A sore shoulder is easy to work around. You stop reaching up, you sleep on the other side, and the months pass.
Then one night it wakes you up. Shoulder pain is not one problem. It is at least eight, and each needs a different first move.
Our Richmond clinic on Steveston Highway treats shoulder pain. No referral needed in BC. Call (604) 284-5113 or book an assessment.
The short answer
- Deep, aching pain that is worse at night usually means the rotator cuff tendons.
- Sharp pain as you lift the arm out to the side is the most useful clue we get.
- Throbbing, swollen pain right over the point of the shoulder is often the bursa.
- Radiating pain with tingling down the arm often starts in the neck, not the shoulder.
- Chest pain or pressure with shoulder pain is a 9-1-1 call, not a physio booking.
- In BC you do not need a referral to see a physiotherapist.
Eight causes of shoulder pain, and what each one feels like
Find the one that matches yours. HealthLink BC sorts shoulder problems into sudden injuries, overuse injuries and other causes. All three appear below.
Deep, aching pain that is worse at night
This is the classic rotator cuff pattern. HealthLink BC notes the pain may be worse at night and may keep you awake, especially lying on that side.
Most rotator cuff disorders come from a mix of overuse and ordinary wear.
Sharp, catching pain when you lift your arm to the side
HealthLink BC states plainly that lifting the arm to the side or to the front makes rotator cuff pain worse. Where in the arc it bites tells us a lot.
Burning, pinching pain at the top of the shoulder when reaching overhead
Impingement syndrome is the likely label. HealthLink BC describes it as overhead arm movements causing tendons to rub against the acromion, the bony tip of the shoulder blade.
Stiff, constant pain that limits how far the arm will go
Frozen shoulder is the pattern when movement itself is lost. HealthLink BC calls it a condition that limits shoulder movement, and notes it may follow an injury.
Our post on the symptoms of frozen shoulder walks through the stages.
Throbbing, swollen pain right over the point of the shoulder
Bursitis inflames the fluid filled sac that cushions the joint, in HealthLink BC’s words. Pressure on that spot is tender and obvious.
Nagging pain at the front of the shoulder, running into the upper arm
Bicipital tendinitis is inflammation of the biceps tendon. HealthLink BC places it where the tendon runs through the groove on the upper arm bone.
Sudden, severe pain after a fall, with a step in the collarbone
A shoulder separation is an AC joint injury. HealthLink BC describes the outer end of the collarbone separating from the acromion because of torn ligaments.
A visible bump on top of the shoulder is the giveaway.
Radiating pain and tingling down the arm, with no tender spot
Sometimes the shoulder is the messenger. HealthLink BC lists referred pain, a pinched nerve and a herniated disc in the neck among the other causes of shoulder pain.
Press around the joint and nothing hurts. That sends the assessment up to the neck, as our post on pain under the right shoulder blade explains.
A 60 second shoulder self-check before you book
This diagnoses nothing. It tells you what to say when you call.
See a doctor first if any of these apply
HealthLink BC lists these among the reasons to seek medical care for a shoulder problem.
- Chest pain or pressure, or a strange feeling in the chest. Call 9-1-1 now.
- An arm that is blue, very pale or cold, unlike the other arm
- Numbness, tingling or weakness in the arm or hand lasting more than 1 hour
- A shoulder or collarbone twisted out of shape, or popped out of place
- Trouble moving the shoulder for more than 2 days, or movement getting worse
- Signs of infection, such as increased warmth, redness, pus or fever
- Pain that is severe, 8 to 10 out of 10, or that keeps getting worse
For an emergency, call 9-1-1.
What a physiotherapist checks at the first visit
A shoulder assessment is mostly questions and movement. It takes about an hour, and treatment starts that visit.
| What we check | Why it matters |
|---|---|
| Where you point | Top, front, outside and upper arm narrow the list before anything is touched |
| Active range, then passive range | Separates a stiff joint from a painful tendon, which changes the plan |
| Rotator cuff strength tests | Shows whether the tendon needs protecting or loading |
| Neck screening | HealthLink BC lists a pinched nerve or neck disc among shoulder pain causes |
| Shoulder blade control | How the blade moves on the ribs sets how much room the tendons have |
What shoulder physiotherapy usually involves
Exercise does most of the work. HealthLink BC describes rotator cuff rehab as stretching and slowly strengthening the shoulder.
It is also clear about the opposite error. In its words, do not keep your shoulder completely still.
HealthLink BC gives a usable starting dose for its home programme. Do the stretching exercises 5 to 10 times a day, and any discomfort during exercise should not last more than 2 hours afterwards.
That progression is what active rehabilitation and kinesiology are for. A physiotherapist in Richmond sets the starting point and moves it weekly.
Talk to a physiotherapist first, and stop if an exercise hurts. That is HealthLink BC’s own advice.
Hands-on treatment, and when needles are used
Hands-on work settles a shoulder enough to let the exercise happen. Massage therapy and chiropractic often join the plan.
Some people also do well with acupuncture, which our Richmond clinic lists on its own window. It supports the exercise rather than replacing it.
Overhead work, and why late autumn fills the schedule
HealthLink BC names repeated overhead arm use as a risk for rotator cuff problems, and gives painting as an example. November in the Lower Mainland is full of it.
Gutters, leaves, ladders and lights hold the arm above shoulder height for hours.
Work injuries follow the same logic. WorkSafeBC accepted 20,509 claims for strains other than back strains in BC in 2023.
Who pays for shoulder physiotherapy in BC
You do not need a referral. The Physiotherapy Association of BC states that no referral or recommendation from a physician or nurse practitioner is required.
After a crash, ICBC pre-approves 25 physiotherapy treatments in the first 12 weeks, plus 12 with a kinesiologist. After a work injury, our post on WorkSafeBC physiotherapy coverage explains that route.
Otherwise most extended health plans cover it. Our Richmond window lists ICBC, WCB, MSP and extended health direct billing, so you rarely pay up front.
Frequently asked questions
Why does my shoulder hurt more at night?
Night pain is typical of rotator cuff problems. HealthLink BC notes it may be worse at night and may keep you awake, especially lying on that side.
What does shoulder pain when lifting my arm usually mean?
Most often the rotator cuff or the space above it. HealthLink BC states that lifting the arm to the side or front makes that pain worse.
Is it my shoulder or my neck?
Tingling down the arm, with no tender spot on the shoulder, points at the neck. HealthLink BC lists a pinched nerve and a neck herniated disc among the causes.
Do I need a referral to see a physiotherapist in Richmond?
No. The Physiotherapy Association of BC confirms no referral is needed. Call the Richmond clinic and book.
How long does shoulder physiotherapy take to work?
HealthLink BC says recovery varies, and that most people feel better after several weeks of rehabilitation. Ask for a timeline at the first visit.
Find a Synergy Rehabilitation clinic near you
Nineteen clinics across the Lower Mainland and Fraser Valley.
| Clinic | Address | Phone |
|---|---|---|
| Nordel (Surrey) | #116 12565 88 Avenue, Surrey, BC V3W 3J7 | (604) 503-1688 |
| Fleetwood (Surrey) | #103 8585 160 Street, Surrey, BC V4N 1G4 | (604) 503-4799 |
| King George (Surrey) | #101 8056 King George Blvd, Surrey, BC V3W 5B5 | (604) 503-9033 |
| Cedar Hills (Surrey) | 12852 96 Avenue #120, Surrey, BC V3V 6A8 | (604) 498-0877 |
| Clayton Heights (Surrey) | 19161 Fraser Hwy #105B, Surrey, BC V3S 8E7 | (604) 547-2860 |
| Clayton Corners (Surrey) | 18811 72 Ave #110, Surrey, BC V4N 6W7 | (604) 416-0580 |
| Sullivan (Surrey) | 15325 56 Avenue #106, Surrey, BC V3S 0X9 | (604) 566-8773 |
| Cloverdale (Surrey) | 5645 177b St Unit 102, Surrey, BC V3S 4H9 | (604) 579-1367 |
| Newton 72nd Ave (Surrey) | 14468 72 Ave #101, Surrey, BC V3S 2E7 | (604) 547-3761 |
| Central City (Surrey) | 13655 Fraser Hwy #120, Surrey, BC V3T 2V6 | (604) 954-1475 |
| Strawberry Hill (Surrey) | 12422 72 Ave Unit 206, Surrey, BC V3W 2M5 | (604) 547-0670 |
| South Surrey | 2388 156 St Unit 106, Surrey, BC V4A 4V4 | (604) 385-5855 |
| Delta | 10757 Delsom Crescent Unit 103, Delta, BC V4C 0A5 | (604) 516-8505 |
| New Westminster | 301 East Columbia Street #405, New Westminster, BC V3L 3W5 | (604) 553-3303 |
| Burnaby | 4695 Canada Way Unit #201, Burnaby, BC V5G 1K8 | (604) 558-8873 |
| Richmond | 11688 Steveston Hwy #8060, Richmond, BC V7A 1N6 | (604) 284-5113 |
| Vancouver (Point Grey) | 3609 W 16th Ave, Vancouver, BC V6R 3C3 | (604) 416-2600 |
| Yorkson Village (Langley) | 8045 204 St Unit A130, Langley Twp, BC V2Y 5K1 | (604) 371-1988 |
| Abbotsford | 3720 Townline Rd #100, Abbotsford, BC V2T 5W8 | (604) 776-5700 |
Stop sleeping on the other side.
Book a shoulder assessment at our Richmond clinic on Steveston Highway, or any of the nineteen Synergy locations.
This article is general information, not medical advice. It does not replace assessment by a qualified health professional. Benefit counts are set by ICBC and your insurer, so confirm coverage before you book. If the arm goes numb or weak, or you have chest pain, seek medical care immediately.
