Shoulder Pain

Shoulder pain is one of the most frequent complaints people bring to physiotherapists or GPs. It can affect daily tasks like dressing, reaching overhead, or even sleeping. Knowing what causes it, and what can increase your risk, helps with earlier treatment and better recovery.

Most Common Shoulder Conditions

1. Rotator cuff tendinopathy / tear
   
   

   • The rotator cuff is a group of muscles/tendons that stabilise and move the shoulder. Over time or with overload, the tendons can become irritated, inflamed, frayed, or even tear.
     
     

2. Shoulder impingement / subacromial pain syndrome
   
   

   • This is when structures like tendons or bursae (small fluid sacs) get “pinched” under the bone during arm movements, particularly overhead.
     
     

3. Adhesive capsulitis (Frozen Shoulder)
   
   

   • The shoulder capsule becomes stiffened and painful, leading to gradually restricted movement. This often occurs in phases (painful, stiff, then recovery).
     
     

4. Subacromial bursitis
   
   

   • Inflammation of the bursa under the acromion can cause pain, especially when lifting the arm.
     
     

5. Calcific tendinopathy
   
   

   • Calcium deposits can form in tendons, causing sudden sharp pain or long-term aching.
     
     

6. Acromioclavicular (AC) joint disorders
   
   

   • Pain at the top of the shoulder due to arthritis, overuse, or injury.
     
     

Why Does Shoulder Pain Happen?

• Overuse or repetitive strain (e.g. overhead work or sports)
  
  

• Age-related changes (tendons lose elasticity and blood supply as we get older)
  
  

• Biomechanical factors (poor posture, weak or imbalanced muscles)
  
  

• Reduced movement (immobilisation after injury/surgery can cause stiffness)
  
  

• Health conditions (diabetes, thyroid disease, obesity, metabolic issues)
  
  

Risk Factors

Research shows several things increase the chance of shoulder pain:

• Age – more common after age 50
  
  

• Gender – frozen shoulder is more common in women
  
  

• Occupation – jobs with heavy lifting or overhead work raise risk
  
  

• Sports – swimmers, throwers, and overhead athletes are at higher risk
  
  

• Health conditions – diabetes, thyroid disease, poor sleep, and metabolic problems
  
  

• Previous shoulder pain – having had it once increases the chance of recurrence
  
  

• Psychosocial stress – stress, low job satisfaction, and poor support can also play a role
  
  

What Recent Evidence Tells Us

• A 2024 study of 1,200 people found that being female and having diabetes are independent risk factors for frozen shoulder, and poor sleep quality was also linked.
  
  

• Overhead athletes benefit from strengthening, scapular control, and injury-prevention programs—these reduce risk.
  
  

• Occupational studies confirm that repetitive overhead work and heavy shoulder load significantly increase the risk of tendon-related problems.
  
  

Take-Home Message

Shoulder pain is common, but often treatable. Many risk factors—like activity levels, posture, and strength—are modifiable. Physiotherapy helps by restoring movement, strength, and confidence in using the shoulder.

If your shoulder pain is affecting daily life, early assessment with a physiotherapist can set you on the right path to recovery.

References

1. Verywell Health. Rotator Cuff Tear: Symptoms, Causes, and Treatment. 2024.
   
   

2. Verywell Health. Common Causes of Shoulder Pain. 2023.
   
   

3. BMC Musculoskeletal Disorders. Epidemiology and risk factors for frozen shoulder: a population-based study. 2024.
   
   

4. BMC Musculoskeletal Disorders. Risk factors for subacromial shoulder pain: a systematic review. 2022.
   
   

5. Journal of Experimental Orthopaedics. Risk factors for shoulder injuries in overhead athletes: a systematic review. 2022.
   
   

6. PubMed. Work-related risk factors for shoulder disorders: a review. 2000.
   
   

7. PubMed. Work-related arm elevation and shoulder disorders: meta-analysis. 2017.

Achilles tendinopathy is a common condition that affects the tendon at the back of your ankle. This tendon, called the Achilles tendon, connects your calf muscles to your heel bone and is the strongest tendon in the body. Despite its strength, it can become painful if it’s put under too much stress, too often.

It’s not just athletes who get it—many people who don’t play sports can develop this problem too.

What is Achilles Tendinopathy?

Achilles tendinopathy refers to a mixture of pathological changes that happen to the tendon when it has been overloaded in excessive repetition or increased structure stress. This can be from too much running, jumping, or even sudden changes in your activity levels. Over time, the tendon’s structure changes and it can become stiff, painful, and sometimes swollen.

It usually develops gradually rather than from a single injury. Morning stiffness or pain at the back of the heel is a very common symptom.

For symptoms that occur suddenly, this is possible due to a tear in the tendon fibers. 

Where Does it Happen?

Achilles tendinopathy can occur in two main areas:

• Mid-portion tendinopathy – pain and thickening in the middle of the tendon (about 2–6cm above the heel).
  
  

• Insertional tendinopathy – pain where the tendon attaches directly to the heel bone.
  
  

Why Does it Happen?

There are several reasons why the Achilles tendon might develop tendinopathy:

• Overuse or sudden increase in activity (e.g. ramping up running distance too quickly)
  
  

• Poor flexibility or stiff calf muscles
  
  

• Foot mechanics, such as excessive pronation (foot rolling inwards)
  
  

• Reduced blood supply to the tendon, which makes healing slower
  
  

• Other risk factors like being overweight, having high blood pressure, type II diabetes, or using certain medications such as steroids
  
  

Sometimes genetics and age can also play a role.

Common Symptoms

• Pain or stiffness in the morning, especially when taking the first steps
  
  

• Tenderness at the back of the ankle
  
  

• Pain when running, jumping, or climbing stairs
  
  

• Thickening of the tendon in some cases
  
  

What’s Happening Inside the Tendon?

When overloaded, the tendon’s normal structure becomes disrupted. Instead of strong, well-aligned fibers, the tissue becomes weaker and less organized. The tendon tries to heal, but without enough rest or the right treatment, this process doesn’t complete properly—leading to ongoing pain.

How is it Treated?

The good news is that Achilles tendinopathy responds well to physiotherapy. Treatment often includes:

• Exercise therapy – especially eccentric strengthening exercises for the calf and tendon
  
  

• Load management – adjusting activity levels to allow healing without complete rest
  
  

• Flexibility and mobility work – to reduce strain on the tendon
  
  

• Footwear advice or orthotics if biomechanics are a factor
  
  

• Education – understanding how to gradually build activity levels back up safely
  
  

In more severe or long-term cases, other medical treatments may be considered, but most people improve with the right physiotherapy approach.

Summary

Achilles tendinopathy is a very common condition that develops from overuse or overload of the tendon. While it can be stubborn, it is very treatable with the right exercises, activity management, and professional guidance.

If you have ongoing Achilles pain, especially in the morning or when active, a physiotherapist can help you recover and get back to the activities you enjoy.

Plantar fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It involves irritation and degenerative changes of the plantar fascia—a thick band of connective tissue on the sole of the foot that supports the arch and absorbs shock. Despite the “-itis” suffix implying inflammation, modern studies show that the problem is largely degenerative and overuse-related, not primarily inflammatory. Because of this, some clinicians prefer the term plantar fasciopathy.

Characteristic features include:

• Sharp heel pain on the medial inferior heel, especially during the first steps in the morning or after rest.
  
  

• Pain that eases once you’ve walked a bit but may return later in the day.
  
  

👤 Who does it affect?

Plantar fasciitis is common and can affect many people, but certain groups have higher risk:

Typical demographics / risk factors

• Adults aged 40–60 years.
  
  

• More common in women than men.
  
  

• People with obesity or those who spend long periods standing/weight-bearing.
  
  

• Runners and athletes, especially with recent increases in training load.
  
  

• Foot biomechanics issues (flat feet, high arches, tight calves/Achilles).
  
  

Overall, studies estimate that about 4–7% of the general population experience plantar fasciitis at some point.

🔍 Why does plantar fasciitis happen?

The underlying issue is repetitive micro-trauma and mechanical overload, which leads to structural breakdown of the plantar fascia rather than classic inflammation:

• Repeated stress causes tiny tears, collagen disorganisation, degeneration, and altered fascia mechanics.
  
  

• Contributing factors include:
  
  

  • Tight calf muscles/Achilles tendon limiting ankle motion.
    
    

  • Sudden increases in activity or hard surfaces during exercise.
    
    

  • Poor footwear or prolonged standing.
    
    

  • Excess body weight increasing load on the fascia.
    
    

So rather than being primarily “inflammatory,” plantar fasciitis is more like tendinopathy—a degenerative, overuse condition with failed healing responses.

🏃‍♂️ Who recovers and what's the natural course?

• Many cases improve with conservative care alone: ~70–80% of people have significant symptom reduction within 9–12 months.
  
  

• A smaller portion (~5–10%) may experience persistent symptoms and require more advanced treatment.
  
  

 Physiotherapist treatments — what’s supported by current evidence?

The evidence for many treatments is evolving, and while no single treatment is a “magic bullet,” research supports a multimodal, exercise-based approach. Here’s the latest evidence:

🟡 1. Exercise and loading programs (best evidence)

• High-load strength training / heavy slow resistance training focused on the plantar fascia/calf complex shows strong improvements in pain and function compared to stretching alone in RCTs. These protocols progressively load the tissue to improve strength and tolerance.
  
  

🟡 2. Stretching

• Stretching the plantar fascia, calves, and Achilles tendon is widely recommended as a first-line intervention and can help reduce pain when used consistently.
  
  

🟡 3. Shockwave therapy (ESWT)

• Extracorporeal shockwave therapy has moderate evidence for reducing pain, particularly in chronic or persistent cases when combined with exercise.
  
  

🟡 4. Taping and orthoses

• Low-Dye taping and orthotics/insoles may provide short-term pain relief and help redistribute mechanical load.
  
  

🟡 5. Manual therapy

• Manual techniques (mobilisations, soft tissue work) may help symptom reduction, although evidence quality is modest and effects often short-term.
  
  

🟡 6. Needling / dry needling

• Some low-moderate evidence suggests dry needling may reduce pain when combined with exercises or other treatments.
  
  

📌 Current Clinical Guideline Themes

Most guidelines and high-quality studies recommend:

1. Education + activity/load modification (avoid aggravating loads early).
   
   

2. Progressive therapeutic exercise (especially strength + stretching).
   
   

3. Adjunctive therapies (taping, orthoses, shockwave) where needed.
   
   

4. Advanced therapies (needling/shockwave) for chronic, non-responsive cases.
   
   

🧠 Why physiotherapy matters

Physiotherapists assess movement, biomechanics, strength, and tissue tolerance to design individualised programs (rather than one-size-fits-all sheets). Combining education, exercises, manual therapy, and load management tends to yield the best outcomes for patients.