Tight, aching shoulders are something most people feel at some point, whether from long days at a desk, stress, carrying bags or working with your arms overhead. For most people this is muscle tension rather than damage, and it tends to ease with movement, strengthening and time. Knowing the difference between everyday tension and a problem with the shoulder joint itself can help you decide what will help, and when to get it checked.

This article is general information, not a diagnosis. If your pain is severe, keeps coming back, or you are unsure what is causing it, see your GP.

Muscle Tension or a Joint Problem?

When people talk about "tight shoulders" they usually mean the upper trapezius, the muscle that runs from the base of the neck across the top of the shoulder, along with the muscles between the shoulder blades. Tension here often feels like a dull ache, tightness or tender knots, and it is usually easier to move the arm than it feels.

Problems with the shoulder joint and its tendons are different. Pain from the rotator cuff, the group of tendons around the joint, is the most common cause of shoulder pain, and a "frozen" shoulder causes deep joint pain and stiffness that makes everyday tasks such as putting on a jacket difficult [5]. If lifting your arm is painful or weak, or your shoulder is getting stiffer rather than looser, it is worth having it assessed rather than assuming it is just tension.

Common Causes of Shoulder Tension

  • Long periods in one position. Desk work, laptops and phones keep the shoulders and neck in the same position for hours, which many people notice as tightness by the end of the day.
  • Stress. Many people hold stress in their shoulders, lifting or bracing them without noticing until the area feels tight or sore.
  • Carrying. A heavy bag on one shoulder, or carrying children or shopping, can overload the same muscles day after day.
  • Overhead and repetitive work. Painting, shelving, some trades and sports such as swimming ask a lot of the shoulder muscles.
  • Old injuries. After an injury, people often move differently to protect the area, and other muscles can end up working harder than usual.

Common Patterns Therapists See

Tender knots. Firm, sensitive spots in the upper trapezius are often described as trigger points. They can refer an ache up into the neck or head, or down towards the shoulder blade.

Reduced reach. Some people notice that reaching overhead or behind their back feels tighter on one side. Occasional clicks without pain are common, but movement that is painful, weak or getting worse should be checked.

How Treatment Can Help

What the research says. Exercise has the best support. Strengthening exercise has been shown to reduce neck pain in office workers [1], and for shoulder pain around the rotator cuff, exercise is recommended as the first approach, with hands-on treatment as a useful addition [2]. The evidence for massage alone is weaker: one review found low-quality evidence that soft tissue massage improves shoulder pain, function and movement in the short term [3]. For trigger points in the upper trapezius, sustained pressure has moderate evidence for easing pain, with results similar to other approaches [4].

That is why treatment here combines hands-on work with movement. Many people find hands-on treatment eases tension in the short term, which can make it easier to start and keep up the exercises that help over time.

  • Remedial massage starts with an assessment of how your shoulders, neck and upper back move, then uses targeted soft tissue techniques on the areas contributing to your symptoms.
  • Trigger point therapy applies focused, sustained pressure to tender knots that may be referring discomfort elsewhere.
  • Deep tissue massage uses firmer pressure for tension that has built up over a long time.
  • Exercise and movement advice. Our therapist's background in exercise science means you leave with simple strengthening and mobility exercises, so the benefits carry over between sessions. You can read more about her qualifications.

Simple Things That Often Help Day to Day

  • Strengthen your shoulders and upper back. Regular strengthening has the strongest evidence [1][2]. Your therapist can show you where to start and how to progress.
  • Keep moving. Gentle movement within a comfortable range usually helps more than holding the shoulder still, and returning to normal activity as soon as you can is generally advised [5].
  • Take regular breaks. When working at a desk, stand up, roll your shoulders and let your arms hang loose regularly through the day.
  • Share the load. Swap sides when carrying, or use a backpack with both straps.

How Long Does It Take to Feel Better?

It depends on what is behind your symptoms and how long they have been building. Tension after a busy week often settles within days, while tightness built up over months of desk work or stress usually takes longer. Joint and tendon problems tend to follow their own, often slower, course. Your therapist can give you an honest idea of what to expect after your first assessment.

When to See a Doctor First

Some shoulder symptoms need medical assessment before massage [5][6]. Call 000 straight away if shoulder, left arm or jaw pain comes with chest pain, breathlessness, sweating or nausea, as this can be a sign of a heart problem [5]. See your GP promptly if your shoulder pain:

  • follows a fall or injury, especially if the shoulder looks out of shape or you cannot lift your arm;
  • comes with fever, or a joint that is hot, red or swollen;
  • comes with numbness, tingling or weakness in your arm or hand;
  • comes with unexplained weight loss, feeling generally unwell, or pain that is worse at night;
  • is severe, getting worse, or has not improved after a couple of weeks.

If you have seen a doctor and been cleared for hands-on treatment, let us know at your appointment so we can work with any advice you have been given.

What to Expect at Your First Appointment

Your first session starts with a conversation about your symptoms, health history and daily routine, followed by a check of how your shoulders, neck and upper back move. Treatment is tailored to what we find, and you will leave knowing what may help between sessions and whether follow-up visits are worthwhile.

Remedial massage may be claimable through your private health fund extras cover, and we offer on-the-spot claiming with HICAPS. When you are ready, you can book online.

References

  1. Louw S, Makwela S, Manas L, et al. Effectiveness of exercise in office workers with neck pain: a systematic review and meta-analysis. South African Journal of Physiotherapy. 2017;73(1):392. doi:10.4102/sajp.v73i1.392
  2. Pieters L, Lewis J, Kuppens K, et al. An update of systematic reviews examining the effectiveness of conservative physical therapy interventions for subacromial shoulder pain. Journal of Orthopaedic & Sports Physical Therapy. 2020;50(3):131–141. doi:10.2519/jospt.2020.8498
  3. van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. British Journal of Sports Medicine. 2014;48(16):1216–1226 (published online 2012). doi:10.1136/bjsports-2011-090553
  4. Cagnie B, Castelein B, Pollie F, et al. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. American Journal of Physical Medicine & Rehabilitation. 2015;94(7):573–583. doi:10.1097/PHM.0000000000000266
  5. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124–1128. doi:10.1136/bmj.331.7525.1124
  6. Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy. 2020;50(7):350–372. doi:10.2519/jospt.2020.9971