What is causing your shoulder pain?
Shoulder pain has a cause, and finding it changes everything. Most shoulder problems fall into one of two categories: a gradual loss of movement (frozen shoulder) or pain triggered by specific arm positions (impingement). The distinction matters because treatment differs significantly between the two. At Costa Health, a clinical assessment identifies which structures are involved and builds a recovery plan around the actual diagnosis, not just the symptoms.
The shoulder is the most mobile joint in the body, which also makes it the most vulnerable. Four small rotator cuff muscles hold the humeral head centred in a shallow socket. When any one of these muscles is weakened, inflamed, or torn, the mechanical balance shifts. That shift is what produces pain, and it’s why generic “shoulder exercises” found online often make things worse.
What does frozen shoulder actually look like?
Frozen shoulder (adhesive capsulitis) follows a recognisable pattern. The joint capsule thickens and contracts, progressively restricting movement in a predictable sequence: external rotation goes first, then abduction, then internal rotation. Research published in the BMJ (2005) estimates that frozen shoulder affects 2-5% of the general population, with higher prevalence among people aged 40-60 and those with diabetes or thyroid conditions.
A patient presenting with frozen shoulder often describes a gradual onset of stiffness. Reaching behind the back to fasten a seatbelt becomes difficult. Sleeping on the affected side is painful. The condition typically moves through three phases: freezing, frozen, and thawing, spanning 12-30 months if left untreated.
Many patients arrive believing they have a rotator cuff injury when the real problem is capsular restriction. The clinical tests are different, the prognosis is different, and the treatment approach is different. Getting this wrong early can add months to recovery.
How does impingement differ from a rotator cuff tear?
Impingement occurs when the supraspinatus tendon or subacromial bursa gets compressed beneath the acromion during overhead movements. The pain is positional: reaching up, reaching across the body, or lifting away from the side at roughly 60-120 degrees (the “painful arc”). A rotator cuff tear, by contrast, often produces weakness rather than just pain. A patient with a significant tear may struggle to hold their arm at shoulder height even when the pain is manageable.
A common misconception is that shoulder impingement always requires surgery. A 2017 study in The Lancet (the CSAW trial) found that arthroscopic subacromial decompression produced no better outcomes than a structured physiotherapy programme alone. This finding has shifted clinical thinking significantly in the last decade.
At Costa Health, physiotherapy for impingement focuses on restoring scapular control, strengthening the rotator cuff in functional positions, and addressing thoracic spine mobility, which is often an overlooked contributor. Osteopathy can complement this by addressing restrictions in the thoracic spine and rib cage that alter shoulder mechanics. Chiropractic care targets joint restrictions in the cervicothoracic region that may be feeding into the shoulder problem.
Why is shoulder pain so common on the Costa del Sol?
Padel is the fastest-growing racquet sport in Spain, and the Costa del Sol has one of the highest densities of padel courts in the country. The overhead smash in padel places enormous demand on the shoulder, particularly the rotator cuff and the long head of biceps. Players who lack adequate thoracic rotation compensate by over-reaching through the shoulder joint itself, creating impingement-type symptoms.
Tennis players face similar risks, but the mechanics differ. The tennis serve involves a full overhead motion with acceleration and deceleration forces exceeding eight times body weight at the shoulder. Daniele Delicati, Costa Health’s physiotherapist (MSc, BSc (Hons), MACP, MCSP, HCPC), sees a seasonal spike in shoulder presentations from October to April, when the expat sporting season is at its peak.
Golf produces shoulder problems too, though less obviously. The lead shoulder in a golf swing undergoes significant horizontal adduction and internal rotation at impact. Poor swing mechanics or insufficient warm-up can irritate the rotator cuff or aggravate an existing impingement.
What treatment options are available for shoulder pain?
No single discipline owns the shoulder. Effective treatment depends on what’s wrong and where the patient is in their recovery.
Sports massage is often the first step for acute muscular tension, releasing trigger points in the upper trapezius, levator scapulae, and infraspinatus that contribute to pain and restricted movement. Chiropractic adjustments address joint restrictions in the cervical and thoracic spine that alter how forces transfer through the shoulder complex. Osteopathy takes a broader view, assessing how the whole kinetic chain, from rib cage to scapula to glenohumeral joint, is contributing to the problem.
Physiotherapy is central to most shoulder rehabilitation programmes. Progressive loading of the rotator cuff, scapular stabilisation exercises, and proprioceptive retraining form the backbone of evidence-based shoulder rehab. For conditions like rotator cuff tendinitis and impingement syndrome, a structured exercise programme produces better long-term outcomes than passive treatments alone.
When should you seek urgent care for shoulder pain?
Most shoulder pain isn’t an emergency, but some presentations require prompt medical attention. Shoulder pain following a traumatic fall or impact, particularly with an obvious deformity or inability to move the arm at all, may indicate a fracture or dislocation. Sudden severe shoulder pain with shortness of breath or chest tightness should be assessed as a potential cardiac event, especially in patients over 40.
An edge case worth knowing: shoulder pain that starts without any obvious injury and is accompanied by rapid, profound weakness in the arm (difficulty lifting a cup of tea, for example) may indicate a neurological issue rather than a musculoskeletal one. This is rare, but it warrants urgent investigation.
For the vast majority of shoulder problems, the right starting point is a thorough clinical assessment. Costa Health’s team can determine whether your shoulder pain is mechanical, inflammatory, or referred from elsewhere, and match you with the right treatment approach from day one.