Why Your Shoulder Pain Might Not Be a Rotator Cuff Problem

If you’ve ever searched for answers about shoulder pain, you’ve probably come across the term “rotator cuff”. It’s one of the most common explanations — whether the pain came on gradually, started during training, or flared up seemingly out of nowhere.

And while the rotator cuff can be involved, it’s not always the root of the problem.

In fact, many people who come to us have been told they have a rotator cuff issue — only to discover their pain is being caused by something completely different.

The rotator cuff is a group of four small muscles that help stabilise your shoulder

What Is the Rotator Cuff?

The rotator cuff is a group of four small muscles that help stabilise your shoulder and assist with movements like lifting, rotating, and reaching overhead. These muscles can become irritated, overused, or strained — especially if the shoulder is under stress or not moving well. But here’s the important part: The rotator cuff often becomes irritated because something else isn’t doing its job. It may be the painful area, but not necessarily the cause.

Three Common Causes of Shoulder Pain That Aren’t Rotator Cuff Tears

1. Scapular (Shoulder Blade) Control

Your shoulder blade acts as the base for all arm movement. If it’s not moving properly — whether due to stiffness, weakness, or muscle imbalance — the muscles around your shoulder have to work harder than they should. This can lead to fatigue, poor movement patterns, and eventually pain. We often see this in people who’ve never trained their back muscles, have poor posture habits, or rely heavily on pushing exercises (like bench press or overhead pressing) without enough pulling or stability work.

2. Upper Back (Thoracic) Stiffness

The upper part of your spine — between your shoulder blades — is designed to move, twist, and extend. But modern life often doesn’t encourage that. Sitting for long hours, working at a desk, or not moving the spine regularly can make this area stiff and restricted. When your upper back can’t rotate or extend properly, your shoulder is forced to do extra work during overhead movement or rotation. That extra strain can irritate muscles and joints — even if the shoulder itself isn’t damaged.

3. Poor Training Habits or Load Management

If you’ve been training hard — or even just doing repetitive tasks at work or home — your shoulder may be under more stress than you realise. Common mistakes that contribute to shoulder pain include:

• Too much pressing (e.g. push-ups, overhead presses) without enough pulling

• Skipping scapular or postural control exercises

• Returning to high-load or high-volume activity too quickly after injury or time off

• Ignoring early warning signs and training through discomfort

  
  

The shoulder is one of the most mobile joints in the body — but that mobility comes with less natural stability. Without the right training balance, something often starts to give.

Sports Massage - like the Unity Recovery Session - can provide immediate relief, but long term treatment requires more.

Why Treating “The Sore Bit” Isn’t Always Enough

It’s easy to assume that the painful area is the problem — but that’s not always the case.

In clinical terms, this is called regional interdependence: What happens in one part of your body can directly affect how another part moves and feels. So, even if your shoulder is where you feel pain, the true cause could be a stiff upper back, an unstable shoulder blade, or a pattern of movement your body has developed to avoid discomfort. That’s why effective treatment goes beyond massage, taping, or band exercises — and looks at the bigger picture.

A Real Example

One client came to us after more than a year of shoulder pain. They’d rested, done rotator cuff rehab exercises, and even had scans that showed some wear and tear — but nothing really helped long term. When we assessed them, it turned out their shoulder blade wasn’t moving properly, and their upper back was extremely stiff. We focused on those areas — and over time, their shoulder pain reduced significantly.

No direct shoulder treatment. No injections. Just treating the right cause, not just the symptom.

What Can You Do If Shoulder Pain Keeps Coming Back?

If you’ve been:

• Doing stretches or rehab exercises but still feel stuck

• Avoiding certain movements out of fear of pain

• Getting temporary relief from hands-on treatment, but symptoms always return

• Told it’s your rotator cuff — but something doesn’t feel right

  
  

It might be time to look beyond the shoulder. Effective recovery often requires:

• A clear, whole-body assessment

• Support restoring movement in the upper back and shoulder blade

• A strength plan that actually progresses — not just repetition of the same exercises

• Rebuilding confidence in how your body moves under load

Final Thoughts

Your shoulder is complex — and so is your body. Pain doesn’t always mean something is torn or broken. And if you’ve been stuck doing the same rehab with little change, the problem might not be where you think it is.

The good news? These issues are often very treatable — with the right approach, enough time, and a focus on the full picture. If you’ve been living with shoulder pain that won’t go away, you don’t have to keep guessing or Googling. Getting a proper assessment — one that looks at your whole movement system — can be the first step toward long-term relief.