Body Composition, Strength, Mobility, and Posture Associated with Shoulder Pain and Disability in Community-Dwelling Older Adults: A Narrative Review.

Shoulder pain ranks among the leading causes of functional decline in older adults, affecting approximately one in five community-dwelling individuals and contributing to loss of independence and reduced quality of life. Despite its prevalence, shoulder pain in this population is frequently underreported and poorly understood beyond structural pathology, limiting early identification and targeted intervention. This narrative review synthesizes current evidence on the associations between four interrelated physical domains, body composition, grip and shoulder muscle strength, cervical-shoulder range of motion (ROM), and postural alignment, with particular emphasis on forward head posture and shoulder pain and disability in community-dwelling adults aged 60 years and older. A structured search of major electronic databases, including PubMed and Web of Science, was conducted using predefined eligibility criteria and keyword combinations linking shoulder pain and disability with each physical domain. Additional primary studies were identified through manual reference screening of key articles and citation tracking. Evidence was synthesized thematically, highlighting patterns of association, methodological inconsistencies, and contradictions across studies. Findings indicate that higher adiposity, reduced lean mass, shoulder and grip strength deficits, restricted glenohumeral and cervical ROM, and postural deviations are each associated with greater shoulder pain and disability. However, the evidence is not uniformly consistent: associations between Body Mass Index and shoulder ROM are largely absent at moderate adiposity levels, resting postural deviation does not reliably distinguish individuals with shoulder pain from those without, and the causal direction between strength deficits and postural deterioration remains debated. Despite these contradictions, emerging evidence suggests that these domains may interact with one another, and the literature collectively supports an integrated, multifactor assessment framework over single-variable approaches for the evaluation and management of shoulder dysfunction in community-dwelling older adults. Evidence quality was not formally assessed, and evidence for forward head posture specifically in older adults remains limited and largely indirect, drawn mainly from younger populations.