Frozen shoulder, rotator cuff, bursitis, impingement . . . shoulder pain can come with a lot of different names and root causes.

But there are some common themes – difficulty raising your arm overhead, difficulty working or doing your sport, problems sleeping and, of course, pain!

But what happens when you’re not making progress? When the pain and difficulty moving continues?

Pain Perception

I’ve spoken before about chronic pain and its biggest symptom – Central Sensitisation.

What exactly does this mean?

A change in pain perception and / or intensity. Pain stimulus level is often lowered.

In other words pain feels more painful.

Why is the shoulder important?

In the muscles and tendons of the shoulder, particularly the rotator cuff and supraspinatus muscles there are lots of nociceptor nerve cells. These are a particular kind of nerve cell that send “damage / danger” signals to the brain.

So a small injury to the shoulder activates a comparatively HUGE danger signal to the brain.

And the brain interprets danger as pain.

So you end up with a huge amount of pain which doesn’t always correspond to a huge amount of damage.

This Big Pain response makes treatment, particularly movement and exercises much more painful and difficult so people often don’t make progress as quickly as they expect.

What to do

Get treatment as quickly as possible, within 48 hours ideally. The longer your brain is receiving an onslaught of pain/danger signals the more work is required to lower that message.

These pain/danger signals can also result in pain seeming to “spread” and include the elbow and wrist. Tennis Elbow and Carpal Tunnel like symptoms can often be related to a shoulder injury that wasn’t looked after properly.

Don’t be dismissed – when you have a BIG pain / little damage situation, it can be easy to find yourself in the position of not being taken seriously. In an age where an MRI is the ultimate diagnostic tool, if there isn’t significant damage on the picture, the pain in the person can be ignored. If you aren’t making progress, get a 2^nd opinion.