Conditions · Shoulder pain

Shoulder Pain Treatment in Midtown NYC

For shoulder pain that hasn’t settled with rest, a cortisone shot, or a standard exercise sheet.

Hiro Nakano, DC, DACBSP · USA Fencing medical staff · 2021 Tokyo Olympic Games, Team USA volunteer medical staff


Does this sound like you?

  • It hurts to reach overhead, behind your back, or into the back seat.
  • Pain wakes you up when you roll onto that side.
  • Your shoulder is getting stiffer, not looser.
  • An MRI showed a rotator cuff tear or a labral tear, and you’re not sure surgery is the answer.
  • A cortisone shot helped — for a few weeks.
  • Your neck or elbow has been bothering you too.

Most of the shoulders I see are frozen shoulder, rotator cuff tendinopathy or tears, and labral tears. Most of the people attached to them work at a desk and still try to stay active — lifting, swimming, tennis, golf. You don’t need to be an athlete to start.


What’s wrong: a diagnosis, not a scan hunt

A clear diagnosis matters. But I usually work from a differential diagnosis — a short, ranked list of what’s most likely going on. If the treatment would be the same for each possibility, running test after test to pin down one name doesn’t help you get better.

Imaging can also point the wrong way. Most adults — and almost every former athlete — show something on a shoulder MRI, whether it hurts or not.

What the research shows: in a village-wide ultrasound screening in Japan, about 65% of people with a rotator cuff tear had no symptoms.[1] Even a full-thickness tear doesn’t always mean surgery: of 452 people with tears that didn’t come from an injury, about 75% treated with a physical therapy program avoided surgery at two years — and roughly three in four still hadn’t needed it at ten.[2]

What the research shows: in an MRI study of 53 people aged 45–60 with no shoulder pain, two radiologists found a labral tear in 55% and 72%.[3] And in a trial of 118 people with a common type of labral tear (SLAP), repair and biceps surgery did no better than sham surgery.[4]

So we treat the most likely cause first. If you improve, good. If you don’t, that’s when I order X-rays or an MRI directly, or refer you for more aggressive treatment.


Why it happened: the part most people skip

“You’re getting older.” “You overdid it.” “You didn’t warm up.” Those can all be true — but they’re rarely the whole answer.

The real problem usually sits deeper, in how your body works. So I look at function: stability, mobility, coordination, balance, and posture — and how your shoulder blade, trunk, and legs share the load with your arm.

What the research shows: how the shoulder blade sits and moves is closely tied to shoulder injury, and an international expert consensus recommends assessing it — along with the trunk and legs that drive it — as part of treatment.[5]

Very few clinics look this far past the shoulder joint, and it’s often the missing piece when exercises alone haven’t worked. Sometimes it’s not mechanical at all: poor sleep or nutrition can keep tissue from healing, no matter how good the exercises are.

Find what is wrong, then why it happened. That’s where my treatment starts.


How I treat it

Hands trained for four generations

My great-grandfather opened our family’s hands-on clinic in Japan in 1926. I trained and treated patients there before moving to the U.S. Hands-on care — joint mobilization and soft-tissue work chosen from that day’s exam — is the core of what I do. For a stiff, painful shoulder, it’s often what gets movement back fastest.

Olympic-level sports medicine

I’m a Diplomate of the American Chiropractic Board of Sports Physicians, and I traveled with the U.S. team as a volunteer member of the medical staff at the 2019 Pan American Games in Lima and the 2021 Tokyo Olympic Games. Since 2018, I’ve also worked with USA Fencing, joining national team training camps two to three times a year as part of the medical staff. An athlete’s shoulder is rebuilt from the ground up — legs, trunk, shoulder blade, then the arm. Your shoulder gets the same process. Most of the people I see aren’t athletes — and they don’t need to be.

One doctor, the whole picture

Shoulder pain often travels with the neck or elbow, and sometimes the shoulder isn’t the source at all. I see every patient myself and check what’s above and below the shoulder. Hands-on care, exercise, and changes to how you work and train come from one plan, not separate providers.


Why not just a cortisone shot — or just an exercise sheet?

A cortisone shot can calm a painful shoulder. But the relief is usually short.

What the research shows: across 11 placebo-controlled trials (726 patients) of rotator cuff tendinopathy, steroid injections gave a small pain benefit at 4–8 weeks that was gone by three months, and repeat injections did no better than one.[6] Steroids also weaken tendon tissue.[7] In a one-year trial, people treated with injections ended up no better than those treated with hands-on care and exercise — but were nearly twice as likely to need another injection.[8] And two or more injections before rotator cuff surgery have been linked to a higher chance of needing the surgery redone.[9]

Current guidelines put exercise at the center of care, with hands-on treatment added to ease pain in the short term.[10] But exercise isn’t “three sets of ten” for everyone. A frozen shoulder, an irritated tendon, and an unstable joint need very different work — and so do a 35-year-old who lifts and a 60-year-old who hasn’t exercised in years. I build or modify each exercise around your symptoms, your history, and your life.


Not sure if this fits your situation?

Send me a text and tell me what’s going on. Most questions are easier to answer once we talk.


What working with me looks like

First visit

About 90 minutes: history, an exam of your shoulder, neck, and elbow, a plain-language explanation, hands-on treatment, and exercises to start right away. You get a written summary of the plan.

While it hurts

Hands-on care to ease pain and restore motion, with exercises adjusted to what your shoulder can handle now. Many people notice a change within the first visit or two. Most come weekly at first, then every two weeks.

Rebuilding

We work on the shoulder blade, trunk, and legs along with the shoulder itself, so the arm isn’t doing all the work. The exercises change as you do.

Getting strong

The goal isn’t just “no pain.” It’s being able to pick up dumbbells, lift weights, and carry what life asks of you — without your shoulder hurting.

What the research shows: people who do muscle-strengthening activities have about a 10–17% lower risk of death from any cause.[11]

After the pain is gone

For many people, a painful shoulder becomes the reason they finally start strength training — and stick with it. Many come in every two to four weeks to treat what needs attention and update the plan. Some finish when they feel good; others have kept it up for years.


Common questions

You treat Olympic athletes. Is this really for someone like me?

Yes — most of the people I see aren’t athletes. What carries over from sports medicine is the process: careful assessment, treating the cause, and building back step by step. For most people the path is simpler than for an Olympian, and helping someone who hasn’t lifted a weight in years get strong is some of the most rewarding work I do.

My MRI shows a rotator cuff tear. Do I need surgery?

Not always. Many tears — even full-thickness ones — respond well to treatment and exercise.[2] Some do need a surgeon, especially after a sudden injury with major weakness. I’ll tell you which group you’re likely in, and refer you if surgery makes sense.

Should I get a cortisone shot?

It can help a very painful shoulder settle for a few weeks, but it doesn’t fix why it hurt.[6] If you’ve had one, use that window to start rebuilding strength. We can talk through whether it makes sense for you.

How long does a frozen shoulder take?

Often many months, and it moves through stages. Hands-on care and the right exercises can ease pain and keep motion improving along the way, so you’re not just waiting it out.

Is it my shoulder or my neck?

It can be either — or both. Pain that runs down the arm, tingling, or pain that changes with neck movement often points to the neck. I check both at the first visit.

When should I see a doctor right away?

Go to the ER if shoulder or arm pain comes with chest pain, shortness of breath, or sweating. See a doctor promptly if your shoulder looks deformed after a fall, you suddenly can’t lift your arm, the shoulder is red, hot, and swollen with a fever, or numbness and weakness are spreading.


Related reading

Neck Pain Treatment · Pain Is a Result, Not a Cause · Posture and Pain · Foundations: From Pain to Function · The Recovery & Movement Map


Ready to get back to what matters?

You don’t need to be fit or confident to start. Tell me what’s bothering you and what you want to be able to do again.


References

  1. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. J Orthop. 2013;10(1):8-12. PubMed
  2. Kuhn JE, Dunn WR, Sanders R, 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. PubMed
    Kuhn JE, Dunn WR, Sanders R, et al. The predictors of surgery for symptomatic, atraumatic full-thickness rotator cuff tears change over time: ten-year outcomes of the MOON Shoulder prospective cohort. J Bone Joint Surg Am. 2024;106(17):1563-1572. PubMed
  3. Schwartzberg R, Reuss BL, Burkhart BG, et al. High prevalence of superior labral tears diagnosed by MRI in middle-aged patients with asymptomatic shoulders. Orthop J Sports Med. 2016;4(1):2325967115623212. PubMed
  4. Schrøder CP, Skare Ø, Reikerås O, Mowinckel P, Brox JI. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med. 2017;51(24):1759-1766. PubMed
  5. Kibler WB, Ludewig PM, McClure PW, et al. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the “Scapular Summit.” Br J Sports Med. 2013;47(14):877-885. PubMed
  6. Mohamadi A, Chan JJ, Claessen FM, Ring D, Chen NC. Corticosteroid injections give small and transient pain relief in rotator cuff tendinosis: a meta-analysis. Clin Orthop Relat Res. 2017;475(1):232-243. PubMed
  7. Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570-576. PubMed
  8. Rhon DI, Boyles RB, Cleland JA. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Ann Intern Med. 2014;161(3):161-169. PubMed
  9. Desai VS, Camp CL, Boddapati V, Dines JS, Brockmeier SF, Werner BC. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy. 2019;35(1):45-50. PubMed
  10. Desmeules F, Roy JS, Lafrance S, et al. Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: a clinical practice guideline. J Orthop Sports Phys Ther. 2025;55(4):235-274. PubMed
  11. Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-763. PubMed