Shoulder Pain

You reach for something on a shelf and feel that sharp catch on the outside of the shoulder. You lie down at night and the pain wakes you up. Your arm simply won't rotate behind your back anymore, or lifting it above your head has become something you plan around rather than something you do automatically. Shoulder pain is the third most common reason people come to our practice — and it has a particular quality that sets it apart from other musculoskeletal complaints: it rarely resolves on its own, and without addressing the underlying cause, it almost always becomes chronic.

Schulterschmerzen zählen zu den bedeutendsten orthopädischen Beschwerden weltweit. Eine in BMC Musculoskeletal Disorders veröffentlichte systematische Übersicht (Lucas et al., 2022) fasst zusammen: Die Punktprävalenz von Schulterschmerzen in der Allgemeinbevölkerung liegt je nach Studie zwischen 7 und 34 Prozent, mit einem Erkrankungsgipfel zwischen 45 und 64 Jahren. Laut StatPearls (Creech et al., 2026, NCBI Bookshelf) ist das subakromiale Impingement-Syndrom für 44 bis 65 Prozent aller Schulterschmerzbeschwerden verantwortlich — es ist damit mit Abstand die häufigste Einzelursache.

How do I know what type of shoulder pain I have?

The shoulder is the most mobile joint in the human body — and precisely because of that mobility, it's also the most structurally complex and the most prone to dysfunction. Many muscles, ligaments, tendons, fluid-filled sacs, and bones work together in a confined space. Which of these structures is causing your pain determines everything about how it should be treated.

Shoulder pain when lifting the arm

A stabbing or pulling pain when raising the arm sideways or forward, often worse within a specific arc of movement (known as the "painful arc," roughly 60–120 degrees of elevation). This is the hallmark of shoulder impingement or rotator cuff irritation.

Shoulder pain at rest and at night

Pain that exists independently of movement, typically worsening when lying on the affected side. Can indicate bursitis, a more advanced frozen shoulder, or a rotator cuff tear.

Shoulder pain at the front

Pain at the front of the shoulder joint, worsening with elbow flexion or lifting. Often linked to irritation of the long head of the biceps tendon, which passes through the shoulder joint.

Shoulder pain radiating into the arm

When pain travels down the arm, this may indicate either a cervical nerve root problem (originating in the neck) or involvement of the brachial plexus. A thorough assessment distinguishes shoulder-origin from neck-origin symptoms.

Shoulder pain after sleeping

Morning stiffness and pain upon waking are typical of early frozen shoulder or chronic bursitis.

Left-sided shoulder pain

Left-sided shoulder pain that has no mechanical character — not affected by movement, accompanied by chest tightness, shortness of breath, or arm symptoms — should be assessed medically to rule out cardiac causes. When in doubt, seek urgent medical attention.

Other, lesser-known types of shoulder/arm pain can be classified under Thoracic Outlet Syndrome, Myofascial Trigger Points and Muscle Spasm of the muscles surrounding the shoulder, Sprain/Strain, and rib disfunction.

In many cases, there is no specfic cause or diagnosis given for shoulder pain. Nothing can be seen on X-ray or MRT that explains symptoms.
While this is frustrating, it is actually a good sign that pain is mechanical in nature and is the right candidate for chiropractic care.

When to seek emergency care:

Seek emergency care immediately for: shoulder pain after a fall, trauma or collision (possible fracture or dislocation), sudden significant arm weakness, shoulder pain combined with fever, redness and swelling, or left-sided shoulder pain with any chest symptoms.

What to do about shoulder pain right now

Before your appointment, these measures can help — and there are important mistakes to avoid.

What genuinely helps:

Ice in the acute phase — when shoulder pain is recent, has a clear trigger, and feels warm or swollen, ice is more appropriate than heat. A cold pack wrapped in a cloth, 15–20 minutes several times daily. Avoid direct ice-on-skin contact.

Heat for chronic tension — when symptoms are chronic, stiff and dull rather than acutely inflamed, heat relaxes the surrounding musculature and improves circulation. A heat pack (15-20 minutes) on the shoulder and upper back for 20–30 minutes is a reliable first-aid measure.

Pendulum exercises — one of the most widely recommended immediate interventions for shoulder pain: lean forward with your healthy hand resting on a table. Let the affected arm hang freely downward. Gently swing it in small circles — clockwise, then counter-clockwise. Gravity creates gentle joint distraction without requiring muscle activation, which decompresses the irritated structures. One to two minutes, several times daily.

Keep moving within the pain-free range — complete rest and immobilisation are almost always the wrong approach for shoulder pain. They weaken the musculature, promote capsular tightening, and lengthen recovery. Everyday movements at hip height and below — carrying light objects, normal daily activities — are safe and beneficial for most shoulder conditions.

Adjust your sleep position — sleep on the unaffected side with the painful arm resting on a pillow in front of you, or on your back with a small pillow under the affected arm to keep it in a slightly supported position. Avoid sleeping on the painful shoulder or stretching the arm overhead during sleep.

What usually disappoints:

Painkillers mask the signal without addressing the structure. Ibuprofen or diclofenac may reduce the acute pain enough to improve quality of life — but they do not restore joint mobility, retrain coordination, or strengthen a weakened tendon. When painkillers stop working, or when pain returns immediately after stopping them, that's diagnostic information: the cause is structural and requires structural treatment. Cortisone injections can provide valuable short-term relief during acute flares but do not address the underlying mechanism and can weaken tendon tissue with repeated use. Devices like TENS/electrical therapy, Shockwave, or massage guns are also helpful in the shortterm, but do not treat the underlying problem if there is structural or movement patterns that need correction.

What's causing your shoulder pain? The most common conditions

Each of the following responds well to manual therapy and targeted rehabilitation. This is not an exhaustive list, but it covers the conditions we treat most frequently.

Shoulder Impingement Syndrome (Subacromial Impingement)

Shoulder impingement is the most common cause of shoulder pain in outpatient settings, responsible for an estimated 44 to 65 percent of all shoulder complaints. It occurs when the tendons of the rotator cuff and the bursa (fluid-filled sac) become compressed in the subacromial space — the gap between the rotator cuff and the roof of the shoulder (acromion) — particularly during arm elevation. Faulty scapular mechanics, muscle imbalance, thoracic stiffness, and poor posture all contribute. The good news: it responds very well to targeted rehabilitation when the contributing factors are properly identified.

Frozen Shoulder (Adhesive Capsulitis)

One of the most frustrating shoulder conditions, and one of the most commonly delayed in diagnosis. The joint capsule becomes inflamed, thickens, and contracts — producing progressively worsening restriction in all directions of movement. Pain and stiffness cycle through distinct phases. Untreated, frozen shoulder can last one to three years. Women and people with diabetes are disproportionately affected. Manual therapy combined with a graded exercise programme significantly accelerates recovery and reduces the total duration of the condition.

Rotator Cuff Injuries (Partial Tears and Tendinopathy)

The rotator cuff is a group of four muscles and their tendons that stabilise the shoulder joint and control arm rotation. Overuse, repetitive loading, or degenerative changes can lead to tendon irritation (tendinopathy) or partial tears. Crucially: a partial rotator cuff tear does not automatically mean surgery. Research consistently shows that targeted strengthening — particularly eccentric loading of the involved tendons — produces outcomes equivalent to surgical repair in many cases of partial tears.

Biceps Tendon Irritation

The long head of the biceps tendon passes through the shoulder joint and is vulnerable to irritation from overuse, particularly with overhead or lifting activities. Pain at the front of the shoulder that worsens with elbow flexion or forearm supination is characteristic. This responds well to manual therapy and specific eccentric tendon loading exercises.

Scapular Dyskinesis and Muscle Imbalance

The scapula (shoulder blade) is the foundation of the entire shoulder-arm system. When the muscles that position and stabilise the scapula — primarily the serratus anterior and the lower trapezius — are weak or poorly coordinated, the entire mechanics of the shoulder joint are compromised. This produces increased pressure on the tendons and joint, restricted movement, and pain. Scapular dyskinesis is present in almost every case of chronic shoulder pain and is routinely underaddressed in conventional treatment.

Referred shoulder pain from internal organs

In rare cases, shoulder pain originates not from the shoulder itself but from internal organs. Gallbladder conditions can refer pain to the right shoulder. Diaphragm irritation (e.g. following laparoscopic surgery) frequently produces shoulder pain. Cardiac conditions can manifest as left-sided shoulder symptoms. When pain has no mechanical logic — not influenced by movement, accompanied by systemic symptoms — medical assessment should follow. Your chiropractor can help you identify patterns that require further workup.

How does a chiropractor treat shoulder pain in Munich?

Our approach to shoulder pain is structured, individualised, and built on a three-phase rehabilitation model. This model is not designed for athletes or gym-goers — it applies equally to a 70-year-old who wants to lift their arm to dress themselves, a desk worker with chronic impingement, a retired teacher recovering from frozen shoulder, and a competitive swimmer with rotator cuff tendinopathy. The physiology of the shoulder is the same regardless of who inhabits it.

In addition to a detailed examination and movement analysis, your appointment also includes treatment of the thoracic spine, neck, and rib cage. Depending on the diagnosis, most treatment plans start off addressing adhesions in the shoulder musculature that restrict movement. Subsequent visits generally continue with the following:

Phase 1: Restoring full range of motion

Before strength can be built, the joint needs to move freely again. Restricted mobility is present in virtually every shoulder condition — sometimes dramatically (frozen shoulder), sometimes subtly (a 15-degree internal rotation deficit in impingement). In this phase we use targeted chiropractic mobilisation and adjustment of the glenohumeral joint, acromioclavicular joint, and thoracic spine, combined with passive joint stretching and capsular mobilisation, and manual soft tissue work on the rotator cuff and surrounding musculature.

The thoracic spine deserves specific attention here. A stiff mid-back directly alters scapular resting position and restricts the shoulder's ability to move through its full range. Treating the shoulder without addressing the thoracic spine is treating the symptom while leaving a primary driver in place.

Phase 2: Retraining coordination of the shoulder girdle complex

Once mobility is restored, the rehabilitation work begins in earnest. The shoulder is not an isolated joint — it's part of a coordinated system involving the scapula, clavicle, thoracic spine, and arm, which must work in precise rhythm. When pain, guarding, or weakness has disrupted this coordination, shoulder pain tends to recur even after effective initial treatment.

In this phase we train neuromuscular control of the scapula, the scapulohumeral rhythm (the coordinated relationship between scapular rotation and arm elevation), and deep shoulder stabiliser activation. This is not generic physiotherapy. It is precise, individually calibrated motor relearning. And it is relevant to every patient, regardless of age, fitness level, or athletic background. The goal is to give your shoulder the coordination it needs to function without pain in ordinary life.

Phase 3: Building strength and load capacity across movement planes

This is the phase most often omitted — and the one that explains why so many shoulder problems recur after otherwise successful conservative treatment. Pain-free is not the same as functional. A shoulder that doesn't hurt but has no strength in external rotation or overhead positions is a shoulder that will fail again under load.

We build an individualised strengthening programme covering all relevant planes: rotator cuff external and internal rotation, scapular stabilisation in horizontal and vertical planes, and shoulder girdle integration. This programme starts in the praxis and is designed to be continued at home — no gym membership required, no fitness background assumed. We work with what every body can do and build progressively from there.

The goal of all three phases is the same, for every patient: a shoulder that moves freely, tolerates load, and doesn't become a problem again.

How long does this take?

Depending on the diagnosis and how long the condition has been present, most shoulders respond well to 6-8 visits. Many people relapse or re-injure themselves or experience more pain with starting treatment. Because every case is unique, re-examinations take place regularly so that treatment plans can be altered as needed.

When to see a chiropractor for shoulder pain in Munich

The earlier, the better. Shoulder pain that is left untreated tends to become entrenched: tissues shorten, compensation patterns become habitual, and the window for straightforward conservative treatment narrows. Clinical guidelines for shoulder pain — including those published in Shoulder & Elbow (Rees et al., 2021) — consistently recommend conservative management as the first-line approach, with clear diagnostic pathways to ensure appropriate cases are referred for imaging or specialist review.

You do not need a referral to see us. No GP visit, no orthopaedic waiting list. We offer short-notice appointments because shoulder pain affects sleep, work, and daily life — and waiting six weeks for a specialist is not a realistic option for most people.

When you should see a doctor:

Pain followed a trauma, fall or direct blow to the shoulder
You have significant arm weakness (possible full-thickness tendon tear)
You notice fever, redness or swelling combined with shoulder pain

Symptoms that haven't improved after 6–8 weeks of conservative treatment are typically referred for ultrasound or MRI.

Make an appointment

FAQ — Common Questions About Shoulder Pain

Shoulder pain when lifting the arm.

What is it? This is the classic picture of subacromial impingement: tendons or bursa being compressed in the subacromial space during arm elevation. Pain is often worst in a specific arc of movement (roughly 60–120 degrees) and may ease if you push through it. A structured assessment determines whether impingement, the rotator cuff, or the biceps tendon is the primary driver.

Shoulder pain at rest.

Should I be worried? Rest and night pain in the shoulder is a clinically significant symptom. It can indicate bursitis, advanced frozen shoulder, or a rotator cuff tear. If rest pain is severe or combined with arm weakness, a timely assessment is important. In rare cases, rest pain without mechanical involvement warrants investigation.

Is exercise good for shoulder pain?

Yes — when it's the right exercise, calibrated to the right phase of recovery. Complete rest is counterproductive for most shoulder conditions. Pendulum exercises, controlled mobility work, and progressive loading are the backbone of shoulder rehabilitation. The intensity and type of exercise must match the current clinical picture, which changes across the phases of recovery.

How long does shoulder pain last?

It depends on the diagnosis and how long it's been present. Subacromial impingement treated early often responds within 4–8 weeks. Frozen shoulder, untreated, can last 1–3 years; with targeted manual therapy and exercise, this is significantly shortened. Partial rotator cuff tears managed conservatively typically show meaningful improvement over 3–6 months of consistent rehabilitation.

Which doctor treats shoulder pain?

Orthopaedic surgeons, physiotherapists, and chiropractors all treat shoulder pain through different approaches. Orthopaedic surgeons specialise in imaging interpretation and surgical options. Chiropractors and physiotherapists focus on conservative, functional rehabilitation. For suspected full-thickness tears, fractures, or dislocations, orthopaedic assessment should come first.

Do I need a referral to see you in Munich? No. You can book directly. No GP letter, no waiting list, no referral required. We offer same-week appointments for patients in acute pain.