Shoulder Pain Relief

Shoulder pain questions, answered

We hear the same handful of shoulder questions every week at our North Palm Beach clinic, and three of the shoulder specialists who have been on our Pain 2 Power show have answered a few of them on air. Here they are in one place. Your own answers still come from your evaluation.

Why does my shoulder ache at night?

Night pain is one of the most common things people mention, and it is worth mentioning. Dr. Dave Kashuba, Ph.D., OTR, put it this way on Episode 9: patients start talking about their shoulder “and they’re like, really aches at night. And so now you know, you’re looking more at a bursitis and a tendonitis.” The details you give your therapist steer the whole evaluation, so tell us when it hurts, what you were doing, and how you sleep.

Is it my rotator cuff?

It might be, and you would have plenty of company. Orthopaedic shoulder surgeon Dr. Vani Sabesan, MD, told our listeners that among people over 60, “one out of three people are going to have a rotator cuff pathology.” Rotator cuff strains, tears and repairs are among the conditions we treat most. The evaluation tests how the cuff and the shoulder blade are working before anything gets a label.

Who wears out a shoulder fastest?

Not always the people you would guess. Orthopedic shoulder surgeon Dr. Ryan Simovitch described the patient he sees most as the constant warrior: someone playing pickleball four to six days a week with no moderation and no preparation, until something gives. Dr. Sabesan made the same point about Florida, where the weather lets people play all year round. If that sounds like your schedule, strength work for the cuff and shoulder blade is the cheapest insurance you can buy.

Can therapy help me avoid surgery?

For a lot of shoulder problems, therapy is where care starts, and our approach is the same whether you are trying to avoid surgery or recovering from it: restore pain-free range first, then rebuild rotator cuff and shoulder blade strength, then get back to reaching overhead, lifting, sport and sleep without guarding. If your evaluation points toward a surgical opinion, we will tell you plainly and coordinate with your physician.

What about after rotator cuff repair or a shoulder replacement?

Your surgeon sets the protocol and we follow it exactly. Protocols are changing, too. Dr. Sabesan described comparing six weeks in a sling with moving the shoulder within days after surgery, and said of the result, “we found that the outcomes were similar.” She was also candid about the hard part of cuff repairs: “We’re really good at fixing them. We’re not great at getting them to heal.” That healing window is exactly what post-operative therapy is paced around. If you are facing a reverse shoulder replacement, read Total vs. Reverse Shoulder Replacement: How Surgeons Decide.

Does the therapist really make a difference?

We are biased, so take it from a surgeon. Dr. Sabesan said her team surveyed their shoulder replacement patients and “98 percent of patients said the therapist was a huge impact on their outcome.” Her comparison was a good hairdresser: someone who talks to you, listens, and adjusts. Every session here is one-on-one with a therapist, which is the whole point.

How often will I come in, and what do I do in between?

Usually a few visits a week, and the work between visits counts as much as the visits. Captain Kerry, of Bravo’s Below Deck, came to us about twenty years ago with a rotator cuff injury and has had two surgeries on that shoulder since. On Episode 13 he said, “I’ve got full motion. I’ve had two surgeries in there now and both times Dave and his team have got me back together.” When he traveled, he took a band program with him. Dave’s rule on the same episode: he sees people two to three times a week, “and those other hours they’ve got to be doing their exercises and they got to do them correctly.”

Which exercises are safe to start at home?

The ones your therapist gives you after your evaluation. Most shoulder programs here borrow from Dave’s at-home set below, because almost everything we do all day pulls the shoulders forward and inward and this set works the other way. Full instructions are on our home exercises page. If a movement causes sharp pain, stop and ask us.

Do I need a referral, and will insurance cover it?

In most cases Florida's direct access law lets you begin a physical therapy evaluation without a physician referral. Post-surgical patients usually arrive with a referral and protocol from their surgeon already. Before your first visit our front desk verifies your Medicare or commercial benefits and tells you what your plan needs. Our 2026 Medicare guide explains deductibles and coinsurance.