How to manage acute shoulder pain at home after a brisk movement?

Home Management of Acute Shoulder Pain After Brisk Movement

For acute shoulder pain following a brisk movement, immediately rest the shoulder, apply ice for the first 48-72 hours, and take ibuprofen 400 mg every 4-6 hours (not exceeding 3200 mg daily) as first-line analgesia, while avoiding overhead movements and aggressive stretching that could worsen tissue injury. 1, 2

Immediate First-Line Interventions

Pain Control

• Ibuprofen is superior to acetaminophen for acute shoulder pain, providing better improvement in pain severity and functional activity 2
• Start with 400 mg every 4-6 hours as needed, which is the optimal dose (higher doses show no additional benefit) 1
• Take with meals or milk to minimize gastrointestinal side effects 1
• Acetaminophen 500 mg every 6-8 hours is an alternative if NSAIDs are contraindicated, though it provides less functional improvement 3, 2

Ice and Positioning

• Apply ice to reduce pain and swelling during the acute phase 4
• Maintain proper shoulder positioning to prevent further trauma 4
• Avoid positions that reproduce the pain, particularly overhead movements 3

Critical Movement Restrictions

What to AVOID

• Never perform overhead pulley exercises - these have the highest risk of causing additional shoulder injury and pain 4
• Avoid aggressive passive range-of-motion exercises, as improper technique can cause more harm than good in the complex shoulder joint 3, 4
• Do not force movements that cause sharp pain 3

Safe Early Mobilization

• Begin gentle stretching and mobilization after the first 48-72 hours, focusing on external rotation and abduction 3, 4
• Progress gradually from passive to active-assisted to active range of motion exercises 3, 4
• Perform exercises within your visual field to maintain control and safety 5

Progressive Exercise Protocol (After Initial 48-72 Hours)

Week 1-2: Gentle Mobilization

• Start with pendulum exercises (letting the arm hang and gently swing) 4
• Perform gentle external rotation stretches using a doorway or towel 3, 4
• Apply local heat before exercises to improve tissue elasticity (stronger recommendation than ultrasound) 4

Week 2-4: Active Movement

• Gradually increase active range of motion while restoring proper shoulder alignment 3, 4
• Strengthen weak shoulder girdle muscles progressively 3, 4
• Continue gentle stretching focused on external rotation and abduction 3, 4

Red Flags Requiring Medical Evaluation

Seek immediate medical attention if you experience:

• Severe pain unresponsive to ibuprofen within 48 hours 6
• Inability to move the shoulder at all (possible dislocation or complete tear) 6
• Visible deformity or swelling 6
• Numbness or tingling down the arm 6
• Pain that worsens despite rest and medication after 1 week 7

Common Pitfalls to Avoid

• Do not assume "no pain, no gain" - aggressive stretching of an acutely injured shoulder can worsen tissue damage 3, 4
• Avoid complete immobilization beyond the first few days, as this can lead to frozen shoulder 3
• Do not continue exercises that cause sharp, stabbing pain (dull stretching sensation is acceptable) 4
• Elderly patients with acute shoulder pain after minimal trauma should be evaluated for fracture, as 85% of humeral head fractures occur in this population 6

When Conservative Management Fails

If pain persists beyond 2-4 weeks despite appropriate home management:

• Consider evaluation for rotator cuff tear, impingement syndrome, or other structural pathology 6, 7
• Physical therapy referral may be needed for supervised rehabilitation 7
• Advanced imaging (ultrasound or MRI) may be warranted to identify tissue injury 5