That Shoulder Pain You’ve Been Ignoring Is Probably Not Going to Fix Itself

Shoulder pain is one of those things people live with for an embarrassingly long time before they come see me. I get it — unlike a back that locks up and stops you cold, a cranky shoulder usually lets you keep functioning. You just can’t reach the top shelf without a wince, or you avoid sleeping on that side, or you’ve quietly stopped serving overhand in pickleball because it’s started to catch. It’s a slow erosion, not a crisis, so it keeps getting put off.

I see two main populations with shoulder pain in this practice, and they’re almost opposites. The first is desk workers — a lot of them commuting into the Hacienda Business Park or working from home with a setup that’s seen better days — whose shoulders have rounded forward from hours of typing and mousing. Over time that forward posture changes how the shoulder blade sits against the ribcage, which changes the mechanics of the whole joint, which is how you end up with impingement pain even though you never did anything that felt like an “injury.”

The second group is the golfers and pickleball players I’ve written about before — people doing a repetitive overhead or rotational motion with a shoulder that was never quite stable enough to handle the volume. That’s usually where I see actual rotator cuff irritation, not just stiffness. The tendons get compressed in that little space under the shoulder blade (your acromion, technically) every time you reach overhead, and enough reps of that and they get inflamed.

Here’s the opinion I’ll actually stand behind: most shoulder pain gets treated like it’s purely a shoulder problem, when the shoulder is often just the part that finally complained. If your mid-back is stiff and rounded forward, your shoulder blade can’t move the way it’s supposed to, and the shoulder joint ends up compensating for a problem that technically started somewhere else. I’ve had patients do months of shoulder-specific physical therapy with partial results, because nobody addressed the thoracic spine restriction that was limiting their shoulder blade’s motion in the first place.

When someone comes in with shoulder pain, I’m checking the whole kinetic chain — neck, thoracic spine, shoulder blade mechanics, and the joint itself — not just poking around the sore spot. Adjustments to the mid-back and restoring shoulder blade mobility often take pressure off the rotator cuff tendons without ever directly touching the thing that hurts, which tends to surprise people.

What I’d actually push back on is the “it’ll work itself out” approach. Shoulders that are quietly compensating tend to get worse gradually, not better, because the compensation pattern just gets more ingrained the longer it runs. If reaching overhead, sleeping on one side, or your golf or pickleball swing has had a nagging ache in it for more than a few weeks, it’s worth getting an actual assessment rather than just continuing to adjust your life around it. More on the kind of joint issues I treat is on my Joint Pain Relief page.