How McFerran Physio Helped a Patient Overcome AC Joint Shoulder Pain and Return to Full Gym Training

Introduction
Shoulder pain is one of the most common reasons people seek physiotherapy — particularly active individuals and gym-goers. In this case study, we explore how McFerran Physio helped a patient with AC (acromioclavicular) joint pain regain pain-free movement, restore sleep quality, and return to full gym activity.

Patient Background
The patient, a 52-year-old man, had been experiencing shoulder pain for 6–8 weeks. Though he worked a desk-based job involving a lot of driving, he was fit and active — regularly attending the gym for weightlifting and staying generally healthy through exercise and walking.

His primary complaint was pain during certain gym activities, particularly:

• Overhead exercises (e.g. military press)
• Bench press movements

In daily life, his symptoms were tolerable. However, he experienced significant night pain when lying on his right side — often waking from sleep and requiring painkillers, anti-inflammatory medication, ice, heat, and topical gels to manage the discomfort.

Assessment & Diagnosis

Subjective Findings

• No red flags for sinister pathology.
• No signs of referred pain from internal organs.
• Pain predominantly triggered by mechanical loading of the shoulder in specific positions.

Objective Findings

• Full range of motion
• Normal strength
• Cervical spine clear (no nerve root or radicular symptoms)
• Pain specifically reproduced:
  • At end-range shoulder elevation and abduction
  • Localized pinpoint tenderness over the AC joint

Special Test

• Scarf test: Elbow brought across the chest → reproduced AC joint pain

Scarf Test for AC Joint | Shoulder Exam | SIMON MOYES

Diagnosis

AC joint pain (acromioclavicular joint inflammation) confirmed through both clinical examination and provocative testing.

Treatment Approach

The initial treatment goal was to reduce pain and maintain function, allowing the patient to remain active and engaged in gym-based exercise while addressing the root cause of symptoms.

Exercise Modifications

• Overhead press → changed to landmine press (reduced elevation angle, no pain)
• Bench press → changed to floor dumbbell press (prevented end-range extension)

Strengthening Focus

• Rotator cuff strengthening
• Scapular stability exercises

These adjustments allowed the patient to resume gym training without aggravating the AC joint. His pain levels dramatically improved during exercise, and gym sessions became enjoyable again.

Persistent Symptoms & Imaging Referral

Despite good progress, the patient continued to experience night pain — an indicator that underlying inflammation may still be present. After 3–4 physiotherapy sessions, it became clear that further investigation was warranted.

At McFerran Physio, our philosophy is to avoid unnecessarily prolonging treatment if symptoms plateau. We offer direct referral pathways to leading private hospitals in Bristol — Nuffield Hospital (Bristol Hospital, Private Hospital in the South West | Nuffield Health) and Spire Hospital (Private Hospital in Bristol, Gloucestershire | Spire Bristol Hospital) — allowing for expedited imaging and intervention without needing to route back through the patient’s GP.

Referral Outcome

• Referred for ultrasound scan at Nuffield Hospital.
• Ultrasound confirmed inflammation of the AC joint.
• Steroid injection administered during scan → immediate resolution of pain.

Patient Outcome

Following the steroid injection:

• Night pain resolved completely.
• Patient returned to full gym activity, including:
  • Military press
  • Bench press
• Continues to maintain shoulder health through ongoing rotator cuff and scapular stability work
• Pain-free and fully functional in all activities.

Conclusion

This case highlights an important point:
While manual therapy and exercise-based rehabilitation are effective for many shoulder issues, there are instances where imaging and adjunctive interventions — such as steroid injections — are appropriate.

At McFerran Physio, we offer a comprehensive approach:

• Expert assessment
• Evidence-based physiotherapy
• Direct access to private imaging and injections when needed

If you’re experiencing shoulder pain, struggling with night pain, or want guidance on safe training with an injury, McFerran Physio can help.
Book your assessment today.