What should you do about shoulder pain? Tips and exercises

• If you have shoulder pain, continue to move your shoulder gently and within your limits – do not keep it completely still. A lack of movement can make the problem worse.
• Shoulder pain can have many causes, ranging from temporary overuse to changes in tendons, joints or the joint capsule.
• You should see a doctor if you have had an accident or a fall, or if the pain persists for more than three weeks. 

“As a general rule, people with shoulder problems should continue to move their shoulder within a pain-free range rather than keeping it still. A lack of movement in the shoulder can make the problem worse and may, for example, lead to frozen shoulder,” says Paul Borbas, a specialist in orthopaedic surgery at Klinik Hirslanden in Zurich.

These measures can provide relief:

• Apply heat: According to current expert consensus and studies of people with chronic pain, heat can benefit those with chronic musculoskeletal pain. “Ultimately, however, it comes down to what works best for you – whether heat or cold is more effective at relieving your pain,” says shoulder specialist Borbas.
• Apply cold: For acute pain accompanied by inflammation (e.g. bursitis), cold is generally more effective than heat. Cold is also preferable after overuse or injury, or when swelling is present. “However, there is currently no high-quality scientific evidence showing when cold or heat is the better option,” says Borbas.
• Gentle exercise: Even if you have shoulder pain, continue to move your shoulder as much as possible within a range that causes little or no pain. “Immobilisation is only advisable if it has been prescribed by a doctor,” says Borbas. Gentle exercises that improve shoulder mobility, shoulder-blade control and overall flexibility are suitable.
• Find a comfortable sleeping position: If you have shoulder pain, it’s best to sleep on your back, possibly with a pillow under the affected arm. Slightly raising the head of the bed may also help. If you can only sleep on your side, lie on your unaffected shoulder. Support your painful arm on a pillow in front of your body. “It’s important that the shoulder isn’t further irritated at night by an unsuitable sleeping position. Restful, uninterrupted sleep not only boosts overall well-being but also supports recovery from injuries,” says Borbas. 
• Try physiotherapy: Physiotherapy can specifically improve shoulder mobility, strength and resilience. It is particularly beneficial for persistent or recurring symptoms, or pain caused by everyday activities. ​

With a sore shoulder, many people initially keep it still. Others put too much strain on it or continue exercising despite the pain. You should avoid both.

• Do not immobilise it completely: Do not rest your shoulder for prolonged periods or keep it in a sling continuously unless medically advised. Otherwise, its range of motion could become more restricted, making the problem worse.
• Don’t train through the pain: Avoid movements and exercises that cause sharp or severe pain. For strength training, for example, this means using less weight or stopping the exercise altogether if the pain persists with a lighter weight. 
• Reduce overhead strain: Avoid movements that involve raising your arm above shoulder height. You should also avoid heavy lifting, jerky movements and strenuous sports.
• Don’t sleep on the painful shoulder: Direct pressure can make shoulder pain worse. Instead, support your arm on a pillow and sleep on your unaffected side or your back.
• Don’t ignore warning signs: See a doctor if your shoulder pain began after an accident or fall, or if it has lasted for more than three weeks. Clear warning signs include severe swelling, loss of strength, numbness, fever, redness or warmth, persistent severe pain and restricted movement.

Symptoms and pain intensity vary depending on the type of injury. Typical signs include:

Shoulder pain can have many causes, ranging from temporary overuse to changes in the tendons, joints or joint capsule. “Rotator cuff problems, calcific tendinitis and frozen shoulder are particularly common causes,” says Borbas.

Borbas says it is entirely possible that the pain comes from the neck. “If shoulder pain worsens when you turn your head, the problem is usually not in the shoulder but in the cervical spine.” Possible causes include referred pain from the neck or a herniated disc in the cervical spine.

If there is no structural injury, shoulder pain should resolve within a few weeks. “This type of pain – such as bursitis caused by overuse – typically does not last longer than six weeks,” says Borbas.

• Mild overuse or strain: Symptoms often improve within a few days to a few weeks.
• New on-set shoulder pain: Many cases improve within around six to eight weeks, provided the shoulder is used and moved appropriately.
• After a more severe soft-tissue injury: Following an injury to the muscles, tendons, ligaments, joint capsule or bursa, it may take six to twelve weeks to regain full mobility and load-bearing capacity.
• Chronic or recurring symptoms: These can last for several months, especially when tendons or joint capsules are involved.
• Frozen shoulder: The condition usually lasts much longer – often several months and sometimes more than a year. But it usually heals on its own.

Structural damage, such as a rotator cuff tear or shoulder dislocation, requires targeted treatment with physiotherapy and, if necessary, surgery.

“If left untreated, symptoms from a torn tendon often persist for a long time. The pain typically comes and goes depending on the level of strain,” says Borbas.

Seek immediate medical attention in the following situations:

• After an accident
• If you can no longer lift your arm
• If your shoulder is dislocated or feels as though it is
• If you experience numbness or tingling in your arm, hand or fingers
• If you suddenly lose strength or experience paralysis
• If the pain radiates to your chest
• If you also have chest pain, shortness of breath, a fever or generally feel unwell

You should also seek medical advice for persistent pain:

• If there is no noticeable improvement after two to three weeks
• If the symptoms are still clearly present after six to eight weeks

Your first point of contact should be a family doctor’s practice or a telemedicine provider. They will assess your symptoms and refer you to a specialist if conservative measures, including physiotherapy, do not help or if the pain worsens.

Diagnosis typically involves:

• Medical history: Your doctor will gather key information, including when the pain began, whether it followed an accident or overuse, where it is located, whether it radiates, and whether it occurs at night or at rest. They will also ask about your occupation, sporting activities and any pre-existing medical conditions.
• Physical examination: Your doctor will assess mobility, strength, tenderness, shoulder-blade movement, nerve function and circulation.
• Imaging only when necessary: An X-ray may be performed if a bone injury, degenerative changes or calcification are suspected. An ultrasound or MRI may be considered if the findings are unclear, a significant tendon injury is suspected or surgery is being considered.

“In most cases, it makes sense to begin with conservative treatment,” says Borbas. This generally means adjusting the level of strain, reducing activities that worsen the pain while continuing to move, and managing pain in the short term with anti-inflammatory medication and physiotherapy.

Cortisone injections are also sometimes used during the acute phase. “However, we are now much more cautious about using cortisone injections, particularly in younger and physically active people,” says Borbas. 

Scientific studies clearly show that repeated cortisone injections can weaken tendon tissue and increase the risk of tendon damage. “Although cortisone provides short-term relief from inflammation, repeated use can reduce tendon quality.”

“Prompt surgery is particularly advisable when an active person suffers an acute, complete rotator cuff tear in an accident, such as a fall from a bike or e-scooter, or while skiing,” explains Borbas. 

Surgery may also be recommended for chronic shoulder instability, when the joint repeatedly dislocates, or when several months of targeted physiotherapy fail to provide relief. “Each time the joint dislocates, it can cause further damage to the labrum, cartilage and bone.” 

• Family Doctor, Telmed or HMO: Basic insurance generally covers medically necessary assessments and treatments. Under the Family Doctor, Telmed or HMO models, you must follow the prescribed treatment pathway.
• Specialist and shoulder clinic: Orthopaedic, rheumatology and other specialist assessments are covered if they are medically necessary and permitted under the insurance model. Depending on the model, a referral may be required first.
• Examinations and imaging: Medical examinations, X-rays, ultrasounds, and MRI scans are covered if they are medically justified and prescribed by a doctor. 
• Physiotherapy: Basic insurance covers physiotherapy prescribed by a doctor and provided by recognised physiotherapists. A prescription typically covers nine sessions; additional requirements apply to longer courses of treatment.
• Medicines: Medication prescribed by a doctor is generally covered if it appears on the list of pharmaceutical specialities. Depending on the product and circumstances, you may have to pay for over-the-counter painkillers yourself.
• Surgery and hospital: Basic insurance covers medically necessary operations, outpatient procedures and inpatient treatment on the general ward of an approved hospital.

Shoulder pain does not necessarily indicate permanent damage, and the shoulder does not usually need to be kept completely still. By taking warning signs seriously, temporarily adjusting the strain placed on the shoulder and gradually rebuilding confidence through gentle, low-pain movements, you can actively support the healing process.