Why Does My Shoulder Hurt at Night or When I Sleep on My Side?
Why Does My Shoulder Hurt at Night or When I Sleep on My Side? A Physical Therapist Answers
By Nova Physical Therapy | North Hollywood, CA
Looking for physical therapy in North Hollywood? Explore our rehabilitation services at Nova Physical Therapy Services.
Your shoulder feels relatively manageable during the day.
Then bedtime comes.
You roll onto that side.
Pain.
You roll onto the other side.
A few minutes later, the shoulder starts aching again.
You put a pillow under your arm.
Move it.
Move it again.
Eventually you fall asleep—only to wake up when you roll onto the painful shoulder.
Patients frequently describe it like this:
“My shoulder hurts more at night than during the day.”
“I can't sleep on that side anymore.”
“It hurts when I reach overhead, but sleeping is actually worse.”
“I wake up because my shoulder is aching.”
A common assumption follows:
“If it hurts this much at night, I must have torn my rotator cuff.”
Not necessarily.
Nighttime shoulder pain can occur with multiple musculoskeletal and medical presentations. The pattern may be seen in people with rotator-cuff-related shoulder pain, but night pain alone cannot tell us which structure is responsible or whether a tear is present.
That distinction is important because modern shoulder rehabilitation is moving away from trying to identify one painful structure from symptoms alone and toward evaluating:
movement + muscle performance + function + load tolerance + symptom behavior + patient goals.
Patient Question
“My shoulder hurts when I sleep on my side, and sometimes the aching wakes me up at night. It also bothers me when I reach overhead or behind my back. Does this mean I have a rotator cuff tear, and can physical therapy help?”
The Short Answer
Possibly—but nighttime pain does not automatically mean you have a rotator cuff tear.
Shoulder pain at night can occur with several conditions and presentations.
If the pain is related to the rotator cuff, contemporary literature increasingly uses terms such as rotator-cuff-related shoulder pain because symptoms cannot always be attributed reliably to one individual tendon or structure. PubMed
The 2025 clinical practice guideline supported by APTA addresses adults with shoulder pain and suspected rotator cuff tendinopathy, including presentations with or without calcification and partial-thickness rotator cuff tears. It provides recommendations covering assessment, nonsurgical rehabilitation, prognosis, and return to activity. APTA
For an appropriate musculoskeletal shoulder presentation, physical therapy may help address:
shoulder movement
rotator cuff and shoulder muscle performance
functional strength
activity tolerance
sleep-position aggravation
and
return to work, exercise, recreation, or sport.
But first, the shoulder needs to be appropriately evaluated.
Key Takeaways
1. Nighttime shoulder pain does not automatically mean you tore your rotator cuff.
Symptoms alone cannot establish the underlying tissue diagnosis.
2. Sleeping directly on a painful shoulder can aggravate symptoms in some people.
Changing position or supporting the arm may make sleep more comfortable, but positioning is not a universal treatment.
3. Pain reaching overhead doesn't necessarily mean overhead movement is damaging your shoulder.
The amount of load and the shoulder's current capacity matter.
4. A shoulder can be painful even when imaging findings do not completely explain the symptoms.
Clinical decisions should consider the person and their function—not an imaging report in isolation.
5. Exercise-based rehabilitation is an important component of nonsurgical management for appropriate rotator-cuff-related presentations.
The 2025 APTA-supported guideline specifically addresses active rehabilitation for rotator cuff tendinopathy. APTA
Why Does My Shoulder Hurt More at Night?
This is one of the most common—and frustrating—questions patients ask.
During the day, you continuously change positions.
At night, you may remain in one position for a much longer period.
Imagine lying directly on a sensitive shoulder.
You aren't loading it for:
two seconds.
You may be loading or positioning it for:
20 minutes...40 minutes...or longer.
For a shoulder that is already irritable, prolonged positioning may aggravate symptoms.
But there's another interesting situation.
Some patients tell us:
“Even when I sleep on my good side, the painful shoulder still aches.”
Why?
Because the unsupported upper arm may fall across the body or remain in a position that is uncomfortable for that particular shoulder.
That's why simply asking:
“Which side do you sleep on?”
isn't always enough.
We may also want to know:
Where is your painful arm while you sleep?
Why Does Sleeping Directly on My Shoulder Hurt?
Side sleeping places the shoulder between your body and the mattress.
That changes the mechanical demand around the shoulder.
If the shoulder is already sensitive, direct pressure or sustained positioning may be uncomfortable.
But this does not automatically mean:
“The mattress is crushing my tendon.”
or
“Every night I sleep on it, I'm causing more damage.”
Pain and tissue damage are not interchangeable concepts.
A more useful question is:
Which position lets you sleep while placing the least aggravating demand on the shoulder?
Sometimes relatively small positioning changes can make a substantial difference in comfort.
Why Does My Shoulder Hurt Even When I Sleep on the Other Side?
This surprises people.
They stop sleeping on the painful shoulder but still wake up aching.
Consider what may happen to the upper arm when you're lying on the opposite side.
Without support, the arm may:
fall forward
or
rest across your body
for a prolonged period.
For some patients, supporting the arm with a pillow may improve comfort.
The pillow isn't “healing the rotator cuff.”
It's simply changing the position and demand on the shoulder while you're trying to sleep.
That distinction matters.
What Is a Better Sleeping Position for Shoulder Pain?
There isn't one perfect sleeping position for everyone.
Depending on the individual presentation, some people may find greater comfort by:
sleeping on the opposite side with the painful arm supported
or
sleeping on the back with support under the arm.
But the goal isn't to prescribe a universal:
“correct shoulder sleeping position.”
A better principle is:
Find a position that reduces sustained aggravation while still allowing you to sleep.
Sleep matters.
A technically “perfect” position that keeps you awake for three hours isn't particularly useful.
Should I Sleep on My Back?
You can try it if it is comfortable.
For some people, lying on the back while supporting the affected arm reduces symptoms.
For others, back sleeping simply doesn't work.
Rehabilitation should fit the person.
Not:
person → forced into rehabilitation rule.
But:
rehabilitation strategy → adapted to person.
Does Nighttime Shoulder Pain Mean I Have a Rotator Cuff Tear?
No—not by itself.
This is one of the most important messages in this article.
Patients sometimes hear:
“Night pain means rotator cuff tear.”
That is too simplistic.
Night pain is a symptom.
It does not tell us by itself:
which tendon is involved
whether a tendon is torn
whether a tear is partial or full thickness
or
whether the rotator cuff is even the primary explanation.
The 2025 rotator cuff clinical practice guideline emphasizes a broader assessment of adults presenting with suspected rotator cuff tendinopathy rather than establishing management from one symptom alone. APTA
What Is Rotator-Cuff-Related Shoulder Pain?
This terminology is useful.
Traditionally, patients may have heard labels such as:
shoulder impingement
rotator cuff tendinitis
supraspinatus tendinitis
or
subacromial pain syndrome.
But shoulder pain is often more complicated than:
one painful structure = one diagnosis.
A 2025 Journal of Orthopaedic & Sports Physical Therapy commentary discusses the growing use of “rotator cuff-related shoulder pain” because individual rotator cuff tendons cannot necessarily be identified as the definitive and sole source of symptoms from clinical presentation alone. PubMed
That terminology also supports a more useful patient conversation.
Instead of:
“Which exact millimeter of tissue hurts?”
we can also ask:
“What has your shoulder lost the ability to do?”
Why Does My Shoulder Hurt When I Reach Overhead?
Overhead reaching asks the shoulder to coordinate movement between several regions.
Your upper arm moves.
Your shoulder blade moves.
The muscles surrounding the shoulder produce and control force.
And the demands increase further if you're holding something.
Compare:
raising an empty hand
with
putting a coffee mug into a cabinet
with
lifting a 20-pound object overhead.
All three involve overhead movement.
They are not the same physical demand.
That's why:
“Does reaching overhead hurt?”
is only the beginning of the evaluation.
We also want to know:
At what height?
With how much weight?
During lifting or lowering?
How many repetitions?
What happens afterward?
Why Does My Shoulder Hurt Reaching Behind My Back?
Patients frequently report difficulty with:
putting on a belt
fastening clothing
reaching into a back pocket
washing their back
or
putting on a jacket.
These movements require a combination of shoulder motions.
The important question isn't necessarily:
“Which tendon causes behind-the-back pain?”
It may be:
How much motion is available?
Is muscle performance limited?
Where does the pain occur?
Is the limitation primarily pain, stiffness, or both?
That distinction can influence rehabilitation.
What If I Have a Painful Arc?
Some patients describe:
“It hurts halfway up, then gets easier when my arm is all the way overhead.”
That symptom behavior can provide information during an examination.
But again:
painful arc ≠ automatic tissue diagnosis.
Physical therapists should combine the patient's history, movement examination, muscle-performance testing, functional limitations, and relevant clinical findings rather than using one test to identify a specific tissue problem.
What About Shoulder Clicking and Popping?
Another common story:
“Every time I lift my arm, my shoulder clicks.”
The immediate thought is:
“Something must be torn.”
Not necessarily.
Shoulders can produce sounds.
Clicking alone doesn't tell us whether there is meaningful pathology.
The questions become more useful when we ask:
Is the clicking painful?
Did it begin after an injury?
Is there weakness?
Does the shoulder feel unstable?
Is motion restricted?
Has function changed?
A painless click and a traumatic painful shoulder with major loss of function are very different presentations.
What If My Shoulder Hurts When I Put On a Jacket?
This is a perfect example of why physical therapy should be function-driven.
Suppose your shoulder motion improves by ten degrees.
Great.
But you still can't put on your jacket.
From the patient's perspective:
the problem isn't solved.
Range-of-motion measurements matter.
Strength testing matters.
Clinical tests matter.
But so does:
Can you dress independently?
That's the bridge between clinical measurements and real life.
What If I Can Lift My Arm but It Hurts?
This distinction matters too.
A shoulder may have:
full movement + pain
or
limited movement + pain
or
limited movement + relatively little pain
or
significant weakness despite relatively preserved motion.
Those aren't identical presentations.
That's why simply writing:
“shoulder pain 7/10”
doesn't tell the entire clinical story.
Does Weakness Mean My Rotator Cuff Is Torn?
Not automatically.
Muscle-performance testing can be influenced by:
pain
effort
fear
neurological factors
deconditioning
tissue injury
and other considerations.
Significant weakness, especially after trauma, may warrant further medical evaluation depending on the overall presentation.
But weakness alone does not allow someone to diagnose a rotator cuff tear from a home strength test.
Do I Need an MRI?
Not every person with shoulder pain needs immediate imaging.
The 2025 rotator cuff CPG includes recommendations concerning imaging and assessment in adults with suspected rotator cuff tendinopathy. The overall approach emphasizes clinical assessment and appropriate management rather than assuming imaging is necessary for every shoulder-pain presentation. APTA
Whether imaging is appropriate depends on the individual circumstances.
Factors can include:
- Significant trauma
- Major weakness or functional loss
- Examination findings
- Failure to progress as expected
- Suspicion of another condition
- Medical history
- Surgical considerations
- Other concerning symptoms
Imaging is a tool.
It isn't the entire evaluation.
What If My MRI Says “Tendinosis”?
This is another important patient question.
Patients sometimes read an imaging report and think:
“That's it. My shoulder is damaged.”
Imaging findings can be clinically meaningful.
But an imaging report needs to be interpreted within the patient's overall clinical picture.
Physical therapy is still interested in:
What movements are limited?
How much strength is available?
What activities provoke symptoms?
What can you no longer do?
What are you trying to return to?
The scan describes anatomy.
The evaluation describes the person using that anatomy.
Both can matter.
What If the MRI Shows a Partial Rotator Cuff Tear?
This does not automatically mean surgery is the only option.
Importantly, the 2025 APTA-supported clinical practice guideline specifically includes adults with partial-thickness rotator cuff tears within its scope for nonsurgical medical care and rehabilitation. It excludes full-thickness tears from that particular guideline. APTA
Management should still be individualized based on the patient's presentation, medical evaluation, functional limitations, goals, and other relevant factors.
What About Full-Thickness Rotator Cuff Tears?
This is where careful language matters.
The 2025 rotator cuff tendinopathy guideline we are discussing does not cover full-thickness tears. APTA
APTA separately lists the 2025 American Academy of Orthopaedic Surgeons Management of Rotator Cuff Injuries Clinical Practice Guideline, which addresses rotator cuff tears more broadly. APTA
So we shouldn't take evidence for one population and casually apply it to another.
That's an important part of evidence-based practice.
Should I Stop Using My Shoulder?
Usually, the question isn't simply:
move
versus
don't move.
A more useful concept is:
What can your shoulder currently tolerate?
Imagine that reaching into the first shelf of your cabinet is comfortable.
Second shelf:
mild discomfort.
Third shelf holding a heavy object:
significant pain.
That gives us information.
Rehabilitation can sometimes begin within tolerable ranges and progressively increase the demand.
That is different from:
“Never reach overhead again.”
Is Rest Enough?
Sometimes reducing a highly aggravating activity temporarily can help settle symptoms.
But complete avoidance does not necessarily rebuild the shoulder's capacity for:
lifting
reaching
carrying
pushing
pulling
or
sports.
If your goal is to return to those activities, rehabilitation eventually needs to prepare your shoulder for them when clinically appropriate.
Should I Strengthen My Rotator Cuff?
For appropriately selected rotator-cuff-related shoulder pain presentations, active rehabilitation can be an important component of nonsurgical management.
The current APTA-supported CPG specifically provides recommendations for the rehabilitation of adults with suspected rotator cuff tendinopathy. APTA
But:
“strengthen your rotator cuff”
is not a complete treatment program.
The clinician still needs to determine:
starting load
range
volume
frequency
symptom response
functional goals
and
progression.
A person who has difficulty reaching a coffee cup overhead doesn't necessarily start in the same place as an athlete trying to return to serving a tennis ball.
What About the Shoulder Blade?
The shoulder blade—or scapula—participates in upper-extremity movement.
Depending on the patient's presentation, rehabilitation may address muscle performance and movement around both the glenohumeral joint and scapular region.
But we should avoid simplistic statements such as:
“Your shoulder hurts because your shoulder blade is out of place.”
The human body isn't a machine with one loose component that simply needs to be pushed back into position.
Movement is dynamic.
What About Posture?
Another common belief is:
“My shoulders round forward, so that must be causing the pain.”
Posture can influence how certain positions feel and may be relevant to particular activities.
But treating posture as the sole explanation for shoulder pain is usually too simplistic.
Rather than chasing a universal “perfect posture,” rehabilitation can focus on:
movement options + strength + endurance + task tolerance + position changes.
Especially for someone working at a desk all day, the ability to change positions may be more practical than trying to hold one rigid posture for eight hours.
What About Manual Therapy?
Manual therapy may sometimes be incorporated as part of a broader physical therapy program when appropriate.
But Nova's philosophy should remain clear:
Passive treatment shouldn't automatically become the entire rehabilitation plan.
If your goal is to:
lift groceries
reach overhead
return to the gym
work
play tennis
or
sleep comfortably,
the shoulder eventually needs adequate movement and functional capacity for those demands.
Manual treatment may support the process when appropriate.
It doesn't replace the process.
Can Physical Therapy Help?
For appropriately selected musculoskeletal shoulder presentations, yes, physical therapy may be part of nonsurgical management.
The 2025 clinical practice guideline supported by APTA, the Academy of Orthopaedic Physical Therapy, the Quebec Rehabilitation Network, and Quebec Pain Research Network provides 25 evidence-based recommendations and 15 consensus recommendations covering assessment, prognosis, nonsurgical care, rehabilitation, and return to sport for adults with suspected rotator cuff tendinopathy. APTA
Depending on the individual evaluation, physical therapy may address:
- Shoulder mobility
- Rotator cuff muscle performance
- Scapular muscle performance
- Functional strength
- Reaching
- Lifting
- Carrying
- Pushing and pulling
- Work tolerance
- Exercise tolerance
- Sport-specific demands
- Activity modification
- Progressive loading
- Patient education
- Sleep-position strategies
- Return to meaningful activity
But the goal isn't:
“Make everyone with shoulder pain do the same five exercises.”
The goal is:
evaluate the limitation → identify meaningful functional deficits → establish appropriate goals → progressively build the capacity required for those goals.
What Does Research Say?
2025 APTA-Supported Rotator Cuff Clinical Practice Guideline
This is the strongest reason to revisit this topic now.
In January 2025, APTA published an evidence-based clinical practice guideline covering rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation.
The guideline was subsequently published in the Journal of Orthopaedic & Sports Physical Therapy in April 2025.
It addresses adults with shoulder pain and suspected rotator cuff tendinopathy, including cases:
with or without calcification
and
with partial-thickness rotator cuff tears.
It provides evidence-based guidance for:
assessment
prognosis
nonsurgical rehabilitation
and
return to function and sport. APTA
Why Terminology Is Changing
A 2025 JOSPT commentary addressed an important issue:
What should clinicians call this broad group of shoulder presentations?
The authors argued for “rotator cuff-related shoulder pain”, noting that the rotator cuff tendons are not necessarily the definitive and sole source of symptoms and reporting that this term was overwhelmingly preferred in a global clinician survey. PubMed
This isn't simply academic terminology.
It changes the patient conversation from:
“We know exactly which tendon hurts because this one test was positive.”
toward:
“Let's combine your history, physical examination, functional limitations, and relevant medical information.”
2025 Updated Rotator Cuff Injury Guideline
APTA also lists the updated American Academy of Orthopaedic Surgeons Management of Rotator Cuff Injuries Clinical Practice Guideline, published in 2025, which provides recommendations for patients with rotator cuff tears. APTA
What Does This Mean for Patients?
Current evidence supports moving away from overly simplistic shoulder narratives.
Not:
night pain = tear
Not:
positive shoulder test = exact damaged tendon
Not:
MRI finding = entire explanation
And not:
shoulder pain = stop using the shoulder.
A more useful pathway is:
history → movement and functional evaluation → appropriate clinical testing → determine whether PT is appropriate → individualized rehabilitation → progressive return to meaningful activity → referral or additional medical assessment when indicated.
What Happens During a Physical Therapy Evaluation?
At Nova Physical Therapy, a shoulder evaluation may include, when appropriate:
- Detailed symptom history
- Shoulder range of motion
- Active versus passive movement
- Muscle-performance testing
- Rotator cuff-related testing
- Scapular movement and muscle performance
- Relevant cervical screening
- Functional reaching
- Lifting or carrying tasks when appropriate
- Work-related movements
- Sport-specific movements when relevant
- Patient-reported functional measures
- Screening for findings requiring referral
The PTBC states that a physical therapist evaluates a patient's physical status, establishes a plan of care and goals, and provides treatment to improve movement and function. PTBC also describes evaluation as including health history and observation of posture, movement, and limitations. Physical Therapy Board of California
But here's where Nova's evaluation becomes personal.
We may ask:
Can you sleep on the painful shoulder?
Does the pain wake you?
Can you reach the top cabinet?
Can you wash your hair?
Can you put on a jacket?
Can you reach behind your back?
Can you lift groceries?
Can you carry your child?
Can you perform your job?
Can you return to the gym?
Can you throw, swim, play tennis, or perform your sport?
Because:
“shoulder flexion = 150°”
is useful clinical information.
But:
“I can finally put my dishes into the top cabinet again”
is functional information.
We want both.
When Should You Seek Medical Attention?
Shoulder pain that gradually appears with reaching or exercise is different from a sudden traumatic event followed by major loss of function.
Seek appropriate medical evaluation for shoulder symptoms associated with:
- Significant trauma
- Obvious deformity
- Sudden major inability to lift the arm after injury
- Significant or rapidly progressive weakness
- New neurological symptoms
- Significant redness, warmth, or swelling
- Fever or signs of infection
- Unexplained systemic symptoms
- Rapidly worsening symptoms
- Symptoms that do not behave like a typical musculoskeletal presentation
And remember:
Not every symptom felt around the shoulder originates from the shoulder.
Seek urgent medical attention for shoulder or upper-body discomfort accompanied by concerning symptoms such as:
- Chest pressure or pain
- Significant shortness of breath
- Sweating or feeling acutely ill
- Fainting
- Other symptoms suggestive of a cardiovascular or medical emergency
Persistent unexplained night pain, particularly when it is not clearly influenced by movement or position or is accompanied by systemic symptoms, also warrants appropriate medical assessment.
Why Patients Choose Nova Physical Therapy
At Nova Physical Therapy, our philosophy is simple:
We Care.
But shoulder pain shows exactly why those words need to mean something.
One patient tells us:
“My shoulder hurts at night.”
But maybe what that really means is:
“I haven't slept through the night in three weeks.”
Another says:
“My shoulder hurts when I reach overhead.”
But what they actually mean is:
“I can't pick up my child anymore.”
Another says:
“I can't reach behind my back.”
But the real problem is:
“I need help getting dressed.”
And another says:
“My shoulder hurts at the gym.”
But their actual goal is:
“Exercise is part of my life, and I want to know how to safely get back to it.”
Those are four different people.
They shouldn't automatically receive the same rehabilitation program simply because the body part is:
shoulder.
We want to understand:
What movement bothers you?
How much can you currently tolerate?
What has changed?
What does the physical therapy examination show?
What do you need your shoulder to do?
What are you trying to get back to?
Then rehabilitation can be built around the individual.
Our approach emphasizes:
individualized physical therapy evaluation
evidence-informed rehabilitation
progressive strengthening
functional movement
appropriate load management
patient education
return to meaningful activity
and
appropriate referral when findings warrant additional medical evaluation.
The goal isn't simply to make your shoulder feel better for an hour after treatment.
The goal is to help build the movement and functional capacity you need outside the clinic.
That's part of what We Care means to us.
Frequently Asked Questions
Why does my shoulder hurt more at night?
Prolonged positioning and direct pressure may aggravate a sensitive shoulder. However, nighttime shoulder pain has several possible explanations and cannot establish a diagnosis by itself.
Why does my shoulder hurt when I sleep on it?
Side sleeping places sustained pressure and positional demand on the shoulder. A symptomatic shoulder may tolerate that poorly.
Why does my shoulder hurt even when I sleep on the other side?
The painful arm may remain unsupported or fall across the body. Some people find supporting the arm more comfortable.
Does nighttime shoulder pain mean a rotator cuff tear?
No. Night pain alone cannot establish whether a rotator cuff tear is present.
Why does my shoulder hurt when I reach overhead?
Overhead reaching increases movement and muscular demands around the shoulder. Several shoulder presentations can produce symptoms during this activity.
Does shoulder clicking mean something is torn?
Not necessarily. Clicking or popping alone cannot identify a rotator cuff or labral tear.
Does weakness mean my rotator cuff is torn?
No. Weakness can have multiple explanations. Significant weakness—particularly after trauma—should be appropriately evaluated.
Do I need an MRI for shoulder pain?
Not automatically. Imaging decisions depend on the history, physical examination, trauma, functional loss, progress, and other clinical considerations.
Can a partial rotator cuff tear be treated without surgery?
Some partial-thickness rotator cuff tear presentations may be managed nonsurgically. The 2025 APTA-supported CPG specifically includes partial-thickness tears within its rehabilitation scope. Individual management still requires appropriate evaluation. APTA
Should I stop lifting if my shoulder hurts?
Not automatically. Depending on the presentation, load, range, volume, or activity may be temporarily modified and progressively advanced.
Should I strengthen my rotator cuff?
Active rehabilitation is part of evidence-based management for appropriately selected rotator cuff tendinopathy presentations, but exercise selection and progression should be individualized. APTA
Can physical therapy help nighttime shoulder pain?
If the symptoms are associated with an appropriate musculoskeletal shoulder presentation, physical therapy may address movement, muscle performance, activity tolerance, functional limitations, and relevant positioning strategies.
Schedule an Evaluation
If shoulder pain is making it difficult to:
- Sleep
- Reach overhead
- Reach behind your back
- Get dressed
- Wash your hair
- Lift groceries
- Carry your child
- Work
- Exercise
- Throw
- Swim
- Play tennis
- Return to sports
Nova Physical Therapy can evaluate your movement and functional limitations and determine whether physical therapy is appropriate.
Our rehabilitation approach focuses on:
movement + strength + progressive loading + function + education + return to meaningful activity.
Ready to learn more? Visit Nova Physical Therapy Services to explore our services and learn more about physical therapy care at our North Hollywood clinic.
Disclaimer
This article is for general educational and informational purposes only. It does not constitute medical advice, medical diagnosis, imaging interpretation, exercise clearance, or individualized physical therapy treatment.
Nighttime shoulder pain, pain when sleeping on one side, painful overhead reaching, weakness, clicking, or other symptoms cannot independently establish rotator cuff tendinopathy, a rotator cuff tear, shoulder impingement, arthritis, labral injury, adhesive capsulitis, cervical involvement, or another medical condition.
California physical therapists evaluate physical status, movement, function, and relevant limitations and establish individualized plans of care within their regulated scope of practice. Physical Therapy Board of California
The intervention concepts discussed in this article represent general evidence-informed rehabilitation principles and should not be interpreted as individualized recommendations.
Physical therapy, exercise, manual therapy, activity modification, sleep-position modification, or other conservative interventions cannot guarantee symptom resolution or prevention of recurrence.
Seek appropriate medical evaluation for significant trauma, deformity, sudden major functional loss, progressive weakness, neurological symptoms, signs of infection, systemic symptoms, rapidly worsening symptoms, or other concerning findings.
Seek urgent medical attention for shoulder or upper-body symptoms associated with possible cardiovascular or other medical emergencies.
Individual results vary.
References
- Desmeules F, Roy JS, Lafrance S, et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy.2025;55(4):235-274. doi:10.2519/jospt.2025.13182. PubMed
- American Physical Therapy Association. Rotator Cuff Tendinopathy Diagnosis, Non-surgical Medical Care and Rehabilitation: A Clinical Practice Guideline. Published January 30, 2025. The guideline contains 25 evidence-based and 15 consensus recommendations for assessment, prognosis, rehabilitation, and return to activity. APTA
- American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries Clinical Practice Guideline. Updated 2025; listed by APTA August 18, 2025. APTA
- What's in a Name? The Case for Using “Rotator Cuff-Related Shoulder Pain” in Clinical Practice. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(7). PubMed
- American Physical Therapy Association. Shoulder Conditions — Evidence-Based Resources. APTA's shoulder-condition library includes current clinical practice guidelines and outcome measures relevant to shoulder rehabilitation. APTA
- Physical Therapy Board of California. Consumer Information/FAQs. PTBC describes physical therapists as licensed health care professionals who evaluate physical status, establish plans of care and goals, and administer treatment intended to improve movement and function. Physical Therapy Board of California
- Physical Therapy Board of California. Physical Therapy Practice Act. Current California statutory framework governing physical therapy practice. Physical Therapy Board of California
Evidence resources: APTA Rotator Cuff Tendinopathy Clinical Practice Guideline · 2025 JOSPT Rotator Cuff Clinical Practice Guideline on PubMed · APTA Shoulder Conditions Resources · Physical Therapy Board of California