Why Shoulder Pain Is So Likely to Come Back

Shoulder pain often returns after periods of rest, especially when individuals resume activities they previously engaged in regularly, such as swimming, tennis, gardening, or exercise. According to Dr. Martin Mikek, a specialist in orthopedics, returning too quickly to previous levels of physical activity can lead to recurring issues. The solution lies not in prolonged rest but in improving movement patterns, restoring flexibility, and maintaining muscle strength. Many patients describe a common progression of symptoms: initial discomfort after extended swimming, followed by difficulty reaching overhead during the day, and eventually pain when turning over in bed at night. While reducing activity eases the shoulder and allows life to return to normal, problems often resurface after several months. This pattern is particularly common among individuals over fifty who remain physically active and wish to stay that way. Underlying causes frequently involve degenerative changes in the rotator cuff tendons. As people age, these tissues regenerate more slowly, making them less able to handle sudden increases in workload. Treatment does not end once the pain subsides. First, the condition must be calmed, and appropriate treatment selected. Then, the shoulder must be prepared to withstand regular loads again, a step many people overlook. Just because the pain has gone doesn’t mean the shoulder is ready for all the demands it faced before the issue arose. When workload exceeds capacity In clinics, doctors often see patients who have returned to regular exercise after long periods of rest. Some start swimming three times a week after retirement, others take up gardening and complete more work in one month than in the entire previous year, while others tackle tasks they had postponed for years. All patients describe similar progressions: initially mild pain after exertion, followed by discomfort during activity, and finally pain at night. Most attribute the cause to a single awkward movement, such as a poor serve in tennis, lifting a heavy object, or awkwardly reaching into the back seat of a car. However, it's often not a single movement but rather the fact that workload increased faster than the shoulder could handle. Limiting activity reduces pain, leading to better sleep and more comfortable movement. The problem arises because rest primarily silences the warning signal but does not restore flexibility, improve movement patterns, or maintain muscle strength. It is therefore more useful to monitor the balance between what the shoulder currently can manage and what is being asked of it. Problems arise when demands exceed its capacity for too long or excessively. Why tendons become more vulnerable Tendons are living tissue that constantly regenerate. Their cells build new collagen and repair minor injuries caused by daily activities. However, this ability diminishes with age. If workload increases faster than the tendon can recover, changes accumulate within it, known as tendinopathy. This does not necessarily mean every worn-out tendon will hurt or that every partial tear will progress. Such tendons struggle more with sudden increases in workload, meaning an activity that once passed without consequence might trigger issues after a long period of rest or a rapid increase in volume. In some cases, minor damage accumulates over time into a partial tear. Factors influencing its progression include size and location, how it occurred, age, and demands from work and sport. A partial tear itself is not always a reason for surgery. More on decision-making regarding such injuries is discussed in the article titled “What I Advise Regarding Partial Tears of Rotator Cuff Tendons.” Pain is a useful indicator When the shoulder hurts, a common reaction is complete rest. Short-term unloading can be sensible, especially if the pain disrupts sleep or normal movements. Prolonged avoidance of movement can reduce flexibility and muscle strength, but it does not address the underlying patterns causing the tendons to overload. When deciding on the appropriate level of workload, a simple guiding rule can help. Often, the correct answer becomes clear the following morning. Mild discomfort during activity may be acceptable if it quickly subsides and movement remains controlled. If the shoulder still hurts in the evening, it may indicate that the workload was too high.