Shouldering the Pain: Understanding Rotator Cuff Tendinopathy

Introduction

Rotator cuff tendinopathy is one of the most common causes of shoulder pain, especially in people who perform repetitive overhead activities. It’s estimated that up to 30% of adults will experience rotator cuff-related shoulder pain at some point in their lives. This condition can significantly interfere with daily activities like reaching, lifting, dressing, and sleeping comfortably.

Causes and Risk Factors

Common Causes:

Rotator cuff tendinopathy is typically caused by repetitive strain or overuse of the shoulder muscles and tendons. It can also result from acute injuries or poor shoulder mechanics that lead to tendon irritation and degeneration over time.

Risk Factors Include:

  • Repetitive overhead activities (e.g., painting, swimming, throwing sports)

  • Occupations involving frequent lifting or reaching

  • Poor shoulder and scapular (shoulder blade) control

  • Weakness or imbalances in the rotator cuff or upper back muscles

  • Poor posture, particularly rounded shoulders or forward head position

  • Age-related tendon degeneration (common over age 40)

  • History of shoulder injuries or impingement

Symptoms

Early Symptoms May Include:

  • Pain when lifting the arm overhead or reaching behind the back

  • Discomfort or stiffness when first waking up

  • Mild weakness in the shoulder

Advanced Stages Can Present With:

  • Persistent pain at rest or at night, especially when lying on the affected side

  • Significant shoulder weakness

  • Difficulty with basic daily tasks like brushing hair, reaching for shelves, or carrying objects

  • A "catching" sensation or restricted movement

Diagnosis

Rotator cuff tendinopathy is typically diagnosed through clinical assessment by a physiotherapist or healthcare provider.

Common Assessments Include:

  • Review of activity history and symptom patterns

  • Observation of shoulder posture and movement

  • Strength and flexibility testing of the shoulder and upper back

  • Special tests such as the Empty Can Test, Hawkins-Kennedy Test, and resisted shoulder movements

Imaging, like ultrasound or MRI, may be used in cases where the diagnosis is unclear or if a full-thickness tear is suspected.

Physiotherapy Approach

Physiotherapy is one of the most effective, evidence-based treatments for rotator cuff tendinopathy and focuses on both symptom relief and long-term shoulder function.

Physiotherapy Interventions May Include:

  • Targeted strengthening exercises for the rotator cuff, scapular stabilizers, and shoulder muscles

  • Postural correction exercises to improve alignment and reduce strain on the tendons

  • Manual therapy to address muscle tightness, joint stiffness, and improve mobility

  • Progressive loading programs to gradually build shoulder strength and endurance

  • Taping or supportive techniques to assist with pain and improve mechanics in the short term

  • Education on proper lifting techniques, posture, and activity modifications to prevent re-injury

Patient Education and Self-Management

Helpful Tips:

  • Avoid repetitive overhead movements or heavy lifting during flare-ups

  • Focus on maintaining good posture throughout the day

  • Perform home exercises consistently to strengthen the rotator cuff and upper back muscles

  • Use ice packs to manage discomfort after activities that aggravate the shoulder

  • Gradually return to sport or high-demand activities under physiotherapy guidance

  • Understand that complete rest is not recommended, controlled movement is key for recovery

Conclusion

Rotator cuff tendinopathy is a common and treatable cause of shoulder pain that can become chronic if ignored. Early physiotherapy intervention can significantly improve pain, restore shoulder function, and prevent future injuries. If you’re experiencing persistent shoulder pain, don’t wait, seek a physiotherapy assessment to start your recovery and get back to moving confidently.

Call to Action

If shoulder pain is limiting your daily life, contact us at Integrative Physiotherapy and Wellness to schedule your physiotherapy assessment today. Our team is here to help you move better, feel stronger, and stay active.

Written By: Stacey Stys, PT, MPT, BA Kinesiology

References

Lewis, J. S. (2009). Rotator cuff tendinopathy: A model for the continuum of pathology and related management. British Journal of Sports Medicine, 43(4), 236–241.

Littlewood, C., Bateman, M., Connor, C., Gibson, J., & May, S. (2013). Physiotherapy management of rotator cuff tendinopathy: A clinical consensus and overview of current best practice. Shoulder & Elbow, 5(4), 271–277.

Malliaras, P., Barton, C. J., Reeves, N. D., & Langberg, H. (2013). Achilles and patellar tendinopathy loading programmes: A systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Medicine, 43(4), 267–286.

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