Shoulder Pain: “Why does it hurt so much?”


Dr. John De Noyelles, PT, OCS, CSCS

There exists a lack of association between findings on MRIs and pain. In other words, what is seen and reported from an MRI may have all or nothing to do with the pain you are experiencing. There is plenty of evidence that people who have no pain will have positive findings on an MRI.

Much of the approach at Move Physio is geared towards addressing all the other structures in your body that may be causing undue stress on painful parts such as your shoulder. If we treat those other structures the shoulder eventually stops hurting. Pain is a “good” thing, a “sign” that should not be ignored.

But, (the reason you are reading this) why does your shoulder hurt so much? You can’t sleep, raise your arm, throw, etc. A sprain or strain (including partial and full tears of the rotator cuff) likely does not explain your level of pain. Instead, it’s your body’s healing and protective response.

Yes, healing hurts. Even though it hurts, inflammation is a good thing. It is your systems way of repairing by eating up the dead cells and laying down new tissue. During this process, a protein called interleukin is released to help the healing process. This protein alone may contribute to an abnormally increased sensitivity to pain known as hyperalgesia. Furthermore, those with rotator cuff-related pain have high concentrations of other substances (substance P and pro-inflammatory cytokines) released in response to stress for defense, protection, and repair purposes. Yes, healing hurts, and you’ll feel more pain relative to the actual damage. In my experience as a clinician, a healthy but exquisitely exacerbated shoulder is quite common and is unique among the other joints of your body.

A painful experience is further complicated by the brain. Your body is responding to heal the tissues and your brain is reporting the resulting pain. Pain is always an output from your brain. Your brain wants to protect you. Alarming you through the use of pain is one very powerful way for the brain to say, “Hey, don’t do that.” That is why re-establishing appropriate movement with less pain is effective for long-term outcome as it takes the threat away. Without that threat, your brain can relax and not output so much pain.

Here are some important steps to recognize during your path to recovery:

1. Shoulder pain is a sign. Have us figure out what is contributing to the reason for that pain.

2.  Understand that healing hurts and may take some time. Follow step one to keep it from having to constantly heal and return to pain.

3. Do not be afraid of appropriate movement with limited or no pain. Instead, stop movements that exacerbate the shoulder. “Motion is lotion” for joints as continued pain-free movement can decrease the threat. Too much inappropriate movement leads to increased healing and threat, perhaps resulting in why you decided to read this blog post.


More Interesting Articles…

Coronavirus Conundrum

Sleeplessness from quarantine??? Here is why!

Mobilization Over Stretching

A therapist massages a patient's shoulder.

Nagging Shoulder Pain?

Does stress affect your breathing???

“If it’s not their ass it’s their elbow.”

A sparkler ignited on a black background.

The ‘Magic Wand’ of Therapy

New to Us?

Your journey begins with a consultation…

At this session your own Physio will:

Dive deep into your history

Explain why previous treatments didn’t work

Begin assessing your Root Causes

Formulate your optimal Plan of Care

Consultations are required for all new Clients. Learn more.


Returning Clients:

Need to continue your current care?

  • You can book/manage appointments and much more through your online account!

Coming back?

If you’ve had a new situation develop


If we haven’t seen you in the past 2 months:

PLEASE CONTACT US before scheduling!

What would you like to do?

Need Directions to Our Monroe Office?

Pick your preference:

Need Directions to Our Warwick Office?

Pick your preference: