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Shoulder aches that hit suddenly – from a bad movement, a night of awkward sleeping, or overdoing it at the gym – respond well to immediate treatment. The first 48 hours matter. Get the protocol right and you’re probably functional again within a few days. Ignore it and you risk turning an acute problem into a chronic one. Here’s what to do, in roughly the order you should do it.
Use the RICE Method
Rest, Ice, Compression, Elevation. First response to any acute shoulder pain. Stop whatever caused it. Ice the area. Wrap it with an elastic bandage if there’s swelling (snug but not tight enough to cut off circulation). Prop your arm on pillows when sitting or resting to reduce fluid pooling at the injury site.
RICE works because it tackles acute injury from multiple angles at once. Compression limits swelling. Elevation drains fluid away from the joint. Combined with ice and rest, you’re giving the shoulder the best possible environment to settle down quickly. Most acute injuries respond visibly within 24-48 hours of consistent RICE.
Ice
Wrap an ice pack in a thin cloth and hold it on the painful area for 15-20 minutes. Don’t apply ice directly to skin – you’ll get frostbite faster than you’d expect, especially if you fall asleep with it on. Ice reduces swelling and numbs the area, which is the whole point in the first 48 hours when inflammation is active.
Repeat every 2-3 hours while awake for the first day or two. If the shoulder is particularly swollen, keep up 20-minutes-on, 20-minutes-off cycles. The goal is cold without prolonged direct skin contact.
Switch to Heat
After 48 hours, ice stops being the right tool. The initial inflammation has peaked and the goal shifts to increasing blood flow for healing. Heating pad, hot water bottle, or a long hot shower with the water aimed at the shoulder – 15-20 minutes at a time, several times a day.
Heat relaxes tight muscles and eases stiffness that sets in after injury. If heat makes the pain worse, you switched too early. Go back to ice for another day and try again.
Epsom Salt
Once you’re in the heat phase, an Epsom salt bath layers magnesium absorption on top of the warmth. Two cups of Epsom salt in a hot bath, soak for 20 minutes. Magnesium sulfate absorbs through skin and can help relax tight muscles.
The evidence for transdermal magnesium absorption is debated, but the combination of heat, buoyancy reducing mechanical load on the joint, and forced rest time genuinely helps regardless of whether the magnesium part is doing anything. You’re not losing anything by trying it.
Use Anti-Inflammatory Medication
Ibuprofen (Advil, Motrin) or naproxen (Aleve) reduce both pain and inflammation. These aren’t just painkillers – they target the inflammatory process that’s causing the problem. Follow dosing instructions. For acute shoulder injuries, they work better taken on a regular schedule for 3-5 days rather than just when pain spikes.
If you can’t take NSAIDs due to stomach issues, kidney concerns, or medication interactions, acetaminophen handles pain but doesn’t touch inflammation. Better than nothing, but not the same tool.
Try a Topical Pain Reliever
Creams and gels with menthol (Biofreeze, Icy Hot), capsaicin, or topical NSAIDs (diclofenac gel) provide localized relief without affecting your whole system. Rub directly onto the sore area. Menthol and capsaicin work by overwhelming the nerve signals that transmit pain – the cooling or warming sensation essentially drowns out the ache. Topical diclofenac is an anti-inflammatory that absorbs into the tissue directly.
These work best for muscle pain rather than deep joint problems. You’ll know within a day if it’s helping. If it’s just making your shoulder smell like a sports complex without doing anything useful, move on.
Use Arnica Cream
Arnica montana is a plant extract with a long history in European folk medicine for muscle pain, bruising, and joint aches. Apply arnica gel or cream directly to the shoulder three times a day. It’s supposed to reduce inflammation and bruising through compounds that inhibit certain inflammatory pathways.
Scientific evidence is mixed – some trials show benefit for muscle soreness and bruising, others find minimal effect. But it’s safe (unless you’re allergic to plants in the daisy family, like ragweed), widely available, and enough people find real relief that it’s a reasonable add-on if conventional options aren’t covering it completely.
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