Shoulder Pain and Shockwave Therapy: When Can It Help?

Written by Dr. Richard Domenic Simeoni, Physiotherapist

Shoulder pain is incredibly common and can become frustrating when it starts affecting sleep, gym training, work or even simple things like reaching into a cupboard.

There are many different causes of shoulder pain, so getting the diagnosis right is important before deciding on treatment. At Nano Physiotherapy, Shockwave Therapy is one treatment option we may use for certain shoulder conditions, usually alongside a structured strengthening and rehabilitation program.

Two common conditions where Shockwave may be considered are rotator cuff tendinopathy and subacromial bursitis / subacromial shoulder pain.

What is Shockwave Therapy?

Shockwave Therapy uses acoustic pressure waves that are delivered into the affected area using a handheld treatment device.

Despite the name, there is no electrical shock involved.

The treatment provides a mechanical stimulus to the tendon and surrounding tissues. This is thought to influence pain sensitivity and stimulate biological processes involved in tissue repair and remodelling.

Shockwave generally isn't a one-session quick fix. We tend to use it as one part of a broader rehabilitation program rather than as a treatment on its own.

Rotator Cuff Tendinopathy

Rotator cuff tendinopathy is one of the most common causes of shoulder pain.

The rotator cuff is a group of muscles and tendons that help control and stabilise the shoulder. Symptoms can develop following repetitive loading, changes in gym training, heavy lifting or simply gradual overload over time.

Pain is commonly felt around the outer or front of the shoulder and may become worse with reaching overhead, lifting weights, putting your arm behind your back or sleeping on that side.

Shockwave can be used over the affected rotator cuff tendon with the aim of reducing pain and stimulating the tendon.

Research suggests Shockwave may improve pain and shoulder function in some people with rotator cuff tendinopathy, although results vary between patients and it isn't something we would use instead of strengthening and rehabilitation.

Subacromial Bursitis

The subacromial bursa is a small fluid-filled structure located between the rotator cuff and the structures above it. Its job is to help the tissues of the shoulder move smoothly.

When the shoulder becomes irritated or overloaded, the bursa can become sensitive and contribute to pain. This is often referred to as subacromial bursitis, although in practice it commonly occurs alongside irritation of the rotator cuff and other structures around the shoulder.

People will often describe pain when raising the arm, reaching overhead or lying on the affected shoulder. There may also be a particularly painful section of movement as the arm is lifted.

Shockwave may sometimes be considered when this type of shoulder pain has become persistent, particularly where there is an associated rotator cuff tendon component.

The aim isn't necessarily to simply "get rid of the inflammation". Instead, Shockwave may help reduce pain and improve tolerance to loading, allowing us to progressively strengthen the shoulder.

Importantly, Shockwave isn't required for every case of bursitis. Research into Shockwave for broader subacromial shoulder pain has produced mixed results, which is why we use it selectively rather than as a stand-alone solution.

Shockwave + Shoulder Strengthening

This is probably the most important part.

Whether someone has rotator cuff tendinopathy, bursitis or a combination of the two, the shoulder still needs to gradually regain its ability to tolerate load.

At Nano Physiotherapy, Shockwave is generally combined with an individualised strengthening program.

This may include exercises targeting the rotator cuff, shoulder blade muscles and larger muscles around the shoulder and upper back. We then gradually progress the amount of resistance and movement depending on the person's symptoms and goals.

For someone who goes to the gym, that might mean gradually returning to pressing and overhead exercises. For someone whose shoulder pain is affecting work, the focus might be rebuilding tolerance to lifting, carrying or repetitive reaching.

Shockwave can potentially help settle symptoms enough to make this rehabilitation process easier, but the strengthening component is what helps improve the longer-term capacity of the shoulder.

Shoulder Pain Treatment at Nano Physiotherapy Hornsby

If you've been dealing with ongoing shoulder pain, the first step is working out what is actually causing it.

At Nano Physiotherapy in Hornsby, we assess and treat a range of shoulder conditions including rotator cuff tendinopathy and subacromial shoulder pain.

Where appropriate, treatment may include Shockwave Therapy alongside physiotherapy, exercise rehabilitation and progressive strengthening.

Shockwave isn't necessary for every shoulder problem, but in selected cases it can be a useful addition to a well-planned rehabilitation program.