Management of Shoulder Pain: Rest and Recovery Guidelines
For shoulder pain, a short period of relative rest (2-3 days) is recommended, followed by gradual return to activity with progressive range of motion exercises to prevent complications like frozen shoulder. 1
Initial Management Phase (Days 1-3)
- Acute Phase (First 48-72 hours):
- Relative rest of the affected shoulder with avoidance of painful movements
- Ice application for 15-20 minutes every 2-3 hours to reduce inflammation
- Acetaminophen (up to 4g/day) as first-line analgesic 1
- NSAIDs at lowest effective dose if acetaminophen is inadequate 1
- Protect the shoulder from trauma and injuries 2
Early Recovery Phase (Days 3-7)
- Begin gentle active range of motion exercises after the initial rest period
- Focus on stretching and exercises to improve range of motion, particularly external rotation and abduction 2, 1
- Avoid overhead pulley exercises as they have been associated with the highest incidence of developing hemiplegic shoulder pain 2
- Consider shoulder positioning protocols to prevent complications 2
Progressive Rehabilitation Phase (Week 2 onwards)
- Gradually increase activity and exercise intensity
- Implement stretching and strengthening exercises
- Progress to sport-specific or activity-specific exercises as symptoms improve 1
- Evaluate pain and function every 2-4 weeks 1
Important Considerations
Avoid These Common Pitfalls:
- Prolonged immobilization: This can lead to adhesive capsulitis (frozen shoulder) and should be avoided 2, 1
- Overhead pulley exercises: These encourage uncontrolled abduction and can worsen pain 2
- Returning to full activity too quickly: This can lead to reinjury or chronic pain
When to Consider Additional Interventions:
- If pain persists beyond 2 weeks despite appropriate rest and exercise
- If there is significant limitation in range of motion
- If there are signs of nerve compression or other complications
Special Populations:
- Patients with hemiplegic shoulder pain: May benefit from electrical stimulation and positioning protocols 2
- Patients with inflammatory conditions: May require different management approaches, including earlier consideration of corticosteroid injections 1
Diagnostic Considerations
If pain persists beyond 2-3 weeks of appropriate management:
- Plain radiographs should be considered as the first imaging study 1
- MRI or ultrasound may be indicated if soft tissue pathology is suspected 2, 1
Remember that most shoulder pain will improve with appropriate rest followed by progressive mobilization. The key is finding the right balance between rest to allow healing and movement to prevent stiffness and maintain function.