What's Actually Causing Your Shoulder Pain?

Your shoulder is built for mobility, not stability. Unlike your hip (a deep ball-and-socket), the shoulder joint is often compared to a golf ball balanced on a tee. This design lets you throw, reach, and lift in ways no other joint can. But that freedom comes at a cost: the shoulder relies almost entirely on soft tissues (muscles, tendons, and ligaments) to stay in place. When those tissues get overworked, irritated, or injured, the pain can sideline you fast.

Common causes we see in Springfield, MO:

  • Repetitive overhead movements from swimming, tennis serves, golf swings at Millwood or Horton Smith, or CrossFit workouts
  • Desk posture plus sudden weekend activity (rounded shoulders all week, then aggressive pickleball at Cooper or Lost Hill)
  • Poor scapular control when the shoulder blade doesn't move properly, the rotator cuff takes the hit
  • Training load spikes increasing volume or intensity too quickly without adequate recovery

The good news: Most shoulder pain responds well to conservative treatment. Research shows that for impingement and degenerative rotator cuff tears, physical therapy and chiropractic care produce outcomes equivalent to surgery after one year. At 417 Performance, we help Springfield area residents avoid unnecessary surgery every week. (NCBI, 2023)

Types of Shoulder Pain

Rotator Cuff Tendinopathy (Tendinitis, Tendinosis, and Tears)

The rotator cuff is a group of four muscles that act as a "dynamic steering mechanism," pulling the ball of your shoulder down and centered in its socket. The supraspinatus tendon is most vulnerable because it passes through a narrow space under your acromion (the bony roof of the shoulder). Repetitive overhead activity can compress this tendon, reducing blood flow and causing it to fray over time.

Feels like Dull, toothache-like throb in the upper arm (deltoid area); may include weakness when lifting
Worse with Reaching overhead, putting on a jacket, sleeping on the affected side
Better with Supporting the arm at rest, avoiding overhead positions
Key insight Many rotator cuff tears are asymptomatic. Pain often comes from secondary inflammation, not the tear itself. (AAOS, 2023)
Recovery outlook: Mild tendinitis: 2-4 weeks. Non-surgical tears: 3-6 months with proper rehabilitation to strengthen compensating muscles.

Shoulder Impingement Syndrome

Impingement occurs when soft tissues (your rotator cuff tendons or bursa) get pinched between the ball of your shoulder and the bony roof above it. This can happen because of structural factors (a hooked acromion) or functional problems (poor scapular control causing the humeral head to ride too high).

Feels like "Catching" or sharp pinch when raising the arm, especially between 60-120 degrees (the "painful arc")
Worse with Overhead pressing, lateral raises, swimming strokes, reaching into back seat of car
Better with Keeping arm below shoulder height; pain often disappears above 120 degrees once you clear the pinch point
Key insight Secondary impingement (from muscle imbalance) is more common than structural impingement and responds well to rehab
Recovery outlook: 6-12 weeks with consistent scapular retraining and postural correction. (RACGP, 2023)

Subacromial Bursitis

The subacromial bursa is a fluid-filled cushion that allows your rotator cuff tendons to glide smoothly under the acromion. When shoulder mechanics fail, this bursa takes the friction and swells rapidly. Bursitis is highly painful because the bursa is loaded with nerve endings, but strength is usually preserved (unlike tears).

Feels like Sharp, intense pain with movement; severe night pain that disrupts sleep
Worse with Lying on the affected side, any overhead movement, sudden arm motions
Better with Ice, rest, keeping arm supported at side
Key insight Bursitis can be more painful than a rotator cuff tear. High pain does not necessarily mean worse damage.
Recovery outlook: 6-12 weeks. Mechanics must be corrected to prevent recurrence.

Adhesive Capsulitis (Frozen Shoulder)

Frozen shoulder involves the joint capsule (the envelope surrounding the shoulder joint) becoming thick, tight, and scarred. The cause is often unknown, but it's strongly linked to diabetes, thyroid disorders, and prolonged immobilization after injury or surgery. It progresses through three phases: freezing (increasing pain), frozen (stiffness), and thawing (gradual return of motion).

Feels like Deep, diffuse ache inside the joint; arm feels "locked" or "stuck" in certain positions
Worse with Reaching behind back, combing hair, any external rotation; pain wakes you regardless of sleeping position
Better with Heat before movement, gentle stretching within pain-free range
Key insight Loss of external rotation (rotating arm outward) is the hallmark sign. If your arm feels "blocked" when trying to rotate out, frozen shoulder is likely.
Recovery outlook: 12-18 months for natural resolution. Targeted mobilization and stretching can shorten the "thawing" phase significantly. (Johns Hopkins, 2023)

AC Joint Dysfunction

The acromioclavicular (AC) joint is where your collarbone meets the top of your shoulder blade. It's vulnerable to both trauma (falling directly on the shoulder tip) and overuse degeneration (common in weightlifters from heavy bench pressing and overhead work). Repetitive compressive loads cause micro-fractures and gradual bone erosion.

Feels like Pinpoint tenderness directly on top of the shoulder; you can point to it with one finger
Worse with Reaching across body (seatbelt reach), bench pressing, push-ups, dips
Better with Avoiding cross-body movements and heavy pressing; pain typically does not radiate
Key insight Pain at end-range overhead (170-180 degrees) suggests AC joint involvement rather than impingement
Recovery outlook: 4-8 weeks with activity modification. Chronic cases may require longer rehabilitation to address underlying movement patterns.

Referred Pain from the Neck (Cervical Radiculopathy)

The nerves that supply your shoulder (C4-C7) originate in your neck. A disc herniation or bone spur in the cervical spine can compress these nerve roots, creating pain that feels like it's in your shoulder when the source is actually your neck. This is critical to identify because treating the shoulder won't help if the neck is the culprit.

Feels like Pain radiating from neck/shoulder blade down the arm, often past the elbow; may include numbness, tingling, or weakness in the hand
Worse with Neck positions (looking up, turning head), coughing, sneezing
Better with Resting hand on top of head (takes tension off the nerve root); neck traction
Key insight If resting your hand on your head relieves the pain, the neck is likely involved. True shoulder problems are usually aggravated by this position.
Recovery outlook: Variable depending on severity. Most cervical radiculopathy resolves with conservative care in 6-12 weeks.

Quick Comparison: Identifying Your Type

Feature Rotator Cuff Impingement Frozen Shoulder AC Joint Neck (Referred)
Pain location Lateral arm (deltoid) Lateral arm Deep, diffuse Top of shoulder (point) Neck to arm (past elbow)
Worst movement Overhead, sleeping on side 60-120° arc External rotation Cross-body reach Neck rotation
Night pain Yes (side-lying) Sometimes Severe (any position) Minimal Variable
Weakness Often present Pain-limited No (stiffness only) No May have grip/arm weakness
Typical age 40+ Any 40-60 Weightlifters, 30+ Any

How We Diagnose and Treat Shoulder Pain in Springfield

Our Assessment Process

Shoulder pain often has multiple contributing factors. Whether you're a weekend golfer from Nixa, a CrossFit athlete in Republic, or a pickleball player right here in Springfield, we take a systematic approach to identify exactly what's driving your symptoms:

  • Orthopedic testing using specific clinical maneuvers (Hawkins-Kennedy, Empty Can, Speed's Test) to stress individual structures
  • Cervical screening to rule out neck involvement as a pain source
  • Scapular movement analysis to identify poor shoulder blade control that leads to impingement
  • Thoracic spine assessment because a stiff upper back prevents proper scapular movement

Our Treatment Approach

We combine soft tissue work with joint mobilization and movement-specific exercise matched to your diagnosis. Shoulder function depends on the entire kinetic chain. If your thoracic spine is stiff (common in Springfield desk workers and commuters), your scapula cannot rotate properly, and impingement follows. We address the whole system, not just the painful spot. Learn more about our three-phase treatment philosophy.

Treatments That Accelerate Your Recovery

Your corrective exercise program is the foundation. At our Springfield clinic, we use these targeted treatments to reduce pain faster and improve tissue healing:

Shockwave Therapy

Shockwave therapy delivers acoustic waves that stimulate blood flow and trigger the body's natural healing response. Particularly effective for chronic rotator cuff tendinopathy and calcific tendinitis that haven't responded to other treatments.

Dry Needling

Thin needles inserted into trigger points in the rotator cuff, upper trapezius, and scapular stabilizers release muscle tension and improve blood flow. Especially useful for the posterior cuff muscles that are difficult to reach manually. Learn more about dry needling.

Active Release Technique

A.R.T. breaks up adhesions in the rotator cuff, pectorals, and biceps tendons that restrict normal shoulder mechanics. Combines movement with precise pressure to restore gliding between tissue layers.

Frequently Asked Questions

Pain intensity doesn't tell you whether you have a tear. Bursitis (inflammation) can be more painful than a rotator cuff tear. The key differentiator is weakness. If you have difficulty lifting your arm due to weakness (not just pain), a tear is more likely. If you have pain but can still generate force, inflammation or impingement is more probable.

Clinical tests like the Drop Arm test and Empty Can test are highly predictive. We can assess this in your evaluation and determine if imaging is needed.

Usually yes, with modifications. The goal is to train around the pain, not through it. If overhead pressing hurts, switch to floor pressing or neutral-grip variations. If lateral raises pinch, try cable work at different angles.

Avoid movements that reproduce your specific pain pattern, but continue training the rest of your body. Complete rest often makes shoulders worse because the muscles weaken and stiffen. Controlled loading within pain-free ranges actually promotes healing.

Two reasons. First, lying on the affected side compresses the inflamed bursa and rotator cuff, increasing pain. Second, the shoulder position changes blood flow. When you lie down, venous pressure increases in the shoulder, causing swelling in already irritated tissues.

If you cannot find any comfortable sleeping position, that suggests significant inflammation (bursitis or the "freezing" phase of frozen shoulder). Try sleeping slightly propped up or with a pillow supporting the affected arm.

Most rotator cuff tears do not require surgery. Research consistently shows that conservative care (physical therapy and chiropractic) produces outcomes equivalent to surgery for impingement and degenerative tears after one year. Many of our Springfield patients come to us hoping to avoid surgery, and most do. (NCBI, 2023)

Surgery is typically reserved for acute traumatic tears in younger, active individuals, or when 3-6 months of quality conservative care has failed to produce improvement.

Mild tendinitis: 2-4 weeks

Bursitis/Impingement: 6-12 weeks (mechanics must be retrained)

Rotator cuff tear (non-surgical): 3-6 months (tendon heals slowly; compensating muscles need time to strengthen)

Frozen shoulder: 6-18 months (biological process is slow, but targeted treatment shortens the thawing phase)

AC joint: 4-8 weeks with activity modification

When to Seek Emergency Care

Most shoulder pain responds to conservative treatment. Seek immediate medical attention for:

  • Sudden, severe pain after trauma (fall, collision, dislocation)
  • Visible deformity of the shoulder
  • Complete inability to move the arm
  • Numbness or tingling spreading rapidly down the arm
  • Shoulder pain accompanied by chest pain, shortness of breath, or jaw pain (possible cardiac event)

Move Like You Mean It!

Your body was built to perform.

We help you get back there with a clear diagnosis, a real plan, and results that last. Find out more on a free Discovery call with our team. 

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