Shoulder pain when lifting, reaching, sleeping or training?

Shoulder pain can be hard to understand, especially when the scan sounds scary

Shoulder pain is common, but the words used to describe it can be confusing.

You might have been told you have impingement, bursitis, a rotator cuff tear, tendinopathy, or “wear and tear”. These labels do not always explain why your shoulder hurts, why it flares up with certain movements, or what you should do next.

There often isn’t one single cause. Shoulder pain can be influenced by tendon capacity, strength, workload changes, movement limits, sleep, stress, recovery, previous injury, technique, training volume, joint sensitivity and how much your shoulder is being asked to do.

Can physio help with shoulder pain?

Yes. Physio is commonly the first step for non-traumatic shoulder pain, especially when symptoms fit under what clinicians now often call rotator cuff related shoulder pain or subacromial shoulder pain.

These terms can include shoulder pain that has previously been labelled as:

• Shoulder impingement
• Shoulder bursitis
• Rotator cuff tendinopathy
• Rotator cuff overload
• Partial-thickness rotator cuff tear
• Non-traumatic rotator cuff tear
• Subacromial pain syndrome

Older terms like impingement can make it sound like the shoulder is simply being “pinched”. Terms like bursitis can make it sound like inflammation is the whole problem. For some people, these findings are relevant. For others, they are only one part of the picture.

Current imaging research shows why this matters. MRI and ultrasound findings such as rotator cuff changes, bursitis and tendon abnormalities can appear in people who have no shoulder pain. A 2026 JAMA Internal Medicine population MRI study found rotator cuff abnormalities were very common in adults over 40, including in people without shoulder symptoms.

That does not mean scans are useless. It means scans need to be interpreted alongside your symptoms, strength, movement, goals and activity demands.

Common symptoms

You may notice…

• Pain when reaching overhead, out to the side or behind your back
• Pain putting on a shirt, jacket, bra, seatbelt or backpack
• Pain lying on the sore shoulder at night
• A painful arc when lifting or lowering your arm
• Weakness or reduced confidence with lifting, pressing, pushing or pulling
• Pain during or after gym, swimming, surfing, golf, tennis, netball or football
• Shoulder pain that warms up during activity but aches later

Some people feel stuck because rest helps briefly, but the pain returns as soon as they get back to work, training or sport. Others feel worried because their scan mentions a tear or bursitis, even though they are not sure what that means for their future.

Seek urgent medical care if shoulder pain is associated with chest pain, shortness of breath, major trauma, fever, unexplained weight loss, severe night pain that is not easing, or rapidly worsening arm weakness.

What can contribute to shoulder pain?

There often isn’t one single cause. Shoulder pain can happen when the demand on your shoulder is higher than what it can currently tolerate.

Things that may contribute include:

• A recent increase in gym, sport, work or overhead activity
• Reduced rotator cuff, shoulder blade, upper back or trunk strength
• Limited shoulder, neck or upper back movement
• Tendon sensitivity or reduced tendon capacity
• Previous shoulder, neck, rib or upper back injury
• Poor sleep, stress or reduced recovery
• Technique, equipment or workload issues

For example, someone may flare their shoulder after increasing bench press and overhead work, returning to swimming too quickly, doing more manual work than usual, or spending long hours at a desk before trying to train hard at night.

For some people, a rotator cuff tear or bursa irritation is part of the problem. For others, the scan finding is present but not the main reason the shoulder is painful.

How we assess it

In your first session, we’ll look at your shoulder in the context of your life, not just one painful movement.

Your assessment may include:

• Your history, symptoms, concerns and goals
• What movements or activities bring on pain
• Shoulder, neck and upper back movement
• Rotator cuff strength and pain response using hand held dynamometry
• Shoulder blade control and upper limb capacity
• Work, gym, sport or daily tasks that matter to you
• Review of ultrasound, X-ray or MRI results if you have them, or referral for imaging if we feel this is needed.

The goal is to work out what may be contributing to your symptoms and what needs to change first.

Sometimes that means calming pain down so you can sleep and move better. Sometimes it means building strength and capacity. Sometimes it means modifying training or work for a short period. Sometimes it means organising imaging or referral if the presentation suggests a more significant tear or another issue that needs medical input.

How we treat it

Depending on what we find, your treatment plan may include…

• Hands-on physio to help reduce pain and improve movement
• Education and advice about what to keep doing and what to modify
• Exercise rehab for the rotator cuff, shoulder blade and surrounding muscles
• Strength and conditioning in our onsite rehab gym
• Load management for work, gym, sport and daily life
• Return-to-gym, return-to-work or return-to-sport planning
• Referral pathways for imaging, injection or surgical opinion when appropriate

A good rehab plan usually helps you build confidence as well as strength.

For many shoulder pain presentations, rehab starts with movements that are tolerable, then progresses toward what you actually need your shoulder to do: lift, carry, push, pull, press, swim, surf, throw, serve, tackle, work overhead or train without constantly second-guessing it.

What about cortisone injections?

Cortisone injections can be helpful for some shoulders, especially when pain is high, sleep is poor, or symptoms are stopping someone from participating in rehab.

They are usually best thought of as a backup option rather than the first step for most everyday shoulder pain.

The evidence suggests corticosteroid injections may provide short-term relief for some people, particularly around the first 6 weeks, but the longer-term picture is less favourable. The large GRASP trial found subacromial corticosteroid injection provided no long-term benefit over 12 months for people with rotator cuff disorders. A 2026 pragmatic trial comparing corticosteroid injection with physiotherapist-led exercise therapy found the injection group improved more at 6 weeks, while the exercise group showed greater improvement in shoulder pain over 12 months, including at 6, 9 and 12 months.

We recommend a period of at least 4-6 weeks of Physiotherapy before considering an injection. If we feel an injection is required, we are able to help expedite the process of this referral.

What about MRI, scans and rotator cuff tears?

Scans can be useful, but they are not always the first step.

Ultrasound or MRI may help when there is a suspected significant rotator cuff tear, marked weakness, poor progress despite a good rehab plan, or when the result would change the next decision.

The important thing is that scan findings need context. A report may mention bursitis, tendinopathy or a tear, but that does not automatically mean you need an injection or surgery. Imaging findings are common in pain-free shoulders, so the scan should be matched with your story, strength, movement, symptoms and goals.

At Fitness Physio, we can help you decide whether imaging is worth pursuing. Where appropriate, we can help arrange referral pathways for MRI and guide the next step once results are available. If you have already had a scan, we can help explain what this actually means.

What about surgery or rotator cuff repair?

Most everyday, non-traumatic shoulder pain starts with physio, education, load management and progressive strengthening.

Surgery may be worth considering in certain cases, especially when there is a significant rotator cuff tear, clear strength loss, ongoing functional limitation, higher activity demands, or poor progress despite an appropriate rehab plan.

This decision should not be based on the scan alone. It should consider:

• Tear size and type
• Strength and function
• Pain behaviour
• Age and general health
• Work, sport and gym demands
• Goals and expectations
• Response to a well-planned rehab program

At Fitness Physio, we can help you work through this decision. We can help with MRI referral pathways when appropriate, provide pre-surgical or non-surgical rehab, and liaise with local shoulder surgeons we have strong ties with if a surgical opinion is needed.

What to expect from your first appointment

Your first appointment is about getting clarity.

We’ll listen to what has been happening, what you are worried about, and what you need your shoulder to do. Then we’ll assess your movement, strength, pain response and relevant work, sport or gym tasks.

By the end of the session, you should have:

• A clear explanation of what is most likely contributing to your symptoms
• Advice on what to keep doing, stop temporarily or modify
• A starting plan for pain, movement and strength
• Guidance on whether scans, injections or referral are worth considering
• A pathway for returning to work, sport, gym or daily activity

You do not need a referral to book. If you already have imaging, bring the report with you.

Why choose Fitness Physio?

Fitness Physio is based in Merewether, Newcastle, and we regularly help people with shoulder pain from work, sport, gym training and daily life.

Our approach is practical: assess properly, explain clearly, treat what is relevant, and build a plan you can actually follow.

Relevant strengths include:

• Experienced physios
• Hands-on physio when it helps pain and movement
• Evidence-based rehab and strength progression
• Onsite rehab gym
• Sports, spinal, gym and work injury experience
• Clear return-to-work, return-to-sport and return-to-gym planning
• Referral pathways for imaging and surgical opinion when needed

Want a clear plan for your shoulder?

Book an Initial Physio Assessment at Fitness Physio in Merewether. We’ll assess your shoulder, explain what may be contributing to your pain, help you understand any scan results, and give you a practical plan for movement, strength and return to the things you need to do.