Shoulder pain is one of those presentations that can stop you from enjoying your day. Rolling in bed becomes difficult; carrying shopping or even sitting there and doing nothing can be frustrating. At Melbourne Massage and Treatment, I got to see many clients who complained of shoulder pain for a variety of reasons. Although one thing that is common with those different types of pain is the imbalance in the mobility stability joint chain, especially in people who do physical labour, repetitive overhead work, or intense gym training. Therefore, while many people expect me to focus only on the sore spot in the shoulder, my myotherapy approach is always broader and more thorough.
Yes, I treat the shoulder as the primary concern, but effective, long-term relief comes from understanding why your shoulder is overloaded in the first place.
That means looking beyond the glenohumeral joint and assessing thoracic mobility, scapular control, and thoraco-scapular stability, which are key components that are often overlooked but critical for shoulder health and to help you fix the shoulder pain.
Why Shoulder Pain Often Persists
The Shoulder is a joint characterised by a great amount of mobility and not much stability, which puts it at high risk of injury and so pain.
When your shoulder hurts, it’s rarely because the shoulder itself is “weak” or “damaged” in isolation. Indeed, to arrive to the pain response, either you had a severe trauma, like a fall on the shoulder or more commonly, the shoulder is compensating for:
- Poor thoracic spine mobility
- Weak or poorly coordinated scapular stabilisers
- Faulty movement patterns under load
- Repetitive strain from work or training
And let’s be clear, we are all different, so two individuals who do the exact same job or sport may end up having different pain and presentation due to basic anatomical differences in the shoulder.
That said, here are some common presentations that can lead to shoulder pain:
- If the thoracic spine doesn’t move well, the shoulder is forced to work harder.
- If the scapula doesn’t stabilise properly, the ac joint gets overloaded
- Genetically, the space between bonds (Humerus and Acromioclavicle joint) is narrower than the norm
My Clinical Assessment Process For Shoulder Pain
When you come to my Myotherapy Clinic in Fitzroy North for shoulder pain, I don’t just ask where it hurts, but I would assess:
- Thoracic spine mobility (especially rotation and extension)
- Cervical movement in active and passive motion
- Scapular positioning and control
- Shoulder range of motion under load
- Training or work-related movement demands
- Previous injuries or recurring pain patterns
This is particularly important if you:
- Work in trades or manual labour
- Train heavily in the gym or sport
- Perform repetitive overhead movements
- Have had recurring or long-term shoulder pain
A tailored assessment, such as the above one, allows me to not only pinpoint why the shoulder is in pain and what further investigation may be needed to confirm the findings but also address these factors, allowing us to understand the underlying drivers of your pain.
The Role of Thoracic Mobility in Shoulder Pain
The thoracic spine (mid-back) plays a massive role in how your shoulder functions. This is because the thoracic section of the spine is the mobile portion that anticipates the stable scapula-thoracic joint in the mobility, stability chain.
Limited thoracic mobility can lead to:
- Reduced the overhead range
- Increased strain on the rotator cuff
- Poor scapular mechanics
- Neck and shoulder tension
As part of the myotherapy treatment protocol for shoulder pain, I often combine manual therapy, joint mobilisation, and movement-based rehab to restore thoracic movement.
When the thoracic spine moves better, the shoulder doesn’t have to overwork, pain reduces, and then we can increase the strength by increasing the load.
A classic example of the thoracic shoulder relation is a cricket player.
The thoracic rotation along the throwing action is essential to optimise the force imprinted during the throwing action. In fact, imagine the thrower in a cricket game, using only the shoulder, and not rotating that thoracic joint chain. The shoulder load would be excessive, and in a short time, it would cause overload injury and so shoulder pain.
Scapular Stability: The Missing Link
Your scapula (shoulder blade) is the foundation for shoulder movement. Indeed, the scapula-thoracic joint is the stable joint between the thoracic and the glenohumeral mobile joints. But not only that, indeed, the scapula is the origin point of the rotator cuff muscles, a group of muscles that control the positioning of your humeral head in the glenoid fossa.
If it lacks stability or control:
- The shoulder joint becomes vulnerable
- Tendons are placed under excessive stress
- Pain persists despite “strengthening” exercises
As a Clinical Myotherapist, I focus on improving thoraco-scapular stability, ensuring the shoulder blade moves smoothly and supports the arm during load, lifting, and rotation.
This is especially crucial for people involved in:
- Weightlifting
- Cross-training
- Construction or trade work
- Sports requiring throwing or overhead movement
To strengthen the stability of the scapula, we then have to work on the rhomboid muscles and the trapezius (upper, mid, and lower), but even the levator scapulae. So yes, it is not a quick fix to restore shoulder functionality and remove shoulder pain, but there is a step-by-step journey that can be taken, and it is your choice to start walking along this path. I am here only to help you understand what the right path is for your presentation and ensure we take the right route.
Hypermobility and Shoulder Pain
One often overlooked factor in shoulder pain is hypermobility.
Hypermobility means your joints move more than the norms which isn’t always a bad thing, but it significantly increases injury risk when stability is lacking, particularly in the shoulder.
For hypermobile individuals:
- Ligaments provide less passive support
- Muscles must work harder to stabilise joints
- Poor scapular stability leads to shoulder overload
When hypermobility exists alongside poor thoraco-scapular stability, shoulder pain becomes far more likely.
In these cases, treatment isn’t about increasing flexibility; instead would be the opposite:
- Improving neuromuscular control
- Enhancing scapular stability
- Building strength through controlled ranges
- Teaching the body how to manage load safely
This tailored approach is essential for long-term shoulder health.
Testing the hypermobility.
To understand that if you follow the hypermobility presentation, we would look at the Beighton score, which is a test that looks at 9 joints, and evaluate how many of those are hypermobile:
Here is the scoring:
- 0-2 Hypomobile
- 3-4 Norms
- 5-9 Hypermobile
Treating the Shoulder as Part of the Whole System
At Melbourne Massage and Treatment in Fitzroy North, my goal, when delivering a myotherapy treatment, is not just short-term pain relief, but it’s sustainable recovery.
That means combining:
- Hands-on treatment – massage, dry needling
- Thoracic and shoulder joint mobilisation
- Targeted strength and stability exercises
- Education around posture, load, and movement habits
Therefore, I believe that whether your shoulder pain comes from work, training, or underlying hypermobility, addressing the entire kinetic chain is what creates lasting results.
When to Seek Help for Shoulder Pain
You should consider a clinical assessment for shoulder pain if:
- Shoulder pain persists longer than a few days (0 to 72 hours is the inflammatory response, which is acceptable as pain time)
- Pain returns after rest or massage alone
- Overhead movements feel weak or unstable
- You experience clicking, catching, or fatigue
- Training or work performance is declining
Early assessment allows us to correct issues before they become chronic. A scan or further investigations are sometimes needed to pinpoint the reason why you are experiencing pain in the area, and also can help in ensuring that we know what structure need more or less load at what time of the re-hab process.
Final Thoughts
Shoulder pain is rarely just a shoulder issue.
So when someone present themself at my clinic in Fitzroy North, for a Remedial Massage or Myotherapy session, complaining for shoulder pain, I do my best to send across a message of education that yes, the shoulder is our primary concern, but that behind that pain, there maybe other things to look at and address, in order to get to a shoulder pain free experience.
And yes, massage is part of the deal, and that’s what I am here for too, but without a structured re-hab protocol, the pain may settle initially, but it would come back.
If you’re dealing with shoulder pain and want a clinical, evidence-based approach, this is exactly how I work at Melbourne Massage and Treatment.
Giovanni La Rocca
Giovanni moved to Melbourne, Australia, from Italy in 2008 and became a citizen in 2017. He started studying massage therapy in 2016, then completed a Bachelor of Health Science in Clinical Myotherapy in August 2024. During those years, he also specialised in Thai Massage and Manual Lymphatic Drainage for presentations like Lipoedema and Lymphoedema. Nowadays, he runs his clinic in Fitzroy North, Melbourne, where he integrates movement therapy into his practice to enhance overall well-being. He also values meditation, having completed several Vipassana courses. Committed to continuous learning, he aims to share his expertise in integrated therapies to help others achieve balance and resilience.