1. Introduction / Plain Theory

Shoulder pain is one of the most common musculoskeletal problems, affecting up to one in three adults at some point in their lifetime.
Because the shoulder joint (glenohumeral joint) offers the widest range of motion in the body, it also relies heavily on muscular coordination and soft-tissue stability.

Pain can arise from local structures — such as tendons, bursae, or the joint capsule — or from referred sources like the neck, upper thorax, or diaphragm.
Common shoulder-related conditions include:

• Rotator cuff tendinopathy or partial tears

• Subacromial impingement syndrome

• Bursitis

• Adhesive capsulitis (frozen shoulder)

• Referred pain from the cervical spine or upper ribs

In many cases, pain develops gradually without clear trauma, often linked to posture, repetitive strain, or muscular imbalance.

2. Typical Symptoms and Functional Impact

• Dull or sharp pain around the shoulder or upper arm.

• Pain aggravated by overhead movements or reaching behind the back.

• Weakness, stiffness, or clicking sensations during motion.

• Night pain that disrupts sleep (especially when lying on the affected side).

• Reduced mobility affecting work, dressing, or daily activities.

Functional impact:
Shoulder pain can limit independence and athletic performance and may lead to compensatory strain in the neck, upper back, or opposite shoulder if not addressed.

Red flags:
Severe trauma, visible deformity, fever, unexplained swelling, or sudden loss of movement may indicate fracture, infection, or acute pathology — requiring urgent medical evaluation.

3. Contributing Factors / Underlying Causes

Shoulder pain is multifactorial, involving both local tissue irritation and global biomechanical influences:

• Overuse and microtrauma: repetitive reaching, lifting, or sports activities.

• Postural strain: rounded shoulders or forward head posture increasing impingement risk.

• Muscle imbalance: weakness of rotator cuff or scapular stabilizers, overactivity of upper trapezius or pectoral muscles.

• Thoracic spine and rib stiffness: reducing scapular mobility and altering shoulder mechanics.

• Cervical contribution: nerve irritation or referred pain from the neck.

• Emotional and autonomic factors: chronic tension influencing muscular tone and pain perception.

Addressing shoulder pain effectively requires an understanding of regional interdependence — how neck, thorax, and shoulder motion influence each other.

4. Osteopathic Approach

Osteopathic care focuses on improving mobility, balance, and coordination throughout the shoulder complex and associated regions.
Treatment is always adapted to the individual’s presentation and underlying diagnosis.

An osteopathic assessment may include:

• Evaluating shoulder, scapular, and cervical motion; identifying asymmetries or compensations.

• Assessing the thoracic spine, ribs, and diaphragm for movement restrictions.

• Gentle manual techniques — soft tissue release, joint mobilization, and functional methods — to restore fluid motion and reduce pain.

• Supporting circulation and lymphatic drainage to aid tissue recovery.

• Discussion of ergonomics, postural awareness, and gradual load progression.

Osteopathic treatment aims to reduce pain, restore normal movement, and improve shoulder function as part of an integrated rehabilitation plan, often alongside physiotherapy or exercise-based programs.

5. Scientific Evidence & References

Current evidence supports a multimodal conservative approach — combining manual therapy, exercise, and patient education — as the most effective strategy for most shoulder pain conditions.
Systematic reviews suggest that manual therapy can improve pain and mobility, particularly when applied to both the shoulder and cervical/thoracic regions.
Osteopathic techniques are shown to be safe and beneficial when performed by qualified practitioners.

References

1. Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population: a systematic review. Scand J Rheumatol. 2004;33(2):73–81. Link

2. Littlewood C, May S, Walters S. A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy. Shoulder Elbow. 2013;5(3):151–167. Link

3. Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. Arch Phys Med Rehabil. 2004;85(8):1476–1485. Link

4. Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome. J Shoulder Elbow Surg. 2004;13(5):499–502. Link

5. Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17(4):230–236. Link

6. Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther. 2011;16(1):33–39. Link

7. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for musculoskeletal pain: systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2014;15:286. Link

8. Yang Z, Chen Z, Xie Y, et al. Comparative efficacy and safety of manual therapy techniques for shoulder pain: a network meta-analysis. Front Med. 2024;15:1507282. Link