Evidence-based care at Vantage Point
Shoulder Physiotherapy in Bondi Junction
Assessment and treatment for shoulder pain, stiffness, instability and rotator cuff tears, with a clear explanation of what is going on and a plan built around strength and movement.
- APA Musculoskeletal Physiotherapists
- Rotator cuff strength testing with VALD
- Swimming assessments with video analysis
Symptom profiles
Which best describes your symptoms?
Shoulder pain presents in distinct ways, and each profile points to different structures and a different starting point for treatment. Select the one closest to yours.
Pain Lifting or Reaching
Pain at the front or outside of the shoulder and upper arm when you lift, reach overhead or reach behind your back. It is often called rotator cuff related shoulder pain, impingement or bursitis.
You might notice
- Pain reaching for a high shelf or putting on a jacket
- Pain lying on that side at night
- A painful arc as the arm lifts out to the side
What is usually happening
The rotator cuff tendons and the bursa above them have become sensitive to load, often after a change in activity, a spike in training or a long stretch of overhead work. Scans often show tendon changes or small tears, but these are common in shoulders without pain too, so a scan alone rarely explains the pain. Tendons respond to the right amount of load, which is why treatment is built around graded strengthening (Sanders et al., 2025).
Common causes
Rotator cuff tendinopathy
Irritation of the rotator cuff tendons from more load than they are currently ready for.
Subacromial bursitis
Irritation of the bursa, the fluid-filled sac that sits above the rotator cuff.
Calcific tendinopathy
Calcium deposits within a tendon, which can be very painful while the body is reabsorbing them.
Partial-thickness tears
Tears through part of the tendon, which often sit alongside tendinopathy.
What we look at in your assessment
Range of movement, rotator cuff strength measured with VALD dynamometry, how your shoulder blade and upper back move, and a neck screen, because pain from the neck can be felt in the shoulder.
How treatment usually starts
A clear explanation and changes to the loads that aggravate it, hands-on treatment and dry needling where it helps settle pain, then progressive rotator cuff and shoulder strengthening, measured as you go.
Related services
A Stiff, Painful Shoulder
A shoulder that has gradually become stiff and painful, with movement lost in several directions, especially turning the arm outwards. Pain is often worst at night.
You might notice
- Difficulty reaching behind your back or into a back pocket
- Night pain that wakes you
- Movement still blocked when someone else gently moves the arm for you
What is usually happening
In frozen shoulder (adhesive capsulitis), the capsule around the joint becomes inflamed, then thickened and tight. It is more common in people with diabetes, who have about five times the odds of developing it. Many people improve over time, but the idea that it always resolves completely on its own is not supported, and most improvement comes early (Zreik et al., 2016; Wong et al., 2017).
Common causes
Frozen shoulder (adhesive capsulitis)
Painful, progressive loss of movement from an inflamed, tightened joint capsule.
Shoulder osteoarthritis
Wear in the ball and socket joint, with stiffness, grinding and aching, more common later in life.
Stiffness after injury or surgery
Movement lost after a fracture, dislocation or operation, often from guarding and time in a sling.
What we look at in your assessment
Active and passive movement in every direction, strength, and how stiffness and pain affect your sleep, work and daily tasks.
How treatment usually starts
Pain relief and movement within comfort while the shoulder is irritable, then stretching and strengthening as it settles. Where pain is limiting progress, we work with your GP or specialist on options such as a steroid injection.
A Shoulder That Feels Loose or Has Dislocated
A shoulder that has dislocated or partly slipped out (subluxed), or one that feels loose, clunks or gives way, either after an injury or without a clear cause.
You might notice
- Apprehension with the arm out to the side and turned back, as in throwing or tackling
- A dead arm feeling after a sudden movement
- Clicking or clunking in certain positions
What is usually happening
The shoulder trades stability for range of movement. After a traumatic dislocation, the labrum and ligaments at the front of the joint can be damaged, which affects how secure the joint feels. Other people have naturally looser joints and develop instability without a big injury, where muscle control and strength are the focus.
Common causes
Traumatic dislocation
The ball is forced out of the socket, usually out the front, in a fall or contact sport.
Labral and SLAP tears
Damage to the cartilage rim of the socket, including at the top where the biceps tendon attaches.
Multidirectional instability
Looseness in more than one direction, often in people with naturally flexible joints.
What we look at in your assessment
Stability and apprehension tests, rotator cuff and shoulder blade strength with VALD dynamometry, and the demands of your sport. If a significant tear or bone injury is suspected, we refer for imaging and a surgical opinion.
How treatment usually starts
Protection early after a dislocation, then progressive strength and control through the positions your sport needs, with return-to-sport milestones. When surgery is the better option, we prepare you beforehand and guide your rehabilitation afterwards.
Related services
A Rotator Cuff Tear
A tear in one or more rotator cuff tendons, found on a scan or suspected because the arm feels weak. Tears can be degenerative, developing gradually with age, or traumatic, after a fall or a sudden heavy load.
You might notice
- Weakness lifting the arm or turning it outwards
- Pain and weakness after a fall onto the arm
- A scan report that mentions a partial or full-thickness tear
What is usually happening
Rotator cuff tears become more common with age, and many people with a tear have no pain at all. For small degenerative tears in people over 55, a trial found physiotherapy alone gave similar results to surgery at 1 year and after more than 5 years. In a study of 452 people with full-thickness tears not caused by an injury, fewer than 1 in 4 chose surgery within 2 years of starting a physiotherapy program. We liaise with orthopaedic surgeons for significant tears, but many can be managed with progressive loading (Tempelhof et al., 1999; Kuhn et al., 2013; Kukkonen et al., 2014; Kukkonen et al., 2021).
Common causes
Degenerative tears
Tears that develop gradually as tendons age, often found alongside tendinopathy.
Traumatic tears
Tears from a fall, dislocation or sudden heavy load, usually with sudden weakness.
Large and massive tears
Tears involving several tendons, where strengthening the surrounding muscles is a key part of care alongside a surgical opinion.
What we look at in your assessment
Strength testing of the rotator cuff with VALD dynamometry, movement and function, and a review of your scans in the context of your symptoms and goals.
How treatment usually starts
Progressive strengthening of the rotator cuff and surrounding muscles, with your strength measured over time. For significant tears, we liaise with an orthopaedic surgeon and keep your GP informed.
Related services
Shoulder Pain in Athletes
Shoulder pain that comes on with swimming, throwing, racquet sports, gym training or contact sport, often building over a season or after a jump in training load.
You might notice
- Pain during or after training that is creeping up
- Pain on top of the shoulder with bench press, dips or push-ups
- Lost speed, power or range in your stroke or throw
What is usually happening
Overhead and contact athletes put large, repeated loads through the shoulder. Pain usually reflects a mismatch between load and capacity: a spike in training, a change in technique, or strength and range that have not kept up. In contact sport and lifting, the joint at the top of the shoulder (the AC joint) is often involved.
Common causes
Swimmer’s shoulder
Rotator cuff and front-of-shoulder pain linked to training volume, stroke technique and fatigue.
Throwing shoulder
Changes in rotation and shoulder blade control that load the rotator cuff and labrum in throwers and racquet players.
AC joint injury
A sprain or separation of the joint on top of the shoulder, usually from a fall or tackle onto the point of the shoulder.
AC joint overload
Pain on top of the shoulder from heavy pressing, seen in weight training.
What we look at in your assessment
Your training load, stroke or throwing technique with video analysis, shoulder rotation range, and rotator cuff and shoulder blade strength with VALD dynamometry.
How treatment usually starts
Load management and a modified training plan agreed with your coach, technique changes where they help, progressive strengthening and a graded return to full training based on milestones.
Related services
Recovery After Shoulder Surgery
Rehabilitation before and after shoulder surgery, starting when your surgeon advises and following their protocol.
You might notice
- Stiffness and weakness after time in a sling
- Uncertainty about which movements are safe
- Wanting to get back to work, sport or overhead activities
What is usually happening
After shoulder surgery, repaired tissues need time to heal before they can take load, and the shoulder stiffens and weakens while it is protected. A staged program restores movement first, then strength, within the limits your surgeon sets for the repair.
Common surgeries
Rotator cuff repair
Reattachment of a torn tendon to the bone, followed by a protected, staged return to load.
Stabilisation surgery
Labral repair or a Latarjet procedure after dislocation, with a staged return to sport.
Shoulder replacement
Anatomic or reverse replacement for arthritis or large rotator cuff tears.
Fracture fixation
Surgery for fractures of the collarbone or upper arm.
What we look at in your assessment
Your surgeon’s protocol, range of movement, swelling and wound checks, and baseline strength testing once it is safe to test.
How treatment usually starts
Before surgery, prehab builds strength and prepares you for recovery. Afterwards, protected movement comes first, then staged strengthening within your surgeon’s limits, progressed by measured milestones. We communicate with your surgeon throughout, and work collaboratively with exercise physiologists where longer-term conditioning would help.
Related services
Pain spreading from your neck into your shoulder? See neck pain physiotherapy.
Understanding your shoulder
Do I Need Surgery?
Surgery has an important place, especially after a significant injury. For many common shoulder problems, though, high-quality trials have compared surgery with physiotherapy or placebo surgery, and the results are worth knowing before you decide.
Persistent shoulder pain
Subacromial decompression
- What was compared
- Decompression surgery, a placebo arthroscopy where nothing was removed, and no treatment, in 313 people.
- What they found
- Decompression was no better than the placebo operation at 6 months (Beard et al., 2018).
An international guideline now recommends against this surgery for shoulder pain without a significant injury (Vandvik et al., 2019).
Small degenerative tears
Rotator cuff tears over 55
- What was compared
- Physiotherapy alone, physiotherapy with acromioplasty, and tendon repair, in 180 shoulders with small, non-traumatic tears.
- What they found
- Similar results across all three groups at 1 year and after more than 5 years (Kukkonen et al., 2014; Kukkonen et al., 2021).
Physiotherapy is a reasonable first step for these tears. We liaise with orthopaedic surgeons for significant tears, but many can be managed with progressive loading.
Frozen shoulder
Three approaches compared
- What was compared
- Early structured physiotherapy with a steroid injection, manipulation under anaesthetic, and keyhole capsular release, in 503 adults.
- What they found
- None was clinically better than the others at 12 months, and capsular release had more serious adverse events (Rangan et al., 2020).
Physiotherapy with an injection is a valid starting point, and a surgical opinion remains an option if progress stalls.
We communicate with your GP and surgeon, and when surgery is the right choice, we prepare you for it and guide your recovery afterwards.
Your treatment
Five Steps, Each With a Clear Goal
Every consultation is 45 minutes. Your plan is built around what matters to you, whether that is sleeping on your side, reaching overhead at work or getting back in the pool.
- 1
Assess
A detailed history and examination of your shoulder and neck, including screening for anything that needs a medical opinion.
Goal: A clear diagnosis
- 2
Explain
What is causing your pain, what to expect, and which activities are safe to keep doing.
Goal: Confidence to keep moving
- 3
Settle
Hands-on treatment, dry needling where it helps, and changes to your load to calm things down.
Goal: Pain under control
- 4
Strengthen
Progressive exercise for your rotator cuff, shoulder blade and upper body, with VALD dynamometry to measure your strength.
Goal: Strength targets met
- 5
Stay well
A long-term program and a flare-up plan, so you know what to do if pain comes back.
Goal: Managing on your own
Cortisone injections
Where Cortisone Injections Fit
Cortisone (corticosteroid) injections are often offered for shoulder pain. They can ease pain in the short term, but the research shows the benefit fades, so they work best as part of a wider plan rather than on their own.
We do not give injections ourselves, but we often see people who are considering one, and we work with the GP, sports physician or specialist who provides it.
For rotator cuff related pain
A small, short-term benefit
In a trial of 708 people with rotator cuff disorders, a cortisone injection gave a small improvement in pain and function at 8 weeks, but no difference at 12 months (Hopewell et al., 2021).
For frozen shoulder
Used alongside physiotherapy
In the UK FROST trial of 503 adults, early structured physiotherapy with a steroid injection gave results at 12 months similar to manipulation under anaesthetic and keyhole surgery (Rangan et al., 2020).
How we work with injections
Buying time to do the rehab
Any relief from an injection is usually short-term, so we treat it as a window: time bought to build strength, movement and confidence while your pain is lower. We plan your rehabilitation around the injection so you are better prepared when its effect wears off.
The research
What the Research Tells Us
Imaging
Rotator cuff changes are common without pain
A 2025 review of 53 studies found rotator cuff abnormalities in shoulders without pain varied widely between groups. In population-based ultrasound samples, 11% to 17% of people had a full-thickness tear (Sanders et al., 2025).
Guidelines
A strong recommendation against decompression surgery
An international guideline panel recommended against subacromial decompression surgery for adults with shoulder pain lasting more than 3 months without a significant injury (Vandvik et al., 2019).
Rotator cuff tears
Physiotherapy first for small degenerative tears
In 180 shoulders of people over 55 with small, non-traumatic supraspinatus tears, physiotherapy alone, physiotherapy with acromioplasty, and tendon repair gave similar results at 1 year and after more than 5 years (Kukkonen et al., 2014; Kukkonen et al., 2021). In a separate study of 452 people with full-thickness tears not caused by an injury, fewer than 1 in 4 chose surgery within 2 years of starting a physiotherapy program (Kuhn et al., 2013).
Frozen shoulder
It does not always resolve fully on its own
A systematic review found that untreated frozen shoulder improved over 1 to 4 years, but not always completely, and most improvement happened early (Wong et al., 2017).
A scan shows the structure of your shoulder. It does not show how strong, mobile or confident you are. That is why we measure what you can do and build your plan around it.
Fees and funding
Consultations and Rebates
Every consultation is 45 minutes. The number of consultations you need depends on your shoulder and your goals, so we discuss your plan with you at your first visit.
Book an AppointmentWays to claim
- Private health: rebates claimed on the spot with HICAPS
- Medicare: rebates with a GP referral
- Workers compensation: fees set by SIRA, with approvals coordinated with your case manager
- CTP: fees set by SIRA
Common Questions
Do I need a scan before I see a physio?
Usually not. Most shoulder pain can be assessed and treated without imaging, and changes such as tendon tears are common in shoulders without pain (Sanders et al., 2025). If you have sudden weakness after an injury, or your assessment suggests a scan would change your plan, we arrange it through your GP or specialist.
Should I get a cortisone injection for my shoulder?
It depends on your symptoms, and it is a decision for you and your doctor. For rotator cuff related pain, the benefit is usually small and short-term (Hopewell et al., 2021), so if you do have one, we use the period of lower pain to build strength and movement. We are happy to talk it through with you and your GP or specialist.
Do I need surgery for a rotator cuff tear?
Not always. For small degenerative tears in people over 55, physiotherapy alone gave similar results to surgery after more than 5 years (Kukkonen et al., 2021), and in people with full-thickness tears not caused by an injury, fewer than 1 in 4 chose surgery within 2 years of starting physiotherapy (Kuhn et al., 2013). We liaise with orthopaedic surgeons for significant tears, but many can be managed with progressive loading.
Will my frozen shoulder get better on its own?
Many people improve over time, but research shows it does not always resolve fully without treatment, and most improvement happens early (Wong et al., 2017). Treatment aims to ease pain and keep you moving while the shoulder settles.
How many sessions will I need?
It depends on your shoulder, how long you have had symptoms and your goals. We give you an estimate at your first visit and review it as you meet each step’s goal.
Do you work with my surgeon?
Yes. We communicate with your surgeon, GP and anyone else involved in your care, follow your surgeon’s protocol after an operation, and offer prehab before surgery.
Can I claim my physio through private health?
Yes. Rebates are claimed on the spot with HICAPS. Medicare rebates are available with a GP referral, and workers compensation and CTP claims are accepted once approved.
What research is this page based on?
- Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329–338.
- Hopewell S, Keene DJ, Marian IR, Dritsaki M, Heine P, Cureton L, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet. 2021;398(10298):416–428.
- Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371–1379.
- Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EKJ, Kauko T, Äärimaa V. Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results. Bone Joint J. 2014;96-B(1):75–81.
- Kukkonen J, Ryösä A, Joukainen A, Lehtinen J, Kauko T, Mattila K, Äärimaa V. Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial. J Shoulder Elbow Surg. 2021;30(11):2455–2464.
- Rangan A, Brealey SD, Keding A, Corbacho B, Northgraves M, Kottam L, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020;396(10256):977–989.
- Sanders SL, Ibounig T, Haas R, Jones MA, Rämö L, Docking S, Järvinen TLN, Taimela S, Hoffmann TC, Buchbinder R. Rotator cuff imaging abnormalities in asymptomatic shoulders: a systematic review. J Orthop Sports Phys Ther. 2025;55(12):736–751.
- Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296–299.
- Vandvik PO, Lähdeoja T, Ardern C, et al. Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. BMJ. 2019;364:l294.
- Wong CK, Levine WN, Deo K, Kesting RS, Mercer EA, Schram GA, Strang BL. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017;103(1):40–47.
- Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016;6(1):26–34.
- Clinically reviewed by David Cohen and Zachary Ehrenfeld, APA Musculoskeletal Physiotherapists and Directors of Vantage Point Physiotherapy. Last reviewed October 2026.
