Shoulder Pain and a Client Who Wants to Keep Playing
Priya is 62 and plays golf three times weekly; she is entered in a club championship in three weeks. She reports right shoulder pain for six weeks, worse when reaching overhead and when lying on that side. Pain is 5/10 at night and wakes her about twice weekly. She also notices intermittent tingling in the ring and little fingers. There was no trauma, fever, or unexplained weight loss. She has been taking over-the-counter ibuprofen. Observation shows she guards the right arm during the overhead squat and cannot reach full shoulder flexion. Cervical rotation is 55° right and 65° left; shoulder active flexion is 105° with pain at end range. She asks you to "fix it" with stretches and to keep her swinging so she does not lose her place in the event.
1. Decide whether to continue training this client as planned. What findings drive your decision, and what is your scope of practice?
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Do not continue the planned golf-specific loading today. The combination of night pain that wakes her, pain at rest, upper-extremity tingling in the C8–T1 distribution, and a painful end range is beyond a fitness professional's scope. These are not findings to treat with stretching; they require medical or physical therapy evaluation. Age alone is not a red flag, but the neurological symptom and night pain are. I would not diagnose a rotator cuff or cervical issue. I would document the findings, explain the concern, and refer.
2. If she is cleared for exercise with restrictions, what would a safe session look like?
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Keep sessions pain-free: lower-body strength, aerobic conditioning, and gentle thoracic and hip mobility that does not provoke the shoulder. Avoid overhead pressing, behind-neck movements, heavy pulling into pain, and end-range shoulder flexion. Do not aggressively stretch the shoulder to "gain range." Use pain as a guide: keep symptoms at or below 2/10 and stop if tingling occurs. Keep golf swing volume low or hold it until cleared. Coordinate with her clinician and follow any written restrictions.
3. How would you communicate the decision and document it?
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Say plainly: "Your night pain and tingling need a medical look before I load that shoulder. I can keep your legs and conditioning going, but I cannot diagnose or treat this." Document the subjective findings, the objective screening results, the decision not to train the shoulder, and the referral. Give her a written summary and ask her to bring clearance or restrictions. Reassess when she returns. Do not promise she will be ready for the championship.