Shoulder Pain When You Lift Your Arm or Lie on It: Causes, and How Chiropractic Can Help

By Dr Lewis Kingsnorth DC MChiro, Chiropractor · GCC Reg. 3359 · Chiropractic First, Hove · Last reviewed October 2026 · 9-minute read

Key points

• Most shoulder pain is mechanical. The most common source is the rotator cuff, and the classic signs are pain lifting your arm out to the side and pain lying on that side at night.
• The neck and upper back are a common, often missed, source of “shoulder” pain. A good assessment checks both.
• Chiropractic can help with shoulder complaints and rotator cuff problems, using hands-on treatment alongside a progressive exercise plan.
• Frozen shoulder behaves differently and needs a clear diagnosis and a GP-led plan.
• Shoulder or arm pain with chest pain, breathlessness or sweating is a 999 emergency.

If your shoulder catches when you reach for the seatbelt, aches when you wash your hair, or wakes you every time you roll onto it, you are in good company. Shoulder pain is one of the most common reasons people come to see us at Chiropractic First.

The good news is that most shoulder pain is mechanical. It comes from the tendons, joints and muscles around the shoulder, or from the neck and upper back, rather than from anything serious. The less good news is that “shoulder pain” covers several quite different problems, and the right plan depends on working out which one you have.

In this guide I’ll explain the common causes, how to tell a shoulder problem from a neck problem, when shoulder pain needs urgent medical attention, and how we assess and help shoulder complaints here in Hove.

Why does my shoulder hurt when I lift my arm?

The most common cause of shoulder pain, accounting for up to around 70% of cases, is a problem with the rotator cuff: the group of four muscles and tendons that wrap around the ball of the shoulder joint and keep it centred as you move.

You may have heard it called impingement, rotator cuff tendinopathy, bursitis or subacromial pain. Clinicians increasingly group these together as rotator cuff-related shoulder pain, because they tend to behave the same way and respond to similar care. Typical signs include:

• Pain on the outside of the upper arm, often felt over the deltoid muscle rather than “in” the joint
• A painful arc: it hurts as you lift your arm out to the side, roughly between shoulder and head height, then eases once the arm is higher or lower
• Pain reaching behind your back, into the back seat of the car, or putting on a coat
• Pain lying on that side at night
• A shoulder that feels weak or tires quickly with overhead work

It is most common from your 40s onwards and often follows a change in load: a new gym programme, a weekend of painting ceilings, a return to swimming or tennis, a busy spell in the garden, or long hours at a laptop with your arms reaching forward.

The old explanation was that a tendon was being “pinched” by bone. Current thinking is that the bigger factor is usually a tendon that has become sensitive to load because it was asked to do more than it was ready for. That is encouraging, because tendons can be gradually re-trained to tolerate load again.

It is also worth knowing that scans often show wear, fraying or even small tears in the rotator cuffs of people who have no pain at all. A scan finding on its own doesn’t always explain your symptoms.

Why does my shoulder hurt more at night?

Night pain is one of the most common shoulder complaints, and one of the main reasons people finally book an appointment. Lying on an irritated rotator cuff compresses the sore tendon and the bursa, a small fluid-filled cushion that sits above it. Lying on your back can be uncomfortable too, as the arm drops backwards and stretches the front of the shoulder. Frozen shoulder (see below) is also known for severe night pain.

Some positions that can make nights easier:

• Avoid lying on the painful side for now.
• If you sleep on your good side, hug a pillow so the sore arm rests on it rather than dropping across your body.
• On your back, put a small pillow under the sore arm so it doesn’t fall backwards.

Night pain on its own is not a warning sign. Night pain together with unexplained weight loss or feeling generally unwell is different; see when shoulder pain is an emergency.

Is it your shoulder, or your neck?

This is where a chiropractic assessment can make a real difference. The nerves that supply the skin and muscles around the shoulder start in your neck, so a problem in the lower neck or upper back can produce pain that feels as though it is coming from the shoulder itself.

Clues that your neck may be involved:

• Pain starts at the base of the neck and spreads across the top of the shoulder or into the shoulder blade
• Moving or turning your neck changes the shoulder pain
• The shoulder moves fairly freely, yet it still aches
• Pain travels below the elbow, or comes with pins and needles or numbness in the arm or hand (see our guide to pins and needles in the hands)
• You also have neck stiffness or headaches that start in the neck

Often it is both. A stiff upper back and neck change how the shoulder blade moves, which in turn puts more load through the rotator cuff.

What the research says. In a randomised controlled trial published in the Annals of Internal Medicine (Bergman et al., 2004), 150 people with shoulder pain and stiffness in the upper back, neck and ribs all received usual care from their GP. Half also received manual therapy to the upper back, neck and ribs. The group who had the additional manual therapy recovered faster, with better shoulder pain and function scores that held up over a year of follow-up. It is one of the reasons we always examine the neck and upper back when someone comes in with shoulder pain.

Could it be frozen shoulder?

Frozen shoulder (adhesive capsulitis) is less common than rotator cuff pain, but it is one of the most searched shoulder conditions, and it behaves very differently.

• It usually affects people aged roughly 40 to 60, and is more common in people with diabetes.
• It typically starts with a gradual, deep and often severe ache, commonly worse at night.
• This is followed by increasing stiffness, especially when turning the arm outwards, such as reaching out to the side to open a door.
• The key difference: with rotator cuff pain, someone else can usually lift your arm further than you can. With frozen shoulder the joint itself is stiff, so it won’t go further even when someone helps.

Frozen shoulder tends to move through painful and stiff phases and usually improves over time, although recovery can be slow. Because other conditions, including arthritis of the shoulder joint, can look similar, it needs a clear diagnosis.

If our examination suggests frozen shoulder, we’ll explain what we’ve found and write to your GP, so you can discuss the options set out in UK guidance. Getting the diagnosis right early saves a lot of wasted time.

Other causes we check for

• Arthritis of the shoulder joint: gradual pain and stiffness, sometimes with grinding. An X-ray can confirm it.
• AC joint problems: pain right on top of the shoulder, often after a fall or heavy pressing work in the gym.
• Calcific tendinopathy: calcium deposits in a rotator cuff tendon, which can cause sudden, intense pain and show up on X-ray.
• Instability: a shoulder that feels loose or as if it might slip, usually in younger, active people or after a previous dislocation.
• Pain referred from internal organs: rarely, shoulder pain comes from the heart, lungs, gallbladder or diaphragm. See the warning signs below.

How can chiropractic help with shoulder pain?

Chiropractic can help with shoulder complaints, including rotator cuff problems and soft-tissue disorders of the shoulder, as well as mechanical neck pain that refers into the shoulder. Our approach combines hands-on treatment with a structured exercise plan, because that combination is where the evidence is strongest.

1. A thorough assessment

We take a detailed history, then examine your shoulder, shoulder blade, neck and upper back: range of movement, strength, specific orthopaedic tests, and a neurological check of the arm where needed. The aim is a clear working diagnosis, which we explain in plain English.

2. Imaging only when it is justified

Most shoulder pain doesn’t need an X-ray or scan. Our on-site digital X-ray is used selectively: after a fall, when arthritis or calcific tendinopathy is suspected, or when symptoms aren’t behaving as expected. If a different type of scan would be more useful, we’ll explain why and point you to the right route.

3. Hands-on treatment

Depending on what we find, this may include gentle joint manipulation or mobilisation of the shoulder, shoulder blade, upper back, neck and ribs, plus soft-tissue work for tight, overworked muscles. Our massage therapists can support this where it helps.

4. A progressive exercise plan

This is the part that matters most over the long term. You’ll get a small number of targeted exercises, usually starting with gentle movement and static holds, and building towards strengthening the rotator cuff and the muscles that control your shoulder blade. We progress them as your shoulder tolerates more.

5. Advice for daily life

Workstation set-up, sleeping positions, and how to adjust (rather than stop) the things you enjoy, from gym sessions and swimming to golf, gardening and decorating.

A systematic review of manual and manipulative therapy for shoulder conditions (Brantingham et al., 2011) found fair evidence for hands-on treatment of the shoulder, shoulder girdle and related areas for rotator cuff disorders and general shoulder complaints, particularly when combined with exercise and other care. That is why we rarely rely on one approach on its own.

If your shoulder isn’t progressing as expected, we’ll tell you and discuss other options, including onward referral. For longer-standing rotator cuff tendon problems, the clinic also offers shockwave therapy; you can read more on our sister site, Hove Shockwave.

How long does shoulder pain take to get better?

It varies. NHS guidance notes that shoulder pain can take six months or longer to settle fully. Many rotator cuff-related problems improve noticeably over weeks to a few months with the right loading, but tendons adapt slowly and longer-standing problems usually take longer. Frozen shoulder runs on its own, longer timescale.

At your first visit we’ll give you an honest estimate based on what we find, and we’ll tell you if your problem is not one we are best placed to help with.

What can I do at home in the meantime?

• Keep moving it gently. Completely resting the shoulder tends to slow recovery. Keep using it within a comfortable range.
• Change the load, not everything. Drop your training weights, break overhead jobs into short bouts, and keep things you use often between waist and chest height.
• Try heat or cold. A wrapped hot water bottle or cold pack for 10 to 15 minutes can ease discomfort. Never put either directly on the skin.
• Sleep smart. Use the pillow positions above.
• Check your desk. Raise the screen and bring the keyboard and mouse closer, so your arms aren’t reaching forward for hours.
• Get it checked if it isn’t improving after about two weeks, or sooner if the pain is severe.

When is shoulder pain an emergency?

Most shoulder pain is not serious, but some symptoms need urgent attention. If anything in your history or examination points to one of these, we’ll refer you on rather than treat.

Call 999 if shoulder, arm or jaw pain comes with:

• chest pain, pressure or tightness
• shortness of breath
• sweating, nausea or feeling faint

These can be signs of a heart attack. Don’t wait to see if it settles.

Get same-day help (NHS 111, an urgent treatment centre or A&E) if:

• the pain started after a fall or injury and you can’t lift your arm, or the shoulder looks a different shape
• the shoulder is hot, red and swollen and you feel feverish or unwell
• your arm or hand is numb, or feels unusually hot or cold to the touch
• you have sudden, very severe shoulder pain

See your GP promptly if:

• you suddenly can’t lift your arm after a strain or injury, as a significant rotator cuff tear needs prompt assessment
• you have a history of cancer and develop new shoulder pain, or have unexplained weight loss, a lump, or feel generally unwell
• right shoulder pain comes with tummy pain or vomiting, or seems linked to eating
• you are over 50 and have pain and stiffness in both shoulders (often the hips too) that is worst in the morning, which can be a condition called polymyalgia rheumatica

Visiting Chiropractic First in Hove

We’ve been looking after people across Brighton and Hove since 2006, from our clinic at 82 Goldstone Villas, a short walk from Hove station. Our chiropractors are registered with the General Chiropractic Council, and we have on-site digital X-ray, shockwave therapy and massage under one roof. We’re recognised by a number of major health insurers, including AXA and Vitality; check your policy for cover.

Early appointments start at 6:45am on Mondays, Tuesdays, Thursdays and Fridays, so you can be seen before work.

Frequently asked questions

Can a chiropractor help with shoulder pain?

Yes. Chiropractic can help with shoulder complaints, including rotator cuff problems, soft-tissue disorders of the shoulder, and pain referred from a mechanical neck problem. Care usually combines hands-on treatment of the shoulder, upper back and neck with a progressive exercise plan. The first step is always an assessment, to make sure chiropractic care is appropriate for you.

How do I know if my shoulder pain is coming from my neck?

Clues include pain that starts at the base of the neck and spreads to the top of the shoulder or the shoulder blade, pain that changes when you move your neck, a shoulder that moves freely but still aches, and symptoms below the elbow such as pins and needles. Often the neck and shoulder are both involved, which is why we examine them together.

Should I see a chiropractor or a physiotherapist for shoulder pain?

Chiropractors and physiotherapists are both regulated health professionals who assess and manage shoulder pain, and both use hands-on care and exercise. What matters most is a thorough assessment, a clear diagnosis and a plan built around progressive exercise. Chiropractors pay particular attention to the neck and upper back, which is useful when shoulder pain has a spinal component.

How do I know if I’ve torn my rotator cuff?

A tear caused by an injury, such as a fall or a sudden heavy lift, often brings sudden pain and marked weakness: you may be unable to lift your arm out to the side. That needs prompt medical assessment. Many rotator cuff tears, though, develop gradually with age and cause few or no symptoms, and pain and weakness can also come from an irritated tendon without a significant tear. An examination is the place to start.

Do I need an X-ray or scan for shoulder pain?

Usually not. Most shoulder pain can be diagnosed from a careful history and examination. Imaging is useful after an injury, when arthritis or calcium deposits in a tendon are suspected, or when symptoms are not following the expected course. We have on-site digital X-ray and use it only when it is clinically justified.

What is the difference between frozen shoulder and a rotator cuff problem?

With a rotator cuff problem, movement is painful but the joint usually is not stiff, so someone else can often lift your arm further than you can. With frozen shoulder, the joint capsule itself tightens, so movement is restricted whether you move the arm yourself or someone moves it for you, especially turning the arm outwards. Frozen shoulder needs a clear diagnosis and a GP-led plan; if we suspect it, we will explain our findings and write to your GP.

About the author

Dr Lewis Kingsnorth DC MChiro is the founder and lead chiropractor at Chiropractic First in Hove. He holds a Master of Chiropractic (MChiro) with honours from the Welsh Institute of Chiropractic, has practised since 2009, and is registered with the General Chiropractic Council (Reg. 3359) and a member of the United Chiropractic Association.

This article is for general information and is not a substitute for an individual assessment. If you are unsure about your symptoms, speak to your GP or a registered healthcare professional. Chiropractors are regulated by the General Chiropractic Council. “Dr” is used as the courtesy title Doctor of Chiropractic; Dr Kingsnorth is not a registered medical practitioner.

References

1. NHS. Shoulder pain. nhs.uk/conditions/shoulder-pain
2. NICE Clinical Knowledge Summaries. Shoulder pain. cks.nice.org.uk/topics/shoulder-pain
3. British Elbow & Shoulder Society (BESS). Patient care pathway: frozen shoulder.
4. Arthritis UK. MSK decision aids: shoulder pain rapid evidence summaries.
5. Bergman GJ, Winters JC, Groenier KH, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med. 2004;141(6):432-439.
6. Brantingham JW, Cassa TK, Bonnefin D, et al. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manipulative Physiol Ther. 2011;34(5):314-346.