Some back and neck pain needs a doctor today, not a chiropractor. Some back and neck pain is not a case for a chiropractor and needs a doctor the same day. Go to an emergency room, not to us, if you have numbness in the groin or inner thighs, if you have lost control of your bladder or bowels, if a leg is becoming weak rather than just painful, if the pain followed a serious fall or a car crash, if you have a fever with back pain, if you have unexplained weight loss alongside it, if you have a history of cancer, or if a headache came on suddenly and is the worst you have ever had. We would rather you rang your doctor and never rang us at all.
The shoulder is the most mobile joint in the body and it achieves that by giving up bony stability almost entirely — the ball sits against a shallow socket and is held there largely by muscle. That design produces enormous range and a predictable set of problems, most of which come down to the rotator cuff being asked to do more than its current capacity allows, most often overhead, most often after something in the training or the job changed.
The first thing worth knowing is that resting a painful shoulder rarely fixes it. Rotator cuff pain responds to progressive loading in the way that tendons generally do, and the common pattern of avoiding everything that hurts for two months produces a shoulder that is less painful in the short term and weaker, stiffer and just as unreliable when you go back to using it. Most of our shoulder programmes start loading in the first week, at a level chosen not to provoke it.
The second is that not all shoulder pain is the shoulder. Pain referred from the neck is common, particularly pain felt over the top of the shoulder and down the outside of the arm, and a shoulder that has been treated for months without improvement is very often a neck that was never examined. We check the neck on every shoulder patient as a matter of routine, and it changes the diagnosis often enough to justify the two minutes it takes.
What is actually wrong
Four common answers with genuinely different timelines. Getting this right is most of the value of the first visit.
Rotator cuff related pain
The commonest by far. Pain on the outside of the upper arm, worse reaching overhead or behind, often worse at night and worse lying on it. It is a capacity problem rather than a damage problem in most cases, and it responds to progressive loading over roughly eight to twelve weeks. Imaging frequently shows cuff changes in people with no pain at all.
Frozen shoulder
A genuinely different animal: progressive loss of range in all directions, including when somebody else moves the arm for you, with a characteristically severe painful phase. It has a long natural course measured in many months to a couple of years and it does not respond to the same loading approach. Recognising it early changes the advice completely and avoids months of the wrong treatment.
Pain referred from the neck
Common, under-recognised, and the reason plenty of shoulders get treated for months without improving. Suspect it when the pain sits over the top of the shoulder or down the outside of the arm, when the shoulder's own movements do not reproduce it, or when neck movements do. We examine the neck on every shoulder patient.
Instability
A shoulder that has dislocated, or one that feels as though it is about to give way, particularly in younger people and overhead athletes. This needs proper assessment, because the management is quite different and a first-time dislocation in a young athlete has a high recurrence rate. Some of these need a surgical opinion.
How we treat it
Hands to buy range and reduce pain, then load — with the emphasis firmly on the second half.
Settle the irritability
Soft-tissue work through the cuff and the muscles around the shoulder blade, joint mobilisation where the joint or the upper back is stiff, and advice on sleeping position — because the night pain is usually what people find hardest and it is often improved substantially by propping the arm.
Free the upper back
A shoulder cannot go overhead properly if the upper back will not extend, and a stiff thoracic spine is one of the more common contributors to shoulder pain that nobody thinks to check. Treating it frequently produces an immediate change in overhead range, which is satisfying and also genuinely useful for the loading that follows.
Load the cuff progressively
Isometric holds early if the shoulder is irritable, then progressive strengthening through range, then the specific positions your sport or job actually demands. Written down, with a rule for progressing. This is the part that changes the outcome and it typically runs eight to twelve weeks rather than three.
Shoulder blade control
How the shoulder blade moves on the ribcage determines the space and the mechanics the cuff has to work in. Work on the muscles that control it is a routine part of a shoulder programme, and it is particularly relevant for people whose job or sport puts them overhead repeatedly.
When a shoulder needs somebody else
Not everything is a rehabilitation problem, and delaying on some of these costs you.
Genuine weakness after an injury
An inability to lift or hold the arm after a fall or a sudden load — as opposed to weakness limited by pain — can indicate a substantial cuff tear, and in some patients that is a surgical conversation with a better outcome if it happens sooner. We assess for it specifically and refer quickly when we find it.
A dislocation
A shoulder that has come out of its socket needs proper assessment, and a first dislocation in a young athlete carries a high recurrence rate that changes what should be done about it. Do not have it manipulated back by an enthusiastic bystander, and do get it looked at properly afterwards rather than assuming it is finished.
Frozen shoulder, correctly identified
It needs to be recognised rather than treated as a stubborn rotator cuff for six months. Management differs, the timeline is long, and there are medical options in the painful phase that are worth discussing with your doctor. Telling somebody honestly that this will take many months is kinder than implying weekly treatment will shorten it much.
Pain that is not mechanical
Shoulder pain that does not change with position or movement at all, particularly on the left, particularly with exertion, breathlessness or nausea, is a medical emergency until proven otherwise. So is shoulder-tip pain with abdominal symptoms. These are uncommon, and they are why we ask questions that appear to have nothing to do with your shoulder.
Shoulder Pain in western Queens
Shoulders that hurt overhead, hurt at night and will not settle on rest. Most respond to loading rather than avoiding — and some come from the neck rather than the shoulder at all.
Every course of care here starts the same way: a full hour, a proper history, an examination, and then a plain statement of what we think is going on and how confident we are about it. You are told what we propose, roughly how many visits it ought to take and what should have changed by when — and we agree a date to stop and look at whether it worked. If the honest answer at any point is that this needs somebody else, you get that instead, and we write to them the same week.
Chiropractic care is not a substitute for medical diagnosis. Chiropractic care is not a substitute for medical diagnosis, and nothing on this website is medical advice for your particular problem. We are not physicians: we do not prescribe medication, we do not perform surgery, and we do not treat disease. What we do is examine how your spine and joints move, work on them by hand, and give you something to do between visits. If your problem turns out to be outside that, we say so and refer you — which happens often enough that you should expect it as a normal outcome rather than a failure.
What chiropractic does not treat. We treat musculoskeletal problems: the spine, the joints, the muscles and the nerves that are irritated by them. We do not claim that adjusting a spine treats asthma, allergies, ear infections, colic, digestive disease, high blood pressure, infertility, immune function or any other internal illness. Chiropractors who make those claims are making them without good evidence, and you should be wary of anybody who does. If somebody has told you that spinal care will fix a condition on that list, we will tell you honestly that it will not.
Questions
Shoulder Pain — the questions we are asked most
Should I rest my shoulder until it stops hurting?
Generally no. Rotator cuff pain responds to progressive loading rather than to avoidance, and two months of not using a shoulder produces one that is less sore in the short term but weaker, stiffer and no more reliable when you go back to using it. What changes is the load, the range and the positions — not whether you use it at all. Most of our shoulder programmes start loading in the first week.
Why does my shoulder hurt so much at night?
Night pain is characteristic of rotator cuff problems and it is usually the symptom people find hardest. Lying on the affected side compresses the structures, and lying flat lets the arm fall into a position that loads them. Propping the arm on a pillow in front of you, or sleeping on the other side hugging a pillow, often makes a substantial difference. Constant unrelenting night pain unrelated to position needs assessing.
Is my shoulder pain actually coming from my neck?
It might well be, and this is missed often enough that we check the neck on every shoulder patient. Suspect it when the pain sits over the top of the shoulder or runs down the outside of the arm, when moving the shoulder itself does not reproduce it, or when neck movements do. A shoulder that has been treated for months without improving is very often a neck that was never examined.
Do I need an MRI of my shoulder?
Usually not initially. Cuff changes and tears show up routinely on scans of people with no shoulder pain whatsoever, and the proportion rises steeply with age, so a finding on a scan does not establish that it is causing your symptoms. Imaging earns its place after a significant injury with genuine weakness, or when a well-run rehabilitation programme has not worked.
What is frozen shoulder and do I have it?
It is a condition in which the joint capsule thickens and tightens, producing progressive loss of movement in every direction — crucially including when somebody else moves your arm for you, which is what distinguishes it from a painful but mobile shoulder. It has a long course measured in many months. Recognising it early matters, because the advice is quite different from cuff rehabilitation.
How long will my shoulder take to get better?
Rotator cuff related pain typically needs eight to twelve weeks of consistent loading, which is longer than most people hope and shorter than they fear. Progress is measured in what you can lift and how far you can reach rather than in whether it aches today. Frozen shoulder is much longer. We will give you a realistic figure after the examination rather than an encouraging one.
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Read moreA fee agreed before the visit, not after it
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Pick a chiropractor and an hour from the calendar — it shows only the times each of them genuinely has free. A first visit is a full hour and costs $95 for the examination on its own, or $145 if we treat you at the same appointment. You decide which after the examination, not before.