but it also means there are several structures that can contribute to pain. The likely cause can also vary depending on your age. Shoulder pain in younger people In younger people, one of the more common problems is shoulder instability. This can happen following an injury where the shoulder partially or completely dislocates. Some younger people are naturally very flexible or "double-jointed" and may experience instability without a significant injury. Shoulder instability can be particularly troublesome for people who enjoy sports or activities involving the arm above the head. Physiotherapy normally focuses on restoring normal movement, strength and the body's ability to react quickly to unexpected movements. This can help reduce the risk of the shoulder becoming unstable again. Surgery is not usually necessary, although it may sometimes be considered following a significant injury or when instability continues despite appropriate rehabilitation. 

Shoulder pain in your 30s, 40s, 50s and 60s One of the most common causes of shoulder pain in adults is pain related to the rotator cuff — a group of muscles and tendons that help control and stabilise the shoulder. This type of shoulder pain can develop after an increase in activity, strenuous exercise or an injury such as a fall. However, it can also appear without any obvious cause. 

You may notice: 

• Pain when lifting your arm, particularly above shoulder height

•  Difficulty reaching overhead 

• Pain when reaching behind your back 

• Some weakness in the arm 

• Discomfort when sleeping on the affected side 

You may hear this problem described using several different terms, including rotator cuff tendinopathy, subacromial shoulder pain or bursitis. Although these terms describe different structures or aspects of the problem, they can produce very similar symptoms. Poor exercise technique can contribute to shoulder pain As physiotherapists, we often see shoulder pain develop after someone changes their exercise routine or increases the amount they are doing too quickly. This doesn't mean that exercise is bad for your shoulders. In fact, the right exercise is an important part of recovering from most shoulder problems. 

Instead, it is worth considering whether you have recently: 

• Increased your gym training 

• Started swimming or playing a new sport 

• Increased the amount of lifting you do 

• Changed your exercise technique 

• Started exercising after a long period of inactivity 

A gradual increase in activity, good technique and appropriate strengthening can help your shoulder adapt. 

Frozen shoulder 

Another common cause of shoulder pain, particularly in people in their 50s, is frozen shoulder. Frozen shoulder can be particularly painful, often causing significant discomfort at night. The shoulder gradually becomes increasingly stiff, making everyday activities such as dressing, reaching into cupboards or putting on a jacket difficult. Unlike some other shoulder problems, the main issue is not simply pain when moving the arm — movement becomes restricted in several directions. Pain relief is often important because it can otherwise be very difficult to exercise. Once pain is better controlled, gentle stretching and strengthening exercises can help restore movement and function. A steroid injection may sometimes be recommended, particularly when pain is preventing you from exercising and sleeping properly. Most people improve without surgery, although other treatments may occasionally be considered when symptoms persist. 

Shoulder arthritis 

As we get older, arthritis can also affect the shoulder. Shoulder arthritis can cause pain, stiffness and a gradual reduction in movement. It can sometimes become particularly noticeable during periods when you are more active. The good news is that shoulder arthritis can often be managed successfully without surgery. Maintaining movement and strength through appropriate exercise is important. Adjusting activities, using pain relief when necessary and occasionally having a steroid injection during a painful flare-up may also help. For severe arthritis that significantly affects quality of life and does not respond to conservative treatment, shoulder replacement surgery may sometimes be considered. 

Should you stop exercising if your shoulder hurts? Usually, no. When something hurts, our natural reaction is often to stop using it completely. With shoulder problems, however, avoiding movement altogether can sometimes make things worse by allowing the joint to become stiff and weak. In most cases, it is better to keep your shoulder moving within comfortable limits. You may need to modify what you are doing rather than stop altogether. For example, if gardening, DIY or household jobs aggravate your shoulder, try doing them in shorter periods with regular breaks rather than completing everything in one go. If your pain is more severe, temporarily reducing strenuous activities can be sensible while continuing gentle movement. The aim is not to completely avoid pain, but to find an appropriate level of activity that allows your shoulder to gradually recover. 

What about painkillers and steroid injections? Pain relief can sometimes play an important role in helping you remain active. For some shoulder problems, simple painkillers may make it easier to continue with your normal activities and complete your exercises. Always check that medication is appropriate for you, particularly if you take other medicines or have existing medical conditions. Steroid injections can also have a role in managing certain shoulder conditions, particularly when pain is preventing someone from sleeping or participating in rehabilitation. They are not appropriate for every shoulder problem, however, which is why an accurate assessment is important. 

What treatments actually help? 

There are many treatments available for shoulder pain, but they are not all equally useful. For most common shoulder problems, exercise and appropriate activity modification form the foundation of treatment. A physiotherapist can assess your shoulder and develop an exercise programme based on your specific symptoms, strength, movement and goals. Treatments such as massage, manual therapy, electrotherapy and acupuncture may be offered by some practitioners. However, these treatments have limited evidence for many common shoulder conditions and should not replace an appropriate rehabilitation programme. The important question is not simply "What treatment can I have?" but rather: "What is causing my shoulder pain, and what can I do to help it recover?" When should you see a physiotherapist or doctor? Most shoulder pain does not require an urgent hospital visit. If symptoms are mild, you can often start by modifying your activities, keeping the shoulder moving and following an appropriate exercise programme. However, it is sensible to seek professional advice if your pain is severe, persistent or not improving. A physiotherapist can carry out a detailed assessment and, in many cases, identify the likely cause without the need for an X-ray or scan. Imaging may sometimes be appropriate depending on your symptoms and examination findings. If your symptoms are not improving after around six weeks of sensible self management, arranging an assessment with your GP or physiotherapist is a good next step.

For expats living in Málaga, this can sometimes be confusing because healthcare systems and terminology differ between the UK and Spain. A local physiotherapist who is familiar with both systems can help you understand your options and, when necessary, advise you about whether you should see a GP, specialist or hospital service. 

When is shoulder pain more urgent? 

Although most shoulder pain is not serious, there are situations where you should seek medical attention promptly. Seek urgent medical advice if you have: 

• A new lump or significant swelling around the shoulder 

• Redness and pain around the shoulder accompanied by a fever or feeling generally unwell 

• A sudden change in the shape of your shoulder following an injury, epileptic seizure or electric shock 

• Significant difficulty raising your arm following an injury 

• A major injury or very severe pain 

If you have suffered a significant injury or are experiencing very severe symptoms, your local emergency department may be the most appropriate place to seek immediate assessment. 

How can a physiotherapist help? 

Physiotherapists are trained to assess and treat problems affecting muscles, joints and movement. Your assessment should begin with a discussion about your symptoms, followed by an examination of your shoulder and, where appropriate, your neck and upper back. In many cases, an accurate diagnosis can be made without an X-ray or MRI scan. Treatment will depend on what is causing your symptoms. For many people, this means a bespoke exercise programme designed to improve movement, strength and confidence in using the shoulder. Your physiotherapist can also help you understand which activities to continue, which ones to temporarily modify and how to gradually return to the things you enjoy. If your symptoms suggest a more significant problem, or if they fail to improve despite appropriate treatment, you may be advised to see a doctor or orthopaedic specialist. Living with shoulder pain in Málaga Living with ongoing pain can be frustrating, particularly when it starts interfering with sleep, exercise, work or the activities you enjoy. The most important thing to remember is that most common shoulder problems improve over time. Recovery is not always quick, though. Depending on the condition, it can take several months to return to normal. Try to stay active, keep the shoulder moving and avoid the temptation to completely protect it from everyday use. You may simply need to change how you perform certain activities while your shoulder recovers. If you are unsure what is causing your pain, or your symptoms are not improving, getting the right diagnosis is an important first step. Shoulder pain doesn't always mean something is seriously wrong Shoulder pain can be worrying, particularly when it affects your ability to lift your arm or sleep comfortably. Fortunately, most shoulder problems can be managed successfully without surgery. If you live in Málaga, Nerja or the surrounding Axarquía and are struggling with shoulder pain, a physiotherapy assessment can help you understand what is happening and what you can do to get moving again. The goal isn't simply to reduce your pain — it is to help you confidently return to the activities and lifestyle you enjoy.