Physical Therapy for Rotator Cuff Tendinitis
What is rotator cuff tendinitis?
Rotator cuff tendinitis, also known as shoulder tendonitis, is a condition characterized by inflammation, irritation, or swelling of the tendons of the rotator cuff muscles in the shoulder. It often occurs due to repetitive overhead arm movements or activities that put stress on the shoulder joint. This condition can cause pain and discomfort, particularly when raising or rotating the arm.
What does the rotator cuff do?
The rotator cuff is a group of four muscles and their associated tendons that surround the shoulder joint. These muscles and tendons work together to stabilize the shoulder joint and allow for various movements of the arm. The main functions of the rotator cuff include:
Stabilization: It helps to stabilize the shoulder joint, keeping the head of the upper arm bone (humerus) firmly within the shallow socket of the shoulder blade (scapula).
Rotation: The rotator cuff muscles facilitate rotation of the arm, both internally (towards the body) and externally (away from the body).
Lifting and lowering the arm: These muscles are crucial for lifting the arm overhead and lowering it back down in a controlled manner.
What is the difference between rotator cuff tendonitis vs tendinopathy?
Rotator cuff tendonitis and tendinopathy are related conditions involving the rotator cuff tendons, but there are differences in their underlying causes and severity:
Rotator cuff tendonitis: This term specifically refers to inflammation of the rotator cuff tendons. It is often caused by repetitive overhead movements, sports activities, or sudden excessive use of the shoulder. The primary symptom is pain, particularly during activities that involve raising the arm. 2-4 weeks of rest and anti-inflammatory treatments are usually effective in managing tendonitis.
Rotator cuff tendinopathy: Tendinopathy is a broader term that encompasses both tendonitis (inflammation) and tendonosis (degeneration and weakening) of the tendons. It indicates a chronic condition where there may be degenerative changes in the tendon structure due to repetitive strain, aging, or other factors, resulting in a decreased capacity to tolerate load. Unlike tendonitis, tendinopathy may involve structural changes in the tendon without significant inflammation. Management should include a progressive loading program to rebuild the tendon’s capacity to tolerate load, which usually takes a minimum of 10-12 weeks of physical therapy treatment. In some cases, more aggressive treatments like corticosteroid injections are used for temporary pain relief.
In summary, while both rotator cuff tendonitis and tendinopathy involve the rotator cuff tendons, tendonitis specifically indicates inflammation, whereas tendinopathy suggests a broader spectrum including both inflammation and potential degenerative changes, and weakening of the tendon.
How does rotator cuff tendinitis/tendinopathy occur?
Rotator cuff tendinitis and tendinopathy typically occur due to repetitive stress or overuse of the shoulder joint. Here are some common causes and contributing factors:
Repetitive Overhead Activities: Jobs or sports that involve repetitive overhead motions can strain the rotator cuff tendons. Examples include painting, carpentry, swimming, tennis, and baseball pitching.
Poor Shoulder Mechanics: Incorrect posture or mechanics during activities can put undue stress on the rotator cuff tendons. This includes improper lifting techniques or not warming up adequately before physical activities.
Aging: As people age, the blood supply to the rotator cuff tendons may decrease, making them more prone to degeneration and injury.
Sports Injuries: Direct trauma or sudden movements in sports can lead to acute injuries of the rotator cuff tendons, which can later develop into chronic tendinopathy if not properly managed.
Muscle Imbalances: Weakness or imbalance in the muscles around the shoulder, including the rotator cuff muscles themselves, can contribute to abnormal stresses on the tendons during movement.
Anatomic Factors: Certain anatomical features or conditions, such as bone spurs or a narrow space for the tendons to move (impingement), can increase the likelihood of rotator cuff tendon irritation and inflammation.
Degenerative Changes: Over time, wear and tear on the rotator cuff tendons can lead to degenerative changes, making them more susceptible to injury and inflammation.
Systemic Diseases: Conditions like rheumatoid arthritis or diabetes can affect tendon health and increase the risk of developing tendinopathy.
Understanding these factors can help in preventing or managing rotator cuff tendinitis and tendinopathy by addressing risk factors, maintaining proper shoulder mechanics, and seeking timely treatment for symptoms.
Does rotator cuff tendinitis/tendinopathy require surgery?
Rotator cuff tendinitis or tendinopathy typically does not require surgery as the first line of treatment. Most cases can be effectively managed with conservative, non-surgical treatments to reduce inflammation, alleviate pain, and improve shoulder function.
Surgery is typically considered when conservative treatments have been exhausted and symptoms persist or worsen despite appropriate management.
The decision to undergo surgery is based on factors such as the severity of symptoms, extent of tendon damage, response to conservative treatments, and the individual's overall health and activity level. Your orthopedic surgeon will assess your specific condition and recommend the most appropriate treatment plan.
How can physical therapy treatment help for rotator cuff tendinitis/tendinopathy?
Physical therapy is a cornerstone in the treatment of rotator cuff tendinitis/tendinopathy. Here are ways it can help:
Pain Management: Physical therapists use modalities like ice, heat, ultrasound, or electrical stimulation to reduce pain and inflammation.
Manual Therapy: Hands-on techniques such as joint mobilizations and soft tissue massage can reduce pain, improve range of motion, improve flexibility, and reduce muscle tension.
Exercise Prescription: Specific exercises target the rotator cuff muscles and surrounding muscles to strengthen them and improve shoulder stability.
Posture and Movement Education: Correcting posture and teaching proper body mechanics during activities can prevent further injury and promote healing.
Functional Training: Activities are tailored to your daily tasks or sports activities to ensure a safe return to normal function. Physical therapists use modalities like ice, heat, ultrasound, or electrical stimulation to reduce pain and inflammation.
What are the best exercises to do if you have rotator cuff tendinopathy?
Best exercises for rotator cuff tendinopathy:
Wall Slides (flexion, scaption, abduction)
External rotation (cable column progression)
Horizontal abduction and elevation with band
Quadruped T
The best exercise for each individual will vary based on their current levels of symptoms and strength. Your physical therapist can best guide you on the best exercises specifically for you.
Pain is allowed and actually encouraged while exercising with rotator cuff tendinopathy, as we are gradually increasing the tendon’s capacity to tolerate load. We use the following pain monitoring model to ensure adequate strengthening of the tendon but not too much to irritate the tendon:
Pain Monitoring Model
1. Pain is allowed to reach 5 on the Numeric Pain Rating Scale (NPRS) during activity
2. Pain immediately after activity is allowed to reach 5 on the NPRS
3. Pain the next morning after activity should not exceed a 5 on the NPRS
4. Pain and stress should not increase from week to week
Exercise modifications for rotator cuff tendinitis/tendinopathy
In the more irritable stages of rotator cuff tendinitis or tendinopathy, you’ll want to temporarily avoid and/or modify exercises and activities that load the rotator cuff.
Exercises to avoid and their modifications include:
Vertical overhead press
Temporary modification: tall kneeling landmine press
Pull up
Temporary modification: horizontal / low row
Push up
Temporary modification: scapular push up
Bench Press
Temporary modification: dumbbell floor press
How long does it take to heal from rotator cuff tendinitis/tendinopathy?
Rotator cuff tendinitis typically resolves within a few weeks of rest from provoking activities.
Rotator cuff tendinopathy typically takes at least 3 months of physical therapy treatment and progressive strengthening for a full recovery.
Closing Remarks
If you’re experiencing rotator cuff tendinitis/tendinopathy and want to consult us, click the button below to speak with one of our Doctors of Physical Therapy.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy