The shoulder is the second most common cause of physical pain after the lower back. Although problems in this area can be caused by injury and overuse, by far the most common source of pain is imbalance in muscle strength and flexibility. This often comes on gradually, causing pain while sleeping, or when using the arm to reach up over shoulder height. Over the counter medication and cortisone injections are frequently used to reduce pain, however, these are not lasting solutions. Proper assessment and treatment often leads to complete resolution of the problem without the need for ongoing care, and prevents more debilitating degeneration.