On Exercises for Rotator Cuff Tendinopathy

4 min readOct 7, 2019

Shoulder pain is common 1 in 4 people complain of shoulder pain at any given point in time.

Shoulder Pain is a Burden

70% of People Complain of Shoulder pain 6 weeks after an Acute Onset of Shoulder Pain.
50% of People Complain of Shoulder pain 6 Months after an Acute Onset of Shoulder Pain.
40% of People Complain of Shoulder pain 12 Months after an Acute Onset of Shoulder Pain.
Shoulder Pain can be Ongoing and Slow to Resolve. This means that someone having shoulder pain can have an ongoing problem for well over a year.

Rotator Cuff Tendinopathy

Symptoms must be reproducible on Resisted Testing

Rotator cuff tendinopathy tend to present themselves in shoulders that are —

Mobile but painful.
Obese Crowd (Obesity Increases the Chance of Developing Tendinopathy), This is due to a link to insulin as a catalyst of pro-inflammatory growth type hormones. Metabolic diseases such as diabetes also increases risk & perseverance of tendinopathy.
Smoking increases predisposition to rotator cuff pathology and shoulder dysfunction. Because smoking increases incidence of pro-inflammatory cytokines. Link here.
Psychological Stress & Poor Sleep is likely to contribute to the onset and persistence of rotator cuff tendinopathy.

Exercise Effects on Rotator Cuff Tendinopathy

10x Cheaper than Surgery
Great Improvement after 3 Months
Great Continuum of Improvement after 6–12 Months
Even with treatment, symptoms can persist after a year. However there will be improvement with exercises and Physiotherapy!
Exercise of the Unaffected Shoulder has an effect of the affected shoulder (Therefore work both shoulders)
In tendinopathy cases — an improvement of pain and function can occur regardless of scan/ imaging results (Structural pathology does not adequately explain pain)

Why is this the case? Why is Shoulder Tendinopathy so complicated?

Pain is more complicated than we think it is.

Firstly we must consider that pain is a result of a Neural Judgement “Process” that varies between individuals.

Our Pain experience is a result of a feedback loop between our:

Experiences, Knowledge Beliefs, Culture, Behaviours (Observed and Personal)
Environmental
Physical/ Chemical (Damage to Tissues/ Structure)

Be aware that Language, Engagement, Therapist Expression — Matters.

To Treat Clients we must be aware of the following:

Damage/ Symptoms can be a poor indicator of outcomes in the case of rotator cuff tendinopathy.
An observational study conducted Here proved the following.
Clients believing that physiotherapy will work ended up less likely needing surgery.

Outcome Expectations:

Belief that “If I do this I will feel better”

If we believe in something, it increases the likelihood that it will work.

Self-Efficacy Expectation

Belief that “Confidence in myself that if I can do it, it will work”

Adherence and confidence in performing self efficacy tasks affects compliance and success.

Medicine is only good if clients take it.

Self-Monitoring Expectation

“Are you making progress, just not realising it”

Evidence of progress will enhance motivation & greater likelihood of engagement & eventually recovery.

Try utilizing variations of “Patient Specific Functional Scale” in your Subjective/ Objective Evaluations.

Treat Shoulder Tendinopathy By:

Instilling belief, confidence, compliance of clients.
Addressing Expectations & Fear Avoidance
Providing “Exercises” that can be performed well. Keeping in mind that there is no benefit of multiple exercises over 1 or 2 simple exercises. However expectations and perception of progression matters.
In rotator cuff tendinopathy there is no “Superior Rehab Exercise” over another. However they must meet functional capacity/ demands of clients that is still challenging and acceptable to clients.
It is alright to have some pain in exercise prescription in rotator cuff tendinopathy. Explain why it can be uncomfortable “because you are challenging the strength, capacity and fitness of the tendons”
Try to Take Step Approach to Identify Problems — Set goals — Guide Change (Behaviour, actions, etc) — Self Monitor — Have Self Awareness.