BlogOct 1, 2026

Why Does My Shoulder Hurt When I Reach Behind My Back?

Why Does My Shoulder Hurt When I Reach Behind My Back? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Reaching behind your back seems simple—until your shoulder starts hurting.

Maybe you notice it when you:

reach for your back pocket

put on a belt

fasten a bra

tuck in your shirt

wash your back

put on a jacket

reach behind you in the car.

Your arm may move normally in front of you.

You may even be able to lift it overhead.

But the moment you reach behind your body:

“There’s the pain.”

Some patients also notice:

“One arm goes much farther up my back than the other.”

“It feels tight rather than painful.”

“I get a sharp pain in the front of my shoulder.”

“I feel it on the outside of my shoulder.”

“I can reach behind my back, but I can’t lift my hand very high.”

“It hurts when I put my coat on.”

This movement requires a combination of shoulder and shoulder-blade motion, including internal rotation and extension.

Several different musculoskeletal presentations can make it uncomfortable.

But there is an important point:

Pain when reaching behind your back does not tell us which structure is responsible.

Rotator cuff-related shoulder pain, shoulder stiffness, joint mobility limitations, previous injury, postoperative changes, and other conditions can produce overlapping symptoms.

That is why physical therapy evaluates the movement and the person, rather than diagnosing a shoulder condition from one painful motion.

Patient Question

“My shoulder doesn't bother me much when my arm is down, but it hurts when I reach behind my back to put on clothes, reach for my back pocket, or wash my back. Why does that movement hurt, and can physical therapy help?”

The Short Answer

Reaching behind your back requires several movements to occur together.

Your shoulder must combine varying amounts of:

extension

internal rotation

and

movement of the shoulder blade.

If shoulder mobility, muscle performance, load tolerance, or coordination is limited—or if the shoulder is currently irritable—that combined position may become uncomfortable.

Rotator cuff-related shoulder pain is one possible presentation, but it is not the only explanation.

The 2025 rotator cuff tendinopathy clinical practice guideline supported by the American Physical Therapy Associationaddresses examination and nonsurgical rehabilitation for adults with suspected rotator cuff tendinopathy, including people with or without calcification and certain partial-thickness tears. APTA

Most importantly:

“It hurts when I reach behind my back” is a symptom—not a diagnosis.

A physical therapist may evaluate:

where you feel the pain

how far you can move

whether the movement is painful, stiff, or both

shoulder strength

rotator cuff muscle performance

shoulder-blade movement

neck involvement when appropriate

your functional activities

and

whether the presentation warrants additional medical evaluation.

Why Is Reaching Behind My Back Such a Difficult Shoulder Movement?

Try reaching one hand behind your back.

Now slide it upward toward your opposite shoulder blade.

That movement looks simple.

It isn't.

Your upper arm has to move relative to the shoulder socket while your shoulder blade also moves relative to your rib cage.

Your elbow bends.

Your forearm changes position.

Your trunk may contribute.

Your shoulder therefore needs enough:

mobility

muscle control

strength

and

tolerance to the position

for the task to feel comfortable.

That is why someone can sometimes reach overhead reasonably well but still struggle significantly behind the back.

They are not identical movements.

Is Reaching Behind My Back a Test of Shoulder Internal Rotation?

Partly—but not exclusively.

Clinicians often use a hand-behind-back movement as a functional way to observe shoulder mobility.

But reaching your hand up your spine involves more than isolated glenohumeral internal rotation.

It also involves:

shoulder extension

scapular movement

elbow flexion

and other contributions.

This matters because patients sometimes compare:

“My right hand reaches T8, but my left only reaches L2.”

That difference can be useful clinical information.

But it should not automatically be interpreted as:

“Your shoulder joint has exactly this much internal rotation.”

More specific measurements may be performed during the physical therapy examination.

Why Can I Reach Overhead but Not Behind My Back?

Because the movements require different combinations of mobility and muscle activity.

Imagine someone who can easily:

reach into a kitchen cabinet

but struggles to:

tuck in a shirt.

That is completely possible.

Overhead elevation and reaching behind the back place the shoulder in different positions.

A limitation in one movement does not automatically mean every shoulder movement will be limited.

This is why a functional examination often includes several directions rather than simply asking:

“Can you lift your arm?”

Does Pain Behind My Back Mean I Have a Rotator Cuff Tear?

No.

Pain with one shoulder movement cannot tell us whether a rotator cuff tendon is torn.

The rotator cuff consists of four muscles and their tendons:

supraspinatus

infraspinatus

teres minor

and

subscapularis.

These muscles contribute to shoulder movement and stability.

Rotator cuff disorders are common shoulder presentations, but symptoms and structural findings do not have a simple one-to-one relationship.

The 2025 rotator cuff clinical practice guideline specifically covers suspected rotator cuff tendinopathy, including some partial-thickness tears, while excluding full-thickness tears from its treatment scope. APTA

A painful behind-the-back movement alone therefore cannot determine whether you have:

tendinopathy

a partial tear

a full-thickness tear

no tear at all.

Could It Be Rotator Cuff-Related Shoulder Pain?

Possibly.

Rotator cuff-related shoulder pain can be associated with symptoms during:

lifting

reaching

overhead activity

resisted shoulder movement

and other upper-extremity activities.

But a physical therapist should not conclude:

“It hurts behind your back, therefore you have rotator cuff tendinopathy.”

The history and examination matter.

The 2025 clinical practice guideline recommends a comprehensive approach to assessment and rehabilitation rather than relying on one symptom or one orthopedic test. DOI

Could Shoulder Stiffness Be the Problem?

Yes, stiffness can be relevant.

Some patients tell us:

“It doesn't really hurt until I reach the end.”

Others say:

“My shoulder feels physically blocked.”

And others:

“I have pain and stiffness.”

Those are potentially different presentations.

A physical therapist may compare:

active movement

with

passive movement

and examine multiple shoulder directions.

This helps determine whether the main functional limitation appears related to:

mobility

muscle performance

pain

or a combination.

Does Limited Behind-the-Back Motion Mean I Have Frozen Shoulder?

Not necessarily.

Frozen shoulder—also called adhesive capsulitis—is associated with substantial shoulder pain and mobility loss, but one restricted movement is not enough to establish that condition.

Someone may have difficulty reaching behind the back for many reasons.

A therapist would consider the broader movement pattern, symptom history, functional limitations, and other clinical findings.

If the presentation does not appear appropriate for routine musculoskeletal rehabilitation, medical referral may be recommended.

Why Does the Front of My Shoulder Hurt?

Some patients feel behind-the-back reaching primarily at the front of the shoulder.

Others feel it:

laterally

deep inside

toward the back.

Pain location can provide useful information.

But location alone cannot identify the exact painful structure.

Several tissues are located close together around the shoulder, and symptoms can overlap.

That is one reason statements such as:

“Front pain means your biceps tendon is damaged”

are too definitive without an appropriate evaluation.

Why Does My Shoulder Hurt When I Put On a Jacket?

Putting on a jacket can require your shoulder to move:

behind you

outward

and sometimes

quickly through a large range.

A shoulder that tolerates controlled exercise may still be uncomfortable during this particular combination.

This is also why rehabilitation should eventually consider the actual activity that matters.

If your goal is:

putting on a jacket comfortably,

the program should not stop once you can perform a resistance-band exercise.

Function matters.

Why Does My Shoulder Hurt When I Fasten My Bra?

Reaching behind the back to fasten clothing can require considerable shoulder mobility.

For someone with limited or painful internal rotation and extension, this can become one of the first daily activities that feels difficult.

A useful evaluation may ask:

Can you reach the waistband?

Can you reach the middle of your back?

Is the limitation pain or stiffness?

Does assistance change it?

How does the other shoulder compare?

The goal is not simply to measure motion.

It is to understand how the limitation affects everyday life.

Why Does My Shoulder Hurt Reaching Into My Back Pocket?

The back-pocket movement combines shoulder extension and internal rotation.

It is therefore another common functional activity that may expose limitations that are less noticeable when reaching forward.

This can affect activities such as:

getting a wallet

using a phone stored in a back pocket

dressing

personal hygiene.

Is One Shoulder Supposed to Reach as Far as the Other?

Not necessarily.

Human bodies are not perfectly symmetrical.

Dominant-arm use, previous sports participation, past injuries, anatomy, occupational demands, and normal individual variation can all influence movement.

A difference between shoulders is therefore not automatically:

abnormal

dangerous.

The more useful question is:

Is the difference associated with pain or meaningful functional limitation?

Should I Force My Arm Higher Behind My Back?

Not automatically.

Patients sometimes believe:

“If it's stiff, I just need to force it farther every day.”

Aggressively forcing a painful shoulder position may not be appropriate.

The amount and intensity of mobility work should depend on:

the presentation

irritability

movement restriction

response to exercise

and

functional goals.

A therapist may use gradual exposure to the movement rather than repeatedly forcing the shoulder into significant pain.

Should Shoulder Exercises Hurt?

There is no universal rule that every shoulder exercise must be completely painless.

There is also no good reason to assume:

“The more it hurts, the more it's working.”

A therapist may monitor:

symptoms during exercise

symptoms afterward

night symptoms

next-day response

range of motion

strength

and

functional improvement.

Exercise can then be modified appropriately.

Should I Stretch My Shoulder?

Possibly.

If clinically meaningful mobility restrictions are present, mobility exercises may form part of rehabilitation.

But:

not every painful shoulder is simply “tight.”

Someone whose primary limitation is rotator cuff muscle performance may require a different emphasis from someone with substantial mobility restriction.

The physical therapy evaluation helps identify which impairments appear relevant.

Should I Strengthen My Rotator Cuff?

For appropriately evaluated rotator cuff tendinopathy, active rehabilitation is strongly represented in current guidance.

The 2025 clinical practice guideline states that clinicians should prescribe or recommend an active rehabilitation exercise program, which may include motor-control and/or resistance-training exercises of various loads, as an initial treatment approach for reducing pain and disability in adults with rotator cuff tendinopathy. DOI

But that does not mean:

every patient gets the same five band exercises.

Exercise selection may depend on:

current strength

pain response

range of motion

work requirements

sport

functional goals

and

current load tolerance.

Do I Need Shoulder-Blade Exercises?

Sometimes.

Scapular muscle performance and movement may be considered as part of a shoulder rehabilitation program.

A 2025 systematic review and meta-analysis examining specific exercise modes for rotator cuff-related shoulder pain found that different exercise approaches—including scapular stabilization, eccentric exercise, stretching/mobilization, and other strategies—produced varying effects on pain and function. The authors emphasized individualized exercise prescription rather than one universally superior exercise type. PubMed

That is a useful message for patients.

Your shoulder blade does not necessarily need to be:

“put back into the correct position.”

Exercise may instead be used to improve the overall capacity and control of the shoulder complex.

Do I Need an MRI?

Not everyone with shoulder pain needs an MRI.

Imaging decisions depend on the entire presentation.

For example:

gradual pain reaching behind the back

is different from:

falling onto the shoulder and suddenly being unable to raise the arm.

The 2025 rotator cuff guideline addresses diagnostic imaging within a broader clinical decision-making framework rather than recommending imaging for every person with shoulder pain. DOI

A physical therapist can determine whether examination findings suggest that additional medical evaluation may be appropriate.

Does an MRI Finding Explain My Pain?

Not necessarily by itself.

Imaging can provide important structural information when clinically indicated.

But imaging should be interpreted together with:

history

symptoms

physical examination

and

function.

A scan is not the patient.

Likewise, the goal of physical therapy is not simply to treat an imaging report.

The goal is to address meaningful impairments and functional limitations.

Do I Need Surgery?

Pain reaching behind your back does not automatically mean surgery is necessary.

Treatment decisions depend on the actual condition, severity, trauma history, functional loss, response to conservative management, imaging when appropriate, patient goals, and medical assessment.

The current rotator cuff guideline specifically addresses nonsurgical management for rotator cuff tendinopathy and certain partial-thickness tears. APTA

If examination findings suggest a condition requiring medical or surgical assessment, referral is appropriate.

Does Kinesiology Tape Help Shoulder Pain?

A newly published 2026 systematic review and meta-analysis examined kinesiology taping for rotator cuff-related shoulder pain.

The researchers included:

39 randomized controlled trials involving 2,481 participants.

They found at most small short-term benefits for shoulder function, activity-related pain, and night pain, with low to very low certainty of evidence.

The authors concluded that kinesiology tape may be considered an adjunct, but should not replace education-focused, exercise-based rehabilitation. PubMed

That's an important distinction.

Tape may sometimes help symptoms.

Tape does not automatically restore shoulder capacity.

Can Physical Therapy Help?

For an appropriately evaluated musculoskeletal shoulder presentation, physical therapy may help address:

Shoulder mobility
Rotator cuff muscle performance
Shoulder strength
Scapular muscle performance
Movement tolerance
Reaching
Dressing
Reaching behind the back
Reaching overhead
Lifting
Carrying
Work activities
Exercise
Sports
Return to meaningful daily activities

The 2025 clinical practice guideline identifies exercise as a core component of nonsurgical rotator cuff tendinopathy management and recommends an active rehabilitation program as an initial treatment modality. DOI

The meaningful outcome might not be:

“Internal rotation improved by 10 degrees.”

It might be:

“I can fasten my clothes again.”

“I can reach my back pocket.”

“I can wash my back.”

“I can put on my jacket without pain.”

“I can return to the gym.”

“I can use my arm normally at work.”

Those functional goals should help guide rehabilitation.

What Does Research Say?

2025 Rotator Cuff Tendinopathy Clinical Practice Guideline

A major evidence-based clinical practice guideline was published in 2025 addressing rotator cuff tendinopathy diagnosis, nonsurgical medical care, rehabilitation, and return to sport.

The guideline contains:

25 evidence-based recommendations and 15 consensus recommendations.

It applies to adults with rotator cuff tendinopathy with or without calcification and includes certain partial-thickness rotator cuff tears. It does not cover full-thickness tears within the same treatment recommendations. APTA

The guideline recommends patient-centered education addressing:

the condition

pain-management options

activity modification

and

self-management. DOI

It also recommends active rehabilitation exercise that may include motor-control and resistance-training approaches.

Importantly, the guideline acknowledges uncertainty regarding the ideal:

exercise type

load

volume

and

supervision level. DOI

That means evidence supports exercise—

but not the claim that one specific exercise protocol is best for everyone.

2026 Exercise Therapy Meta-Analysis

A 2026 systematic review and meta-analysis compared exercise therapy with passive conservative treatments for rotator cuff-related shoulder pain.

Researchers included:

19 studies involving 1,349 participants.

At short-term follow-up, exercise therapy did not demonstrate clear superiority over passive conservative treatment for pain or disability, and the certainty of evidence ranged from very low to low. PubMed

This is worth discussing because evidence-based care should not turn:

“exercise is important”

into:

“exercise is guaranteed to outperform every other conservative treatment.”

The evidence is more nuanced.

2025 Specific Exercise Meta-Analysis

A 2025 systematic review and meta-analysis included:

13 studies involving 690 participants

with rotator cuff-related shoulder pain.

Specific exercise approaches were associated with modest improvements in pain and function, although effects differed according to the exercise approach and duration. PubMed

The authors emphasized individualized exercise prescription.

That fits well with physical therapy practice:

The best rehabilitation program is not necessarily the exercise with the most views online.

It is the program that appropriately addresses the patient's presentation and goals.

2026 Kinesiology Taping Review

A 2026 systematic review included:

39 randomized trials involving 2,481 participants.

Kinesiology taping produced, at best, small short-term benefits for certain pain and functional outcomes.

The overall certainty of evidence was low to very low, and the authors specifically stated that taping should not replace education-focused, exercise-based rehabilitation. PubMed

What Does This Mean for Patients?

Current evidence does not support reducing shoulder rehabilitation to:

“Your shoulder is impinged.”

“Your shoulder blade is out of position.”

“Your rotator cuff is weak.”

“Never reach behind you.”

“You just need an MRI.”

A more useful process is:

evaluate → understand the painful movement → identify relevant mobility and muscle-performance findings → appropriately manage current demand → progressively restore movement and strength → practice meaningful functional tasks.

If the problem is:

reaching behind your back,

then eventually rehabilitation should consider:

reaching behind your back.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, a shoulder evaluation may include, when appropriate:

Detailed symptom history
Shoulder active range of motion
Shoulder passive range of motion
Internal and external rotation
Shoulder extension
Functional hand-behind-back movement
Rotator cuff muscle-performance testing
Scapular muscle-performance assessment
Relevant shoulder special tests
Neck screening when indicated
Neurological screening when indicated
Lifting and reaching tasks
Dressing-related movements
Work-specific activities
Sport-specific activities
Screening for findings requiring additional medical evaluation

We may ask:

Where exactly does it hurt?

When did it begin?

Was there an injury?

Can you reach overhead?

Can you reach your back pocket?

How high can your hand travel behind your back?

Does it feel painful, stiff, or both?

Does your shoulder hurt at night?

Does it feel weak?

Do you have numbness or tingling?

Does your neck hurt?

What activities are you avoiding?

What do you want to return to?

Those answers help us understand whether the presentation appears appropriate for physical therapy and what rehabilitation should address.

Physical therapy in California is regulated by the Physical Therapy Board of California. Nova's patient education therefore remains focused on physical therapy examination, movement, muscle performance, function, rehabilitation, education, and appropriate referral rather than diagnosing a specific pathology from symptoms alone.

When Should You Seek Medical Attention?

Gradually developing discomfort while reaching behind the back is different from:

“I fell on my shoulder and suddenly can't raise my arm.”

Seek prompt medical evaluation for symptoms such as:

Significant trauma
Obvious deformity
Sudden major loss of shoulder function after an injury
Inability to raise or use the arm following significant trauma
Significant swelling or bruising after injury
Progressive or substantial weakness
Persistent or worsening numbness or tingling
Significant redness, warmth, swelling, or fever
Rapidly worsening unexplained symptoms
Chest pain, shortness of breath, sweating, or other symptoms that may indicate a non-musculoskeletal emergency
Other concerning systemic or neurological symptoms

Persistent symptoms that do not improve or do not behave like a typical musculoskeletal presentation also deserve appropriate evaluation.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our philosophy is simple:

We Care.

But:

“My shoulder hurts”

doesn't tell us enough.

One patient means:

“It only hurts when I reach for my back pocket.”

Another means:

“I can't fasten my clothes anymore because the shoulder is too stiff.”

Another:

“I can reach behind my back, but lifting overhead hurts.”

Another:

“My shoulder hurts after weightlifting.”

And another:

“I fell yesterday and now I can't raise my arm.”

Those patients should not automatically receive the same treatment.

So we want to understand:

Which movement hurts?

Which movement is restricted?

Is the limitation pain, stiffness, weakness, or a combination?

How does the shoulder move actively and passively?

How does the rotator cuff perform?

What activities matter to you?

What does the physical therapy examination show?

Are there findings requiring additional medical evaluation?

Then, when physical therapy is appropriate, rehabilitation can be individualized.

Our approach emphasizes:

individualized physical therapy evaluation

evidence-informed rehabilitation

progressive strengthening

appropriate mobility work

functional reaching

activity modification when needed

patient education

return to work, exercise, recreation, and daily activities

and

appropriate referral when findings warrant additional medical assessment.

The goal isn't simply:

“Make your shoulder feel better on the treatment table.”

The goal is to help you comfortably perform the movements you actually need:

dress

reach

wash

lift

work

exercise