Do physical therapy treatments for the shoulder hurt?

Physiotherapy treatments are generally not painful. You may experience slight discomfort during certain mobilizations or exercises. Your physiotherapist will always adjust the intensity according to your tolerance. Slight sensitivity after the session is normal and temporary.

Many of our patients share this concern before their first visit. It's perfectly normal to wonder if the treatment will hurt, especially when your shoulder is already painful. Rest assured: physical therapy aims to reduce your pain, not increase it.

During manual techniques, you will experience a variety of sensations. Joint mobilizations may create slight pressure or stretching. Some soft tissue release techniques may cause sensitivity similar to a deep massage. This sensation is generally described as "unpleasant but beneficial," never as sharp or intolerable pain.

Your physical therapist communicates with you constantly during treatment. They adjust the pressure, range of motion, or speed based on your feedback.

For exercises, your physical therapist generally applies a pain management principle. Exercises should not significantly increase your pain. Mild discomfort is acceptable (2-3 out of 10 on a pain scale). Moderate to severe pain indicates that the exercise exceeds your current capacity. In this case, avoid pain rated 5 out of 10 or higher.

After your first session, you may experience mild muscle soreness for 24 to 48 hours. This is normal. It is similar to the feeling you get after a new workout. This soreness is different from aggravated pain. It decreases with subsequent sessions.

If your pain worsens significantly after a session or persists for more than 48 hours, contact your physical therapist. Physical therapy should help you feel progressively better, not worse.

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What happens during a physical therapy session for the shoulder?

A physical therapy session for the shoulder typically lasts 30 to 60 minutes. It includes an assessment of your condition, manual treatment techniques, supervised therapeutic exercises, and recommendations for exercises to do at home between sessions.

What happens during the initial assessment?

During the initial assessment, the physical therapist will take your medical history, analyze your symptoms, and perform a complete physical examination of your shoulder. This examination assesses mobility and strength and includes specific tests. The physical therapist will then develop a personalized treatment plan tailored to your condition.

Your first visit usually lasts 60 minutes. Your physical therapist will start by asking you detailed questions. When did the pain start? How did it occur? What movements make it worse or better? What are your daily activities and goals?

The physical examination follows. Your physical therapist observes how you move your shoulder. He or she assesses your active range of motion (when you move yourself) and passive range of motion (when he or she moves your arm). He or she tests the strength of different muscles. He or she performs specific orthopedic tests to identify which structure is involved.

At the end, your physical therapist explains what they have found. They make a clinical diagnosis. They discuss the prognosis. They present a clear treatment plan including the recommended frequency of sessions, the estimated duration, and specific goals. This first session usually includes initial treatment.

What happens during a typical follow-up session?

A follow-up session begins with a reassessment of your progress. It continues with targeted manual techniques and therapeutic exercises tailored to your progress. It ends with an adjustment to your home exercise program based on your progress.

Subsequent sessions last 30 to 45 minutes. They begin with an update. How have you been feeling since the last time? What has improved? Your physical therapist briefly reevaluates certain movements or tests to objectively measure your progress.

Manual treatment usually takes 10 to 15 minutes. It includes joint mobilization and soft tissue release. This is followed by 15 to 20 minutes of exercises. Your physical therapist supervises your exercises to ensure proper technique. They progress the exercises when you are ready: increasing repetitions, adding resistance, or introducing more complex movements.

The session ends with a review of your home program. Wear comfortable clothing that allows your shoulder to be exposed: a tank top or short-sleeved T-shirt. Bring your imaging results if you have them.

How many physical therapy sessions are needed to relieve shoulder pain?

The number of sessions varies depending on the condition: generally 3 to 10 sessions for acute tendon irritation, 12 to 20 sessions for rotator cuff tendinopathy, and prolonged follow-up for capsulitis. The typical frequency is 1 to 3 sessions per week.

The answer depends on your specific condition, its severity, how long it has been going on, and how diligently you do your exercises at home.

For acute tendon irritation or recent bursitis, you may experience significant improvement in 3 to 6 sessions over 2 to 4 weeks. These conditions respond quickly when treated early.

For more established rotator cuff tendinopathy, you can generally expect 12 to 20 sessions over 6 to 12 weeks. These tendons need time to gradually strengthen. We understand that this period may seem long, especially if the pain is affecting your work or daily activities. The good news is that most people see a noticeable improvement within the first few weeks of treatment.

Capsulitis requires long-term monitoring. This condition naturally progresses over 15 to 30 months. Physical therapy cannot radically accelerate this process. However, it minimizes pain, maintains maximum mobility during each phase, and can promote recovery during the thawing phase.

After a shoulder dislocation or surgery, rehabilitation typically lasts 4 to 6 months. The first few weeks involve frequent sessions: 2 to 3 times per week. Then the intervals increase as you become more independent.

Approximately 25% of shoulder pain improves spontaneously within 4 to 6 weeks without treatment. However, physical therapy can speed up recovery and reduce the risk of recurrence.

Several factors influence the duration of your treatment:

• Severity: Mild pain resolves more quickly than severe pain.
• Chronicity: A problem that has been present for 6 months takes longer to treat than a problem that has been present for 2 weeks.
• Adherence: Patients who do their exercises at home 2 to 3 times a day recover faster.
• Aggravating factors: If your work or activities constantly stress your shoulder, recovery may take longer.

How long does it take for each type of shoulder injury to heal?

The healing time varies depending on the condition: 6 to 12 weeks for tendinopathy, a few weeks for bursitis treated quickly, 15 to 30 months for capsulitis, and 4 to 6 months of rehabilitation after a dislocation or surgery.

These durations are averages. The important thing is to make steady progress, even if it is slow, rather than stagnate or regress.

Can physical therapy prevent shoulder surgery?

Yes, physical therapy can often help you avoid shoulder surgery. Studies show that for many conditions, such as minor rotator cuff tears or capsulitis, the long-term results of physical therapy are comparable to those of surgery.

For capsulitis, approximately 94% of cases heal without surgery. The condition resolves naturally over time. Physical therapy optimizes this process by managing pain and maintaining mobility.

For small and medium rotator cuff tears, the results are remarkable. A randomized study from 2020 compared surgery and physical therapy. It found no significant difference in functional outcomes at 12 months. The Constant-Murley score was 83 for the surgery group versus 78 for the physical therapy group. The difference was not significant (p=0.68). For patients over 70 years of age, conservative treatment is often the treatment of choice. For patients over 55 years of age with small non-traumatic tears of the supraspinatus, some studies find no difference between surgery and conservative treatment. The supraspinatus is one of the four muscles of the rotator cuff.

Approximately 25% of patients who underwent rotator cuff surgery had not received adequate conservative treatment beforehand. For unruptured rotator cuff tendinopathy, surgery has not been shown to be more effective than conservative treatment.

For impingement syndrome without tearing, physical therapy achieves excellent results. Subacromial decompression surgery offers no additional benefits compared to physical therapy alone.

Certain situations may benefit from surgery:

• Complete tears of the rotator cuff in young, active individuals
• Tears that enlarge despite conservative treatment
• Significant loss of function after 3 to 6 months of well-conducted physical therapy
• Recurrent dislocations in young athletes
• Severe traumatic injuries

But even after surgery, physical therapy remains essential to restore strength, mobility, and function.

The current evidence-based recommendation is clear: always try physical therapy first for 3 to 6 months before considering surgery. Exception: a condition clearly requires urgent intervention.

When should you see a physical therapist for shoulder pain?

You should consult a physical therapist if your shoulder pain persists for more than 5 to 7 days, limits your daily activities, prevents you from sleeping, or if you have suffered a trauma. Early consultation generally promotes faster recovery.

It's perfectly normal to wonder whether your pain warrants a doctor's visit. Many people wait, hoping it will go away on its own. Here are some clear guidelines to help you make that decision.

• Your pain persists for more than 5 to 7 days without significant improvement.
• Pain limits your daily activities: getting dressed, washing, working
• You cannot sleep on your shoulder, or the pain wakes you up at night.
• You have suffered trauma: a fall, impact, or violent movement.
• Your shoulder has gradually frozen up and you are losing mobility.
• You feel weakness in your arm

Consult a doctor immediately if you experience:

• Intense, sudden pain after a major injury with visible deformation of the shoulder
• Complete inability to move the arm after a fall
• Shoulder pain accompanied by fever and chills
• Shoulder pain with chest pain, shortness of breath, or jaw pain

These situations are rare. In the vast majority of cases, shoulder pain responds well to conservative physical therapy.

If your pain is mild, recent (less than 5 days), and gradually improving, you can wait a few days. Use this time to:

• Temporarily change your activities such as grocery shopping or housework
• Apply ice wrapped in a cloth for 15 minutes several times a day.
• Maintain gentle movements within a pain-free range of motion.
• Take anti-inflammatory medication as needed, according to your pharmacist's recommendations.

If there is no improvement after 5 to 7 days, consult your doctor. Early consultation can facilitate and speed up your recovery.

Research shows that early physical therapy can reduce the risk of chronicity. Seek treatment within the first two weeks. The benefits include accelerated recovery, fewer total sessions, and prevention of recurrence.

In Quebec, direct access to physical therapists facilitates this early consultation. There is no need to wait for a doctor's appointment.

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What physical therapy exercises can I do at home for my shoulder?

Your physical therapist will prescribe personalized exercises to do at home, typically 2 to 3 times a day. These exercises usually include gentle stretching, pendulum mobility exercises, and progressive strengthening with resistance bands, depending on your condition.

Home exercises are the most important part of your treatment. You see your physical therapist for 1 to 3 hours per week. But there are 168 hours in a week. What you do during the other 165 hours influences your recovery much more than what happens in the clinic.

Research confirms this. Patients who adhere to their home exercise program recover faster and more completely. Those who only do the sessions at the clinic recover less well.

Your specific exercises depend on your condition. Most programs include:

Pendulum exercises use gravity to gently mobilize your shoulder without muscle tension. You lean forward, letting your arm hang down. Then you initiate small circles or swings. These movements are particularly useful during painful phases or when you have capsulitis.

Flexion, abduction, and rotation stretches restore lost range of motion. A stretch should create a feeling of tension, never sharp pain.

Strengthening the rotator cuff usually involves using elastic bands or small weights. Exercises include external and internal rotations, abduction in the plane of the shoulder blade, and progressive stabilization exercises. These exercises strengthen the four muscles of the cuff. These muscles act like guy wires. They stabilize the head of the humerus in its socket.

Strengthening the shoulder blade corrects a key element that is often overlooked. Your shoulder blade must move properly for your shoulder to function well. Exercises targeting the middle and lower trapezius, serratus anterior, and rhomboids improve scapular control. Scapular control is the control of shoulder blade movement.

These exercises improve coordination and proprioception. They may include wall supports, exercises on unstable surfaces, or controlled movements in different positions.

For optimal results, do your exercises 2 to 3 times a day. Each session usually takes 10 to 15 minutes. It's much better to do 10 minutes three times a day than to do everything at once.

Your exercises should never cause severe pain. Mild discomfort is acceptable: 2 to 3 out of 10. Moderate to severe pain indicates that you are exceeding your current capacity. In this case, avoid pain rated 5 out of 10 or higher. Reduce the range of motion, resistance, or number of repetitions.

Your pain should not increase significantly during exercise. It should not remain high for more than 30 minutes afterward. If you experience worsening pain that lasts for several hours or the next day, you have probably overdone it.

Your tissues adapt to the loads they receive regularly. Tendons become stronger when gradually stretched. Muscles become more enduring with repetition. Range of motion improves with frequent stretching. These adaptations require time and consistency.

How much does physical therapy for the shoulder cost in Quebec?

In Quebec, a physiotherapy session costs between $95 and $140. An initial assessment generally costs between $115 and $120. Most private insurance plans cover these costs. Work-related accidents (CNESST) and traffic accidents (SAAQ) are fully covered.

We understand that financial concerns are real. Here is some practical information to help you plan your treatment.

The vast majority of private group insurance plans in Quebec cover physical therapy. Typical coverage ranges from $500 to $2,000 per year. Some plans cover 80% or 100% of the costs up to this annual maximum.

Check your coverage before your first visit:

• What is my annual maximum for physical therapy?
• What percentage is reimbursed?
• Do I need a prescription to be reimbursed?
• How much have I used so far this year?

If your pain is the result of a work-related accident or occupational illness, the CNESST will cover the full cost of your treatment. Victims of road accidents are covered by the SAAQ. You pay nothing.

In Quebec, you do not need a medical prescription to see a physiotherapist. Access is direct. However, some insurance companies require a prescription for reimbursement.

Compare the cost of physical therapy to alternatives. A cortisone injection costs $150 to $300. It provides temporary relief without correcting the problem. Shoulder surgery costs the healthcare system between $5,000 and $15,000. It requires months of post-operative physical therapy and extended time off work.

A physical therapy program costing between $800 and $1,500 that permanently solves your problem is an excellent investment.

What is the difference between a physical therapist and a chiropractor when it comes to treating the shoulder?

Physical therapists specialize in functional rehabilitation using therapeutic exercises and manual techniques. Chiropractors focus on spinal adjustments. For shoulder problems, physical therapy is generally recommended because it directly targets muscle and joint rehabilitation.

Physical therapists focus on functional rehabilitation. Their approach to shoulder treatment combines manual techniques and, above all, progressive therapeutic exercises. Manual techniques include joint mobilization and soft tissue release. The goal is to restore strength, mobility, neuromuscular control, and function.

University training for physical therapists in Quebec lasts four years (bachelor's degree) or five to six years (master's degree). The Ordre professionnel de la physiothérapie du Québec (OPPQ) regulates physical therapists.

Chiropractors traditionally focus on spinal adjustments. Spinal adjustments are manipulations of the spine. For shoulders, some chiropractors also use joint mobilizations and soft tissue therapies. But the main emphasis generally remains on adjustments.

For musculoskeletal conditions of the shoulder, physical therapy is generally the first recommended treatment option. Shoulder problems rarely require spinal adjustments. They mainly benefit from progressive strengthening, correction of movement patterns, and restoration of local joint mobility.

International clinical guidelines recommend therapeutic exercise as the first-line treatment for shoulder pain.

How does physical therapy help you return to your activities and sports?

Physical therapy helps you return to your activities by following a structured progression. First, control pain and restore mobility. Then strengthen stabilizing muscles. Finally, gradually reintroduce movements specific to your sport or work.

The first few weeks focus on reducing pain and regaining normal range of motion. You temporarily modify your activities to avoid movements that cause significant aggravation. However, you maintain movement within comfortable ranges. Complete immobilization is rarely beneficial.

Once the pain is under control and mobility has been restored, gradual strengthening begins. You develop the ability of your muscles and tendons to tolerate loads. This phase uses exercises with increasing resistance. First, light elastic bands. Then heavier weights. Then faster or more complex movements.

The final phase reintroduces movements specific to your activity. For a swimmer, this means progressing from dry arm movements to movements in the water. Start with slow laps. Then gradually increase the intensity and volume. For a manual laborer, this involves simulating work movements with increasing loads.

Your physical therapist uses objective criteria to guide this progression:

• Full range of motion without pain
• Restored muscle strength (usually at least 90% of the unaffected side)
• Ability to perform specific movements without compensation
• Absence of pain or inflammation after progressive simulations

For athletes, physical therapy includes exercises that replicate the biomechanical demands of your sport. A volleyball player does progressive hitting exercises. A golfer works on trunk rotation and weight transfer. A climber specifically strengthens overhead pulling positions.

Physical therapy identifies the factors that contributed to your initial injury. Weakness in the shoulder blade stabilizers, muscle imbalance, compensatory movement patterns, training overload, or improper sports technique.

By correcting these factors, you don't just recover from your current injury. You become more resilient.

How to begin your physical therapy treatment for your shoulder?

To begin your shoulder physiotherapy treatment, you can make an appointment directly with a physiotherapist without a medical prescription in Quebec. Contact Physioactif for a personalized assessment and a treatment plan tailored to your condition.

In Quebec, you can see a physical therapist directly. You don't need a doctor's referral. You can call a clinic directly and make an appointment.

During your first visit to Physioactif, your physical therapist will conduct a thorough assessment of your shoulder. They will provide a clear clinical diagnosis and explain the cause of your pain in understandable terms. They will then develop a personalized treatment plan based on the best scientific evidence.

You will receive honest answers to your questions. How long will recovery take? Can you avoid surgery? When will you be able to return to your activities?

The approach at Physioactif combines expert manual therapy, evidence-based progressive exercise prescriptions, and in-depth education. The goal is not just to temporarily relieve your pain. We aim to restore your full function, prevent recurrence, and empower you to manage your musculoskeletal health independently.

Don't let your shoulder pain limit your life any longer. Make an appointment today.

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