What is happening in your shoulder
Above your rotator cuff sits a small fluid-filled sac called the subacromial bursa. Its job is to let the cuff tendons glide smoothly under the bony shelf of the acromion every time you raise your arm. When the space gets crowded, the bursa becomes irritated, swells, and starts producing pain whenever the cuff tries to slide past it.
In rugby this commonly happens after a block of heavy bench and overhead pressing, a season of lots of lineout lifting, or a single hard landing on the point of the shoulder. The shoulder usually still works, but a band of movement in the middle of the lift feels sharp and tight, and lying on that side at night is uncomfortable.
How it usually feels
- A pinch or catch as the arm passes through roughly mid-range overhead
- Pain reaching behind the back, washing hair, or putting on a jacket
- Ache at the outside of the upper arm, especially at night
- Pain when lying on the affected shoulder
- Weakness when lifting the arm out to the side against resistance
What helps in the first two weeks
- Reduce the volume of overhead pressing and bench work; substitute lower-irritation patterns your S&C suggests
- Keep the shoulder moving in its pain-free range every day rather than resting it completely
- Sleep with a pillow supporting the arm rather than letting it fall across the body
- Use ice for short periods after sessions if it helps with night pain
- Avoid carrying heavy kit bags on the affected shoulder
What a physio will typically check
| Test | What it looks at |
|---|---|
| Painful arc | Whether mid-range elevation reproduces the pinch |
| Hawkins-Kennedy | Sensitivity of the bursa under the coracoacromial arch |
| Empty can / resisted abduction | Whether the supraspinatus is contributing |
| Scapular control | How well the shoulder blade tilts and rotates upward |
| Posture and thoracic mobility | Whether the upper back is allowing room overhead |
Recovery timeline at a glance
Settle the irritation
0-2 weeks
Reduce aggravating volume, restore pain-free range, begin gentle isometric cuff work.
Rebuild cuff and scapular control
2-6 weeks
Progressive cuff strengthening, scapular stability, posture, and thoracic mobility.
Reload pressing and contact
6-10 weeks
Gradual return to overhead and bench patterns, then tackle and lineout work.
Return to full training
8-12 weeks
Once symptom-free under full load, return to contact and overhead competition demands.
When to seek further help
- Pain that wakes you most nights for more than two weeks
- Visible weakness lifting the arm or holding it out to the side
- Pain that started with a clear traumatic event rather than gradually
- Symptoms that have not improved with six weeks of structured rehab
- Pins and needles, numbness, or symptoms travelling down the arm