Physiotherapy for shoulder pain and rotator cuff injuries.

• Rotator cuff problems. The cuff tendons can be irritated, strained or torn. Most respond to a progressive strengthening program, and only some tears need surgery.
• Impingement and painful arc. Pain when raising the arm, usually linked to how the cuff and shoulder blade work under load. It commonly settles with rehab.
• Frozen shoulder. A painful, progressive stiffening that moves through stages and gradually eases. Physiotherapy helps you manage it through each stage.
• Shoulder-blade control. If the shoulder blade does not move well, the cuff has to work harder. Retraining scapular control is often part of the plan.
• Instability and dislocation. After a dislocation or in a naturally loose shoulder, rehab rebuilds the strength and control that keep the joint stable.
• After a crash or work injury. A fall, a collision or a workplace incident can injure the shoulder, and ICBC or WorkSafeBC cover the physiotherapy that follows.

• Keep it moving gently. Move the shoulder through a comfortable range often rather than resting it in a sling. Gentle movement keeps a sore shoulder from stiffening.
• Manage the load, do not stop everything. Reduce the overhead and heavy tasks that spike the pain, but keep using the arm within comfort. Total rest tends to leave the shoulder weaker and stiffer.
• Adjust your sleep. If night pain is a problem, try lying on the other side with a pillow supporting the sore arm, or propped up slightly. Small changes often help.
• Ease off the aggravators. Notice which specific movements flare the shoulder and modify them for now. This is information your therapist uses to build the plan.
• Start gentle strength early. Light rotator cuff and shoulder-blade work, at a level that does not flare the shoulder, is usually helpful early. What is right for you depends on the assessment.

This is general information, not a treatment plan or a diagnosis. Get urgent care for a shoulder that has just dislocated, or for severe pain and weakness after a significant fall or impact. The right exercises for you depend on what your assessment finds.

• Rotator cuff tears. Most, including many tears, improve with a progressive strengthening program. Surgery is considered mainly for large traumatic tears with significant weakness.
• Impingement. Rarely needs surgery. It usually settles with rehab that rebuilds cuff and shoulder-blade strength and adjusts the loads that flare it.
• Frozen shoulder. Usually managed without surgery. Physiotherapy helps through each stage while it gradually thaws, and other options are considered only if it stalls.
• Prehab and post-op rehab. If surgery is planned, rehab before and after is a large part of the outcome. Going in with a calmer, stronger shoulder tends to help recovery.

The decision to operate belongs to a surgeon. Our job is to build the rehab around whichever path you and your surgeon choose, and to tell you plainly when your shoulder should be reviewed by a doctor.

• Extended health insurance. Most plans cover physiotherapy. We direct-bill most insurers up to your plan limit, and you pay any balance on the day.
• ICBC (after a car crash). A shoulder injured in a collision is treated within ICBC's pre-approved physiotherapy, with no referral needed. Bring your claim number and we bill ICBC directly.
• WorkSafeBC. If your shoulder injury is work-related and the claim is accepted, physiotherapy is covered at no direct cost to you.
• MSP. MSP helps only with a limited number of physiotherapy visits for people on its supplementary benefits (lower-income households).