Shoulder Pain
Shoulder injuries stop overhead athletes. They don't have to stop you permanently.
Assessment-led shoulder rehabilitation for athletes and active adults — from rotator cuff irritation through post-surgical recovery, with overhead performance as the goal.
Conditions
What we treat.
Partial and full-thickness tears managed conservatively or post-surgically. Loading-based rehabilitation with overhead capacity as the endpoint.
Subacromial pain on overhead movement. Driven by load tolerance, scapular control, and rotator cuff capacity — not by anatomy alone. Responds well to loading-based treatment.
Superior labrum injuries — common in overhead athletes and from acute trauma. Conservative management or post-surgical rehabilitation depending on presentation.
Anterior, posterior, and combined labral pathology. Assessment determines whether instability is the driver and programs for dynamic stability through rotator cuff and scapular strengthening.
Recurrent dislocations or subluxations. Stability through strength — systematic rotator cuff and posterior chain loading with sport-specific return criteria.
Acromioclavicular joint sprains and separations from contact or falls. Graded return to overhead and upper body loading.
Adhesive capsulitis — managed through the appropriate phase with manual therapy, range-of-motion work, and progressive loading as mobility permits.
Long head of biceps irritation — often co-presenting with shoulder impingement. Load-based tendon rehabilitation and addressing contributing factors.
Who we see
Three kinds of shoulder patients.
The overhead athlete.
CrossFit athletes losing overhead capacity. Swimmers with chronic anterior shoulder pain. Throwers — baseball, softball, water polo — with rotator cuff irritation that worsens through the season. The shoulder is loaded heavily and frequently. Rehabilitation must keep that load in view — not simply remove it.
The desk worker with postural impingement.
Pain that builds through the day. Worse with reaching overhead or across the body. Tight pectorals, weak posterior rotator cuff, poor scapular control under load. Common in office workers and anyone who sits for extended periods. Responds well to corrective loading and posture retraining.
The post-surgical patient.
Recovery following rotator cuff repair, labrum surgery, or stabilisation procedure. The repair was successful — now the shoulder needs to be rebuilt. Staged loading through the post-operative protocol with overhead return as the defined goal.
The approach
How shoulder rehabilitation works here.
Scapular control assessment
The scapula is the platform from which the rotator cuff works. Deficits in scapular control under load are a primary driver of shoulder pain that is rarely addressed in passive treatment.
Rotator cuff loading
Progressive, specific loading of the rotator cuff — not generic "shoulder exercises." Posterior rotator cuff strength is built systematically and tested under load before overhead clearance is given.
Overhead strength progression
Return to overhead work is introduced progressively — from supported positions through to full unsupported overhead under load. The goal is not just pain-free overhead: it is confident, strong overhead.
Return-to-sport overhead criteria
For athletes, clearance to return to overhead sport requires demonstrating shoulder capacity at near-competition intensity — not just reporting pain reduction at rest or in daily tasks.
What delays recovery
Four things that slow shoulder rehabilitation.
Prolonged avoidance of overhead movement allows the shoulder to stiffen and the rotator cuff to decondition. Overhead capacity is rebuilt by loading overhead — progressively, safely, and with assessment guidance on when to introduce each level.
Massage, ultrasound, and passive stretching reduce symptoms temporarily. They do not rebuild the rotator cuff or restore scapular control. Symptom reduction without capacity rebuilding leads to recurrence when load is reintroduced.
Scapular dyskinesia — abnormal scapular movement under load — is a primary contributor to shoulder impingement and rotator cuff overload. Addressing it changes the mechanical environment of the shoulder. Missing it means the underlying driver remains untreated.
Most overhead athletes return to sport with adequate anterior strength but deficient posterior rotator cuff strength. The imbalance drives reinjury. Return criteria here require posterior strength benchmarks to be met — not approximated.
Case example
What recovery looks like.
A 29-year-old CrossFit athlete presented with fourteen months of anterior shoulder pain, limiting overhead pressing and kipping movements. Had stopped all overhead work six months prior on advice. No imaging taken. Previous two physiotherapy courses: exercise sheets for rotator cuff, no systematic loading progression.
Assessment: marked scapular upward rotation deficit under load, significant posterior rotator cuff weakness on the affected side relative to the unaffected, pain-free range of motion within normal limits at rest — pain emerging only under loaded overhead positions.
Treatment: isolated posterior rotator cuff loading, scapular control under progressive load, phased reintroduction of overhead positions over ten sessions. Athlete returned to full overhead pressing at session eight. Kipping pull-up reintroduced at session ten. Training continued throughout rehabilitation with exercise modification in the first three sessions only.
Case presented with patient consent. Identifying details modified.
Questions
Common shoulder questions.
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Do I need an MRI before starting?
No. Clinical examination is the primary diagnostic tool. MRI is useful for surgical planning or when a structural question cannot be answered clinically — not as a prerequisite to rehabilitation. Bring any existing imaging if you have it.
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Can I keep training while my shoulder heals?
In most cases, yes. The first session establishes which movements are safe to continue, which need modification, and which to temporarily avoid. The goal is to keep you training at the highest level the shoulder can tolerate — not to stop all activity.
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What is the difference between impingement and a rotator cuff tear?
Impingement is compression of soft tissue in the subacromial space — pain on overhead movement at specific arc positions. A rotator cuff tear is a structural failure of one or more tendons. Both can produce similar symptoms and are managed differently. Clinical assessment — with imaging where indicated — differentiates the two.
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Will I need surgery?
Most shoulder presentations — including many rotator cuff tears and labrum injuries — can be successfully managed without surgery. Conservative rehabilitation resolves a significant proportion of shoulder conditions referred for surgical opinion. Assessment clarifies what conservative treatment can achieve.
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How long does shoulder rehabilitation take?
Impingement and rotator cuff irritation often see significant improvement over six to twelve sessions, though individual timelines vary. Post-surgical shoulder rehabilitation ranges from three to six months depending on the procedure and the patient's goal. After session one, you will have a staged timeline with specific milestones.
More questions? See the full FAQ →
Book an assessment
Get your shoulder assessed properly.
Assessment + treatment from session one. $750 MXN. Zona Rio, Tijuana.