A Guide to Physical Therapy for Rotator Cuff Tendinitis
Shoulder pain is a common complaint, affecting up to 30% of the population at any given time. Approximately half of those reporting pain will still have complaints three years later.1
Rotator cuff tendinitis is a common injury that can occur from overuse or repetitive motions. This condition can cause pain and stiffness in the shoulder, making it difficult to move the arm with your everyday activities.
Working with a CityPT clinician is one of the top treatments for rotator cuff tendinitis.2 In this guide, we will discuss the symptoms, causes, diagnosis, conservative treatment, and how to prevent rotator cuff tendinitis and tendinopathy.
- Understanding Rotator Cuff Tendinitis
- Symptoms of Rotator Cuff Injury
- What are the Most Common Causes of Rotator Cuff Pain?
- Diagnosing a Rotator Cuff Injury
- What to Expect from Physical Therapy
- What If Conservative Treatment Doesn't Work?
- Preventing Shoulder Pain
- Is It Time to Seek Treatment?
The rotator cuff is a group of four muscles and tendons that stabilize the shoulder joint. At a basic level, they attach the arm bone (humerus) to the shoulder blade (scapula). These muscles — the supraspinatus and infraspinatus, subscapularis, and teres minor — work together to keep the ball and socket joint in an optimal position with arm movement.
The rotator cuff muscles and tendons are vulnerable to overuse injuries from repetitive motions or from sudden injury. When the rotator cuff is injured, it can lead to issues like rotator cuff tendinitis, a tear, and/or tendinopathy.
Rotator Cuff Tendinitis vs Tendinopathy
Tendinitis and tendinopathy are often used interchangeably. However, they have different underlying mechanisms. Understanding this can help drive effective treatment.
With tendinitis, the tendons often become swollen and irritated due to mechanical overuse or an acute injury. In contrast, with tendinopathy, there are changes in tendon structure due to chronic overuse. These structural changes can be from things like collagen breakdown, poor blood supply, or microtears in the tendons.
Rotator cuff tendinopathy is the most common cause of shoulder pain complaints.3
Most often, rotator cuff pain starts mildly and progresses over time. If the underlying mechanism is not understood or addressed, it can lead to a gradual increase in pain. As pain increases, tolerance for daily activity reduces. Thus, muscle strength, range of motion, and coordination will be compromised over time.
More specific symptoms of rotator cuff tendinitis or tendinopathy that often occur include:
- Pain — typically achy in nature — especially at night if lying on the affected shoulder
- Tenderness to touch along the affected muscle
- Weakness in the shoulder with elevation
- Stiffness and trouble coordinating movement in the shoulder (getting progressively worse with tendinopathy)
- Difficulty moving the arm, particularly overhead and behind the back
- Localized swelling (common with tendinitis)
There are many potential causes of rotator cuff pain, but the most common include:
- Repetitive overhead motions, especially when done without adequate rest or in awkward positions
- Sudden injury or fall
- Faulty biomechanics (leading to shoulder impingement)
- Poor sleeping position (e.g. lying on the affected shoulder)
- Muscle imbalances around the shoulder
- Arthritis in the shoulder joint
Additionally, certain factors increase your risk for rotator cuff tendinitis or tendinopathy. These include:4
- Age (50 years or older)
- Diabetes and other metabolic disorders
- Changes in shoulder mechanics or general stiffness
- Certain sports that require repetitive overhead motion, such as baseball and swimming
If you're dealing with shoulder pain and want some answers, it's time to find a physical therapist. A CityPT shoulder specialist can conduct a full evaluation to determine the root cause of your pain.
During the evaluation, your therapist will take a thorough history of your symptoms and ask you questions about how your shoulder feels during different activities. They'll also perform a series of tests that assess muscle strength, range of motion, coordination, and other areas of concern. Plus, they'll conduct special tests to rule out other potential causes of shoulder pain.
All this information helps your therapist arrive at an accurate diagnosis. If needed, they can refer you back to your doctor for imaging or other diagnostics and prescriptions if they suspect something else is causing your shoulder pain.
Remember, you do not need a referral to see a physical therapist. You can schedule an appointment as soon as possible to start getting shoulder pain relief.
Once a diagnosis is made, your CityPT therapist will develop a personalized treatment plan to address your specific needs. In most cases, rotator cuff injuries respond well to conservative (nonsurgical) treatment.
Treatment options that you will encounter include:
- Education: Most importantly, you will learn all about your injury and how to effectively manage it and prevent future flares.
- Manual therapy techniques: Including soft tissue work, joint mobilization, and dry needling to help reduce pain and improve range of motion.
- Exercises: To stretch and strengthen the muscles around the shoulder with a focus on optimal shoulder positioning to reduce the incidence of rotator cuff strain.2
- Modalities: Such as heat or cold therapy, electrical stimulation, or ultrasound, to help reduce pain short term and improve tolerance for exercises.
- Biomechanical training: Providing you with guidance on how to improve any faulty movement patterns or postures that are compromising shoulder tissue health.
You can typically expect to see improvements in your shoulder pain and function within a few weeks of starting physical therapy.
In some cases, conservative treatment for rotator cuff tendinitis or tendinopathy doesn't provide enough relief. If this is the case for you, your therapist may recommend other options in conjunction with your care. However, evidence is limited on the efficacy of these options and should be a last resort.
- Platelet-rich plasma (PRP) injections: A concentration of growth factors and other healing cells are injected into the rotator cuff tendon to promote healing. This treatment has promising evidence available, when compared to other injections.5
- Pain medications: Such as anti-inflammatories (NSAIDs)
- Surgery: If all else fails, your doctor may recommend surgery to "repair" or debride the damaged rotator cuff tendon.6
The best way to avoid shoulder pain is to take steps to prevent it in the first place. Let's review some tips for keeping your shoulders pain-free:
- If you have a job or participate in activities that require repetitive overhead motions, make sure to warm up properly and stretch your shoulder muscles before beginning.
- Focus on optimal shoulder mechanics when performing any overhead motions. If relevant, modify and reduce your need for excessive overhead reaching.
- Take regular breaks to give your shoulders a rest (at least a few minutes every hours, if not more).
- Using good form when lifting weights to avoid strain on the rotator cuff muscles and tendons.
- If you experience any shoulder pain, don't ignore it! Modify and pay attention to what is aggravating it.
- Exercise regularly, consistently including stretching and strengthening the shoulder, neck, and mid-back
- Take care of your overall health. This includes managing any chronic diseases, getting enough sleep, adequate stress management, hydration, and a nutrient-dense diet.
Shoulder pain can put a serious damper on your day-to-day routine. Ignoring it and hoping it will go away can lead to a gradual progression of symptoms that can feel eventually feel overwhelming and hard to manage. You can take back control by learning what to do for pain management and boosting overall tissue health.
Book an appointment with one of our experts at CityPT to start getting shoulder relief as soon as today.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Lewis JS. Rotator Cuff Tendinopathy/Subacromial Impingement Syndrome: Is it Time for a New Method of Assessment? Br J Sports Med 2009;43(4):259-64 ↩
Littlewood C, May S, Walters S. A Review of Systematic Reviews of the Effectiveness of Conservative Interventions for Rotator Cuff Tendinopathy. SAGE. 2017; 5(3) https://doi.org/10.1111/sae.12009 ↩ ↩2
Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, et al. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. Journal of experimental orthopaedics. 2017;4(1):18. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449348/ [Accessed October 12, 2022] ↩
Physiopedia. Rotator Cuff Tendinopathy. Physiopedia.com. Accessed October 12, 2022 https://www.physio-pedia.com/Rotator_Cuff_Tendinopathy ↩
Scarpone M, Rabago D, Snell E, DeMeo P, Ruppert K, Pritchard P et al. Effectiveness of platelet-rich plasma Injection for rotator cuff tendinopathy: a prospective Open-label study. Glob Adv Health Med. 2013; 2(2): 26–31. ↩
Coghlan JA, Buchbinder R, Green S, Johnston RV, Bell SN. Surgery for rotator cuff disease. Cochrane Database Syst Rev 2008;(1):CD005619 ↩