Sumiko at 62: 4 simple exercises from a physiotherapist to ease shoulder pain

In late 2023, I felt an unexpected twitch in my right shoulder while exercising. The discomfort was mild at first, so I ignored it, but it gradually worsened into a persistent ache.

Raising my right arm – like when I was washing my hair – hurt. Certain movements, such as a tennis swing or when a lanyard I was holding got caught in a doorknob, sent sharp jolts of pain through my shoulder.

At night, I had to position my shoulder carefully as sleeping on the affected side was painful. I later developed neck pain on my right side, adding to my frustration.

A pain specialist diagnosed a likely strain of my rotator cuff – the set of shoulder muscles and tendons that help you lift, twist and rotate your arm while keeping the joint stable – as well as a strain of my trapezius muscles, which run along either side of the upper back.

She referred me to a physiotherapist at Singapore General Hospital (SGH). I began therapy in September 2024, not realising how long recovery would take.

After 14 long months of daily exercises and regular physiotherapy, I realised, one day, that I wasn’t moaning about my shoulder as much as I used to.

The pain no longer felt constant. Where I once could reach only the back of my head while shampooing, I could now wash my crown with no problem. At night, I didn’t have to treat my shoulder so gingerly.

I am not completely pain-free. When I overuse my right arm or keep my neck static for long periods – like when I’m working at the computer without a break – the pain will flare up, which is why I continue with the exercises and physiotherapy.

This experience also inspired The Physio Fix, a series in which I work with physiotherapists from SGH to show how physiotherapy can help address the aches and pains that many of us accept as part of getting older.

The shoulder joint has been called a marvel of human anatomy, allowing an incredible range of motion that lets us lift, reach, throw, carry, twist and turn with remarkable flexibility.

Dr Xia Zhan, a consultant in the department of orthopaedic surgery at SGH, says the shoulder joint is the most mobile joint in the human body.

Its wide range of motion comes from a ball-and-socket design, in which a large humeral head fits into a shallow glenoid socket. But the design comes with a trade-off. “This makes it also the least stable joint and highly susceptible to injury,” he says.

Shoulder pain can come from inside the joint. This happens when you fall or have an accident, resulting in fractures, dislocations and injuries to tendons or muscles. Pain can also be caused by conditions such as frozen shoulder, where the shoulder capsule stiffens and becomes inflamed; rotator cuff tendinitis, which is inflammation of the shoulder’s stabilising tendons; and arthritis, which involves joint inflammation and degeneration.

Dr Xia says pain can also originate outside the joint, such as when the cervical nerve roots in the neck are irritated. Conditions affecting the diaphragm or even the heart can also lead to shoulder pain, which is why it is essential to get an accurate diagnosis.

To determine the cause of shoulder pain, doctors ask about its history and symptoms, perform a physical examination and may order imaging such as X-rays, ultrasound scans or MRI scans. Warning signs such as severe pain, significant night pain, shoulder deformity, unexplained fever or shoulder pain accompanied by chest pain or breathlessness require urgent attention.

Dr Xia says treatment usually starts with pain relief, modification of activities that aggravate the pain, rest and physiotherapy. Injections such as steroids or platelet-rich plasma may be considered if needed, and surgery is generally a last resort after conservative care.

For many patients with shoulder discomfort, physiotherapy offers a real turnaround.

Ms Teo Yee Jean, a principal physiotherapist at SGH, says patients often complain of pain when lifting their arms sideways or overhead, for example when reaching for a top shelf or slipping into a shirt.

Pain usually stems from weakness, poor coordination or overuse of the shoulder and shoulder blade muscles. When these muscles have to work harder to achieve a movement, pain can follow.

Shoulder pain doesn’t discriminate by age. In younger people, it often stems from overtraining while exercising, doing too much too soon or using poor technique.

Older adults are susceptible due to decades of repetitive movements and heavy loads. Reduced muscle strength from ageing plays a role, and age-related changes in tendon structure can further increase vulnerability.

“The good news is that these changes are very responsive to the right exercises and rehabilitation,” Ms Teo says.

Physiotherapy works in two key ways, she adds.

First, it helps patients understand that pain doesn’t always signal harm. Rather, the nervous system can become more sensitive after injury or prolonged strain. “Understanding this helps people worry less about causing damage and to feel safer when returning to normal movement,” she says. Second, it gives patients a structured exercise programme to rebuild strength, improve control and regain confidence in using their shoulder.

Exercises usually combine stretching and strengthening.

“Stretching helps maintain flexibility and comfort, while strengthening improves support and stability,” Ms Teo says. Both are essential for everyday tasks such as lifting, reaching and carrying.

People with shoulder pain are generally encouraged to keep moving within comfortable limits. “In most cases, gentle movement is better than complete rest,” she says. “Some mild discomfort during movement is usually safe and normal. The goal is to stay active within tolerable limits while managing pain properly.”

Results don’t happen overnight, but most people notice improvement within six to 12 weeks of regular exercise and sticking to their programme. The road to full recovery varies depending on the condition being treated, the severity of the injury and how active the person is to begin with. Patience and consistency are essential.

Ms Teo’s advice on preventing shoulder pain is to stay physically active and keep the shoulder muscles strong. The exercises shown here can help. Maintaining good posture, taking regular breaks from repetitive work and lifting heavy loads below chest level – as opposed to above the shoulders – can also reduce strain on the shoulders.

She adds that most shoulder conditions can improve with the right treatment, but what holds some patients back is fear.

“What often matters more than the diagnosis itself is how worried or fearful a person feels about moving their shoulder,” she says. If someone is very worried or afraid of causing more pain, they may avoid using it, which can actually make the pain last longer.

On the other hand, she says, “confidence and gradual movement usually lead to better recovery”.