Massage for rotator cuff pain

The shoulder is a ball and socket joint, and the socket is shallow. That shallowness is what gives the shoulder its remarkable range, and it is also what makes it dependent on muscle for stability. The rotator cuff is the group of four muscles that do that job. They sit around the shoulder blade, and their tendons pass across the joint, wrapping the ball and holding it centred in the socket as you move.

Because the tendons pass through a narrow space between the top of the arm bone and the bony arch above it, they are vulnerable to being pinched when the arm is raised. This is the mechanism behind most rotator cuff pain, and it is why the problem is usually felt in a particular direction rather than everywhere. Reaching overhead, reaching out to the side, and reaching behind your back to fasten clothing are the movements that most often provoke it.

The tendons themselves can be irritated, inflamed, or torn, and the distinction matters. Irritation that settles is a different situation from a significant tear, and a tear is not something massage can do anything about. Working out which you have is a job for a clinician, which is why the referral section on this page matters more than usual.

What makes someone susceptible is usually repetition rather than a single event. Anything that takes the arm overhead repeatedly asks a great deal of a small group of muscles and tendons. Swimming, tennis, serving in badminton, throwing sports, painting and decorating, plastering, electrical work, shelf stacking and hairdressing all sit in this group, along with anything that involves reaching up above shoulder height for a living. The pattern is the same whether it is a sport or a job. Where the shoulder is also being held in a rounded, forward position, which is common in desk work, the space available for the tendon is reduced further, which is why the two often go together.

The accounts people give of rotator cuff pain are remarkably consistent, and the pattern is quite different from a frozen shoulder.

The most common is the arc. People describe a specific range as they lift their arm to the side where it hurts, roughly between shoulder height and overhead, and then it eases again once the arm is fully up. This arc of pain is one of the most recognisable features of a rotator cuff problem. Lifting something down from a shelf, reaching across a table or putting on a jacket can all reproduce it.

The second is the pain at the front or outside of the shoulder. People often point to the front of the shoulder or to the outside of the upper arm rather than to the joint itself. Some describe it as a catching or pinching sensation, and some feel it down the side of the arm as far as the elbow. Pain that travels below the elbow, or that comes with numbness or pins and needles in the hand, suggests something different and needs assessing.

The third is the night pain, which is often the thing that finally drives someone to make an appointment. Lying on the affected side is uncomfortable, and many people find they cannot sleep in their usual position. This is shared with a frozen shoulder, but the pattern differs, because with a rotator cuff problem you can usually still get your arm into most positions once you are awake and careful.

The fourth is weakness. People notice it in specific actions rather than generally. Reaching for something on a high shelf feels unreliable, lifting a bag is harder than it should be, or a serve or a throw has lost something. Weakness is worth paying attention to, because weakness out of proportion to pain, or weakness that came on after an injury, points towards a tear and needs assessing rather than treating.

Alongside the shoulder, people commonly describe tightness across the upper back and between the shoulder blades, tension in the neck, and the other shoulder starting to complain because it is doing more. Where the neck is a significant part of the picture, see our page on neck and shoulder pain.

Almost every case comes down to repetition rather than a single moment. Below are the four patterns we see most.

The assessment starts with the movements you cannot do. We will ask which specific actions provoke it, whether there is an arc of pain when you lift your arm to the side, how far you can reach behind your back, and whether there is weakness as well as pain. We will also ask whether it came on gradually or after an incident, because a shoulder that followed a fall or a wrenching injury needs assessing rather than treating. If we think your shoulder needs medical review before we work on it, we will say so at that point.

The treatment covers the shoulder, the shoulder blade, the upper back and the neck. Working only on the shoulder itself tends to give relief that does not last, because the shoulder blade and the upper back are part of the same mechanism. The pressure is firm on the upper back and the muscles around the shoulder blade, and more careful around the shoulder itself and the front of the joint, which is not an area to force.

You will also get guidance on what to do between appointments, and for this condition that guidance matters more than the treatment does. It normally covers loading the shoulder in a controlled way rather than avoiding it entirely, some simple work for the muscles that control the shoulder blade, and how to keep training in a way that does not keep provoking the shoulder. Where you are an overhead athlete or you work overhead, we will talk specifically about how to manage the volume rather than stopping altogether.

This page is reviewed by senior therapist Richard Clarke. The treatment most often used is sports massage, a targeted half body treatment aimed at the specific areas around the shoulder that have tightened. Sport is in the name, but the treatment suits anyone whose shoulder is being loaded repeatedly, whether that comes from a pool or a paintbrush.