Shoulder Pain in Menopause: Rotator Cuff or Frozen Shoulder ?

We are all told to lift weights to combat the effects of menopause yet all too often it results in shoulder pain. But which exercises are best for shoulder pain associated with menopause ?

Woman with shoulder pain

If you’re a woman in your 50s who has embraced the gym to feel stronger and combat the effects of menopause, we applaud you! Taking charge of your health during this transitional time is empowering. However, you might have noticed an uninvited guest: persistent shoulder pain that just doesn’t seem to budge.

You are far from alone. Many peri and post-menopausal women experience new aches and stiffness, with the shoulder being a prime culprit. The crucial thing to understand is that not all shoulder pain is the same, and using the wrong approach can, unfortunately, make things worse. The key to a successful recovery lies in a precise diagnosis and following a rehab plan that respects what your shoulder is actually going through.

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Why My Shoulder? The Hormone-Joint Link

The decline in oestrogen during perimenopause and menopause does more than cause hot flushes, forgetfulness and night sweats. Oestrogen plays a vital role in maintaining tendon elasticity and joint lubrication. As levels begin to drop, tissues can become less flexible and more vulnerable to irritation - basically they don't roll with the punches quite so well.....much like the rest of you during menopause really ! When you combine this natural change with a new, enthusiastic gym routine to counter losing muscle mass and bone stocks, it’s easy for the shoulder to become overwhelmed and respond with pain.

The two most common conditions we see are very distinct in their nature and require different approaches:

1. Rotator Cuff Tendinopathy: This is an issue of irritation and overload. It can involve micro-tears and inflammation in the tendons that act as stabilising cables for your shoulder joint. It often feels like a deep, dull ache, with sharp pain during specific movements like overhead presses, bench presses, or even fairly small seemingly innocuous movements.

2. Adhesive Capsulitis (Frozen Shoulder): This is an issue of pathological stiffness. The shoulder joint's capsule—a connective tissue sack that surrounds it—becomes inflamed, thickens, and tightens, literally "freezing" the joint. Pain is often significant in the early 'freezing' stage, but the hallmark is a global loss of movement, making it hard to reach behind your back or brush your hair

Why Diagnosis is Your First Step to Recovery

Understanding the difference between these two conditions is critical because an exercise that is rehabilitative for one can be profoundly provocative for the other. Imagine your rotator cuff tendons are like a rope with a frayed spot. The treatment involves carefully loading that rope in specific positions to make it strong again. Now, imagine your frozen shoulder is a joint encased in sticky glue. The treatment involves gently stretching and mobilising to break up that adhesive tissue.

The critical mistake we see is women with a frozen shoulder trying to strengthen through the stiffness, which is often impossible and incredibly painful, while those with a cuff issue may stretch aggressively, further irritating the tendon.

A physiotherapy or sports therapy assessment will pinpoint the exact source of your pain and the stage of your condition, allowing us to create a personalised and effective treatment and rehab programme to help, not hinder your recovery.

" An exercise that is rehabilitative for one condition can be profoundly provocative for the other. "

Tailoring Your Exercise Plan: A Condition-Specific Guide

Here are some foundational exercises. It is vital to start gently and stop immediately if you experience sharp, worsening pain.

For Rotator Cuff Tendinopathy: The Goal is Controlled Strengthening

The philosophy here is to gently load the tendon to promote healing and resilience. We start with minimal resistance and simple movements.

1. Scapular Squeezes:

   • Sit or stand with your arms relaxed by your sides.

   • Gently squeeze your shoulder blades together, as if trying to hold a pencil between them. Avoid shrugging your shoulders up towards your ears.

   • Hold for 5 seconds and release. This builds the foundation for all shoulder movement. Aim for 2 sets of 15 repetitions.

2. Isometric External Rotation:

   • Stand facing a wall, with the back of your hand (on your affected side) pressing against it.

   • Gently push your hand into the wall as if you were trying to rotate your arm outwards. You should feel the muscles in the back of your shoulder working, but no movement will occur.

   • Hold for 10-15 seconds, then relax. Repeat 5-8 times. This builds strength without moving the irritated tendon through a large range.

3. Resistance Band Rows:

   • Anchor a resistance band at waist height. Hold the ends with both hands and step back to create tension.

   • With elbows bent, pull the band towards your chest, squeezing your shoulder blades together.

   • Control the return. This strengthens the important postural muscles that support the shoulder. Aim for 2 sets of 12-15

For Frozen Shoulder: The Goal is Gentle Mobility Restoration

The philosophy here is to "coax" or " nudge " the joint back to a better range of movement. Aggressive stretching is counterproductive and just provokes more pain. We aim for gentle, sustained stretches to improve capsular flexibility.

1. Table Stretch:

   • Place your affected arm on a table for support. Thumb pointing upwards. It may be more comfortable to sit at a slight angle to the table.

   • Lean your trunk forwards so the arm slides away from you whilst still supported on the table. Oscillate in this position gently nudging the arm a little further away as comfort allows.

   • Do this for 60 seconds, 2-3 times a day. This is a foundational mobility exercise for the frozen shoulder.

2. Cross-Body Stretch:

   • Sitting or standing, use your unaffected arm to lift your painful arm at the elbow.

   • Gently pull it horizontally across your chest until you feel a light stretch at the back of your shoulder. Do not pull to the point of sharp pain.

   • Hold for 30 seconds. Repeat 3-5 times. This targets the tight posterior part of the capsule.

3. Wand (or Stick) ExercisesUsing a broomstick, cane, or similar item.

   • Flexion (Forward Lift): Lie on your back. Hold the stick with both hands, shoulder-width apart. Use your good arm to push the affected arm upwards, toward the ceiling/overhead. Hold for a few seconds and slowly lower.

   • Abduction (Side Lift): Lie on your back, elbows straight. Use your good arm to push the affected arm out to the side, away from your body.

   • External Rotation: Lie on your back or stand. Keep elbows at your side ( as though carrying a newspaper under your arm. Elbows bent to 90 degrees. Use your good arm to push the affected hand outward, rotating the shoulder. This is one of the most important stretches for frozen shoulder.

Your Recovery Timeline: Patience and Persistence

Recovery requires a compassionate understanding of your body’s timeline... Mother Narure can be helped along but sh

• Rotator Cuff Tendinopathy: With consistent, appropriate strength training, you can expect significant functional improvement within 6 to 12 weeks. The key is progressive, pain-free loading.

• Frozen Shoulder: I have to be honest, this sadly is a longer journey, it can often last 12 to 36 months if left untreated. However, proactive and specific physiotherapy can dramatically manage pain, improve function at every stage, and significantly shorten the overall duration. The "thawing" phase can be accelerated immensely with the right exercises.

The above exercises are a great start in the early stages but as with all injuries will need progressing as improvements in pain and movement take place.

A Final Word of Encouragement

Developing shoulder pain can feel like a frustrating setback, especially when you're motivated to stay strong and eager to get going in the gym. But please see this not as a stop sign, merely a detour ! It’s your body asking for a more tailored approach to suit it's own needs. By understanding the root cause and partnering with a physiotherapist or sports therapist, you can navigate this challenge with confidence. You will return to your fitness goals not just stronger, but smarter, with a deeper knowledge of how to care for your body through menopause and beyond.

Your commitment to your health is inspiring. Let us help you ensure that commitment pays off in pain-free, powerful movement.

If you’re struggling with shoulder pain, book an appointment with one of our therapists to get an effective treatment plan for YOUR specific problem.