“Does it work?” is the question people ask first, and we have covered it in our explainer on what the shoulder research supports. Once someone has booked, the questions get more practical: what actually happens, how long does it take, and how will I know if it is working?
Here is the whole sequence.
Visit one: we examine before we treat
The first appointment is mostly assessment, and it is deliberately unhurried.
We want the history: when it started, what changed in your activity around that time, what makes it worse in a specific and reproducible way, whether it wakes you at night, what you have already tried. “It hurts to reach overhead” and “it hurts constantly regardless of position” point in different directions.
Then the examination: range of motion, strength through specific movement patterns, and the tests that help separate a rotator cuff problem from subacromial pain, a stiff capsule, or pain referred from the neck. That last one matters more than people expect. A neck-driven shoulder will not improve with treatment aimed at the shoulder, and finding that out in week one is far better than finding it out in week six.
If your history includes significant trauma, sudden loss of strength, or anything that suggests the problem is not a tendon, we will say so and direct you toward imaging or the appropriate specialist rather than starting a course.
We agree what we are measuring — before anything else
This is the part most clinics skip, and it is the part that protects you.
At the first visit we record:
- Pain on a 0–10 scale, at rest and on the movements that specifically provoke it.
- Range of motion, in degrees, in the directions that are limited.
- A function measure — a short validated shoulder questionnaire, so we are tracking what you can do rather than only how it feels.
- The one thing you most want back. Sleeping on that side. Reaching a high shelf. Getting through a round of golf. We write it down.
We repeat these through the course. If the numbers are not moving, that is information, and it should change the plan rather than be absorbed into a longer package. Every visit gets scored for this reason.
What a treatment session is like
The light therapy portion of a session is undramatic, and we would rather say that plainly than build it up.
You sit or lie with the shoulder exposed and supported. The applicator is held in contact with the skin over specific points — the tendon insertions and structures identified on your examination, not vaguely over the whole shoulder. Each point takes tens of seconds, and the whole application usually runs five to fifteen minutes.
Most people feel very little; some notice mild warmth. It is not painful. You wear eye protection, and so do we. There is no downtime afterwards. The appointment itself is longer, because the exercise review is part of it.
The parameters, and why we write them down
Before treating, we set and record wavelength, output power, energy delivered per point, number of points and total energy for the session, along with exactly where each point was placed.
There is a reason for that bookkeeping. In the shoulder meta-analysis of seventeen randomized controlled trials, adequately dosed treatment produced clinically important pain relief — a weighted mean difference of 20.41mm over placebo as monotherapy, and 16.00mm as an adjunct to exercise therapy, on a 100mm pain scale. The benefit tracked closely with whether the dose was adequate.
The same lesson appears in the knee literature, where doses following international dosing recommendations produced 18.71mm of pain reduction against 6.34mm for doses outside them.
Recorded parameters mean your course can be reviewed and adjusted deliberately. Unrecorded parameters mean nobody can tell whether an unsuccessful course was the wrong treatment or the right treatment delivered badly.
Haslerud S, et al. Physiother Res Int. 2015;20(2):108–125. PMID 25450903 · Stausholm MB, et al. BMJ Open. 2019;9(10):e031142. PMID 31662383
The exercise is the treatment. The rest supports it.
This is an adjunct with modest, real effects — it works alongside exercise and rehabilitation rather than replacing them.
Your loading programme is the part that changes what the tendon can tolerate. It will be specific, progressive, and mildly uncomfortable in a way we will explain, and it will take weeks. Nothing we do in the clinic removes the need for it.
What the in-clinic work is for is making the programme achievable — reducing pain enough that you can do the loading properly, sleep well enough to recover, and stay with it long enough for it to work. Adherence is the single biggest predictor of how these courses go, in our experience, and pain is the single biggest threat to adherence.
So a typical session includes reviewing what you did since last time, adjusting the load, and troubleshooting whatever got in the way.
To be explicit about the regulatory position: we are not citing a device clearance for treating rotator cuff tendinopathy, and we do not present light therapy as an approved treatment for that diagnosis. It is used here as an adjunct for pain within a rehabilitation plan.
How long a course runs
A usual course is two to three sessions a week for four to six weeks, then a review.
Two things about the timeline are worth knowing in advance.
First, improvement is rarely linear. A good week followed by a flat week is ordinary, particularly when the exercise load has just been stepped up.
Second, and more usefully: in the knee trials, the largest pain reduction was recorded two to four weeks after the treatment course had finished, not on the final treatment day. We would not promise you the same timing for a shoulder — different joint, different trials — but it is a good reason not to judge the outcome on the last appointment. We schedule a review after the gap for exactly that reason.
What we do at the review
We re-measure everything from visit one and compare it against the starting numbers, then take one of three decisions:
- Better and holding — we taper the clinic visits and hand the programme over to you, with a plan for maintaining it.
- Better but incomplete — we discuss whether a further block is justified, based on the trajectory rather than on hope.
- Not moving — we stop, and we reconsider the diagnosis. Continuing to sell sessions into a flat curve is not something we are willing to do.
Questions worth asking us, or any clinic
- What do you think is causing my shoulder pain specifically, and what would change your mind?
- What are you measuring, and when will we look at it again?
- What parameters are you using, and why those?
- What is my exercise programme, and how does it progress?
- What would make you stop treating and refer me on?
A clinic that answers those readily is a clinic worth your money. If you would like a shoulder assessed properly, you can book a consultation with us in Oklahoma City.
This article is general education, not medical advice, and it is not a substitute for evaluation by a qualified clinician. It does not establish a physician–patient relationship. Individual results vary, and the studies described report group averages rather than what any one person should expect. Treatments discussed may not be FDA-cleared or approved for the conditions mentioned; where that is the case it is stated in the text. Talk to your own physician before starting, stopping or changing any treatment.
