Shoulder Pain — Physiotherapy in Central London

Usually not as a first step. MRI of the shoulder frequently shows partial-thickness rotator-cuff changes that are present in pain-free people too — so the scan rarely changes management for early shoulder pain. Imaging becomes appropriate when symptoms persist beyond 6–12 weeks of rehab, when there is significant trauma, or when surgery is being considered. Start with a clinical assessment.

Most non-traumatic rotator-cuff problems do not need surgery first. The CSAW trial (BMJ 2018) showed subacromial decompression for impingement gave no benefit over structured exercise. For degenerative cuff tears, many respond to a 12-week loading programme; surgery is reserved for traumatic full-thickness tears or persistent disabling symptoms after rehab. We will refer if your presentation calls for it.

Frozen shoulder follows three phases — freezing (painful, around 3–9 months), frozen (stiff, 4–12 months), and thawing (resolution, up to 24 months). Physiotherapy through all three phases reduces pain, maintains range of motion, and accelerates the thawing phase. We avoid aggressive stretching during the freezing phase (which worsens pain) and gradually increase mobility work as the pain settles.

Yes, and it should be a priority. Recurrent dislocation rates are particularly high in younger patients without proper rehab — strong rotator-cuff and scapular stabilisers significantly reduce recurrence. We typically work through a 12-week progressive programme covering range of motion, isometric strength, dynamic strength, and sport-specific or work-specific loading. Start within 2–4 weeks of the initial event for best outcomes.