You’ve been dealing with shoulder pain for a few months now. Maybe longer. You’ve tried massage, maybe some acupuncture, possibly a round of physio that involved ultrasound and a TENS machine. It settles down — and then you try to lift something overhead, get back to golf, or return to the gym, and it fires right back up.
If that sounds familiar, you’re not alone. It’s honestly the most common shoulder story we hear.
So what’s actually going on?
The current term for what most people are dealing with is rotator cuff related shoulder pain, or RCRSP. It’s a bit of an umbrella that covers most of the labels you’ve probably been handed at some point:
- Bursitis
- Tendinopathy or tendinitis
- Tenosynovitis
- Small or medium rotator cuff tears
- Subacromial pain
- Shoulder impingement
Researchers grouped these together because the approach to treating them is largely the same — and the good news applies across the board. The vast majority of these respond really well to physiotherapy that focuses on rotator cuff strength, coordination, and mobility. Surgery and injections are rarely where you need to start.
The “just settle it down” approach — and why it falls short
The typical playbook goes something like this: calm the shoulder down with soft tissue work, dry needling, taping, and some activity modification. Throw in a few gentle exercises to keep things moving.
For an irritated shoulder, that’s actually a reasonable starting point. Getting the shoulder into a calmer state gives you something workable to build from. The problem is that this is usually where rehab stops — and patients are left to figure out the rest on their own.
The shoulder quiets down. You ease back in. And the first time you push it, it flares again.
Here’s the thing: settling it down is actually the easier half
Rest, some manual therapy, gentle movement — most shoulders will calm down with that. It’s not magic, it just takes a bit of time.
The harder part is getting the shoulder ready to actually do things again. That’s where rehab tends to fall apart, and there are usually two specific things missing.
Missing piece #1: nobody has actually tested how strong your shoulder is
If your shoulder strength has never been measured, everyone’s just guessing at your progress — you included.
At The Physio Hub, we use a tool called a force dynamometer, which gives us a real number for how much force your shoulder can produce across different movements. That might sound technical, but it’s actually pretty straightforward in practice. It lets us:
- Compare your injured side to your healthy side
- See how your shoulder stacks up against benchmarks for your body weight and sport
- Know — not guess — whether you’re actually ready to return to what you want to do
Here’s why this matters so much. You can get a bit stronger and feel like things are improving, but if your shoulder is still producing half the force it should be, the gap between where you are and what your activity demands can be huge. You go back too early, it breaks down, and suddenly everyone assumes the diagnosis was wrong. It usually wasn’t. The monitoring was.
Missing piece #2: the exercises aren’t challenging enough
The exercises you’ve been given might actually be the right ones. The issue is often just the intensity. Bands that don’t create much resistance. Reps that feel pretty comfortable. Sessions that never really fatigue the shoulder.
If you’re working toward lifting, CrossFit, golf, volleyball, or anything that involves repeated overhead movement, your shoulder needs to be able to handle real load. That means working with weights that actually challenge you, sets that get hard, and a progression that bridges the gap between “settled” to “ready for sport.” Comfortable rehab rarely gets you there.
One thing worth doing this week
If your shoulder is in that in-between zone — calmed down, but not really back — try asking whoever is treating you these two questions:
- “How much force is my shoulder producing compared to a healthy benchmark for my body weight?”
- “How do you know the load I’m working at is actually enough for what I want to return to?”
If there isn’t a clear answer to either of those, that’s likely where the gap is.
Ready for some honest answers about your shoulder?
Most of the shoulders we see in our Collingwood clinic don’t need a new technique or a different diagnosis. They need accurate measurement and a clear, honest plan to get back to the activity that caused the flare-up in the first place.
If your shoulder keeps breaking down every time you try to push things, come in and see us. We’ll measure it properly, map out what’s actually going on, and give you a straight answer about what it’s going to take to get there.