Understanding Rotator Cuff-Related Shoulder Pain: Damage vs Pain

If your chiropractor or physiotherapist in Singapore starts by telling you about shoulder impingement, rotator cuff tendinitis, subacromial impingement. or any other diagnostic label, you may want to start seeking a second opinion.

Rotator cuff-related shoulder pain

The first reason is because research no longer supports a structural-based diagnosis. The preferred diagnosis is rotator-cuff related shoulder pain, which is based on the patient’s symptom experience (i.e. shoulder pain).

A structural approach is no longer preferred because it doesn’t take into the non-biomedical factors that may also contribute to your shoulder symptoms.

A true biopsychosocial approach takes into consideration your lifestyle (e.g. gym 7 times a week) as well as other psychosocial factors (e.g. stress) that may potentially be contributing to your symptom experience.

Most people can attribute their shoulder pain to a change in load (e.g. recently started going to the gym, recently changed jobs to one that involves more heavy, overhead lifting).

We CANNOT identify sources of pain in the shoulder joint

A paper published just a few days ago revealed that “special tests” for rotator cuff are fundamentally flawed.

The reason is simple. These tests were developed based on the assumption that it allow us to accurately identify where a patient’s shoulder problems may be. After years of countless research, we realised this is not true.

It is, at this point of time, impossible for chiropractors and physiotherapists alike, to be able to point out which structures exactly are giving you pain from orthopaedic testing alone.

You may think it’s no big deal. Giving the best shot at a diagnosis is better than not giving any right?

Yes, in cases such as dislocated shoulder it matters because you would need to reposition it.

Yes, in cases of heart attack it matters because you will need emergency medical attention.

Yes, in cases of rheumatoid arthritis because you may need to co-manage it with a rheumatologist.

In other rotator-cuff related cases, no. The chiropractor or physiotherapist may give you the wrong information and lead you to choosing the wrong treatment option or referral to help with your pain and stiffness.

Imagine being preferred to a orthopaedic surgeon for a wrongly diagnosed “subacromial impingement syndrome”. First, it’s a waste of your money because that condition doesn’t call for a surgery. Second, it’s a waste of your time because it would lead to no meaningful recovery outcome. Third, you’ll be in more pain and suffering because of delayed recovery.

All of this could be prevented by choosing an evidence-based chiropractor for your pain and stiffness.

Our approach to shoulder pain treatment

The way I approach musculoskeletal conditions – that is muscle and joint issues – is fairly straightforward.

I look at what you are experiencing first. Do you have pain when you lift your arm? Is your range of motion reduced? Is there any way you can move your shoulder without pain?I also take into consideration your past and current lifestyle. Do you spend most of your time at the computer? Did you suddenly just return to the gym or perhaps signed up for HIIT classes? Do you have a history of shoulder injuries?

From there, I’ll plan a recovery program for you to help you get to where you want to be. That’s your own goals! Are you looking to return to playing tennis? Do you want to be able to work at the computer for eight hours without any pain?

It’s important to note at this stage that I DO NOT fix you.

In traditional chiropractic or physiotherapy, patients may come into the clinic to get “fixed”. They lie down on the bench and the clinician does some sort of therapy on time. Their pain improves and they go on their way.

The model I chose to adopt involves working with you to help you find long-term pain solutions.

This means we look at why your shoulder is hurting during tennis. Is there anything we can do to your shoulder to make it more robust so it doesn’t hurt despite your long training hours?

This means we look at why your shoulder hurt every time you push a little harder at the gym. Is there anything we can do to get you over the plateau?

You don’t go to the doctor for high blood pressure and expect to leave without it. You most certainly don’t lie down at the doctor’s office and expect the physician to perform some treatment to make your high blood pressure go away instantly.

Sure, you may be prescribed with some medication, which takes time to work.

More often than not, the true treatment in management of high blood pressure is in lifestyle change. The doctor may advise you to consume less fatty food or to opt for a lower sodium diet. These are lifestyle changes that will help with your hypertension.

Likewise, my approach at Square One Active Recovery is NOT about making your shoulder pain go away. It’s also not about me trying to “fix” your shoulder problem.

We work together to co-construct a pain solution that can help you achieve your recovery goals.

singapore chiropractor, shoulder pain, dry needling
We used to offer dry needling (think western ‘acupuncture’) to help our patients manage their shoulder pain. While the initial relief was good, most patients did not experience any meaningful long-term results. We stopped offering dry needling as a service because we don’t want you to keep coming back.

The primary treatment I offer at Square One Active Recovery is exercise, education, and advice. This means I take a 100% hands-off (in the literal sense) approach to helping you achieve your recovery goals.

The reason is very simple. I don’t want to hand you a fish. I want you to “fish” for your own freedom from pain.

Don’t forget: I aim to make my services redundant to you.

Are you suffering from shoulder pain? Book in an appointment with us today. In light of the COVID-19 situation, I am no longer taking in-person appointments. Online video consultations are still available at a reduced fee. Book now via the form below!


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.