Rotator Cuff Tendinopathy

Education and advice to help patients manage their condition

This leaflet explains about Rotator Cuff Tendinopathy. If you have any further questions,
please speak to the physiotherapist caring for you.

The Shoulder Joint

The shoulder joint is made up of the clavicle (collar bone), humerus (arm bone) and scapula
(shoulder blade). Its main function is to allow the arm to move so that you can reach, pick up
things and carry out your daily activities. The shoulder joint is very mobile therefore it relies on
muscles for stability and support.

The Rotator Cuff

The rotator cuff is a group of four muscles attaching from the shoulder blade to the top of your
arm bone. These muscles are important in stabilising your shoulder joint during movement.

Rotator Cuff Tendinopathy

Rotator Cuff Tendinopathy is a common shoulder problem caused by overload of a rotator cuff
tendon (the soft tissue that connects muscles to bone), causing shoulder pain, inflammation and
sometimes stiffness. The pain can spread further down the arm and up towards your neck.
It can feel worse when you move your arm to during everyday movements/tasks such as
reaching up, putting your hand behind your back, lifting and carrying objects.

What causes a Rotator Cuff Tendinopathy?

Most commonly it is associated with a sudden increase of activity, but it can come on gradually
with no clear cause. This is because many factors influence the condition. Examples of these
include.

You can help change You are not able to change

Increased weight or obesity Use of steroids

Muscle strength Previous tendinopathy

Joint Range of Motion Rheumatological disease

Diabetes Advancing age

Reduced joint range of movement Recent injuries

Physical activity levels Gender

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How do I make my tendinopathy better?
Therapeutic exercises are the best treatment to target the muscles involved. These can improve
your tendon’s ability to cope with the load being put on it through day to day activities. You will
likely try a variety of different exercises before finding ones that work for you, because every
tendinopathy responds differently. Discomfort during the exercise is normal but should be
minimal (up to 3/10) and should not flare your symptoms up for the following 24 hours.

Staying active and continuing with general exercise can really help your recovery – this will also
have positive effects on your physical and mental health. Remember some physical activity is
better than none.

It is important to reduce activities which are particularly painful to allow your pain to settle down.

It is also important to progressively load your rotator cuff muscles by gradually increasing the
amount of activity you do over time. This will give your body time to adjust, get stronger and
cope with the activities that previously brought you pain.

How long will it take to get better?

You should see some improvement in the first six weeks of physiotherapy however it can take
anywhere between three and 12 months to recover, so patience is important. Timeframes for
recovery depend on a variety of factors including the duration and intensity of your symptoms
and adherence to advice/exercises.

For most people, their symptoms will resolve. Some people will have future flare ups, but these
are less often and better managed thanks to the knowledge and information that they have
previously received.

Remember!
Completing the prescribed exercises for at least three months is the key to
getting better.

Recommended Exercises
At first, performing the exercises may be uncomfortable and you may experience some pain.
If the level of pain is not acceptable to you or persists for longer than half an hour after the
exercise, please reduce the frequency or intensity of the exercises but aim to build this up
gradually over several weeks or months.

Start on the Level 1 exercises. If pain and ability allow, then progress to Level 2 exercises.
Aim to perform the exercises on three to four days of the week.

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Level 1 Exercises

Isometric Shoulder External Rotation (aim to perform three rounds of 20 to 30

seconds).

Step 1: Step 2:

Sit or stand up straight next to a wall. Without moving your body, press your
Keep your affected arm by your side and wrist into the wall as if turning your
bend your elbow to 90 degrees. Place forearm outwards. Hold this position and
the back of your wrist against the wall. then relax.

Isometric Shoulder Abduction (aim to perform three rounds of 20 to 30 seconds).

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 Step 1: Step 2:

Sit or stand up straight next to a wall. Without moving your body, press your
Keep your affected arm by your side and elbow into the wall. Hold this position and
bend your elbow to 90 degrees. Place then relax
the outside of your elbow against the
wall.

Level 2 Exercises
Shoulder Abduction with weight (aim to perform three rounds of 8 repetitions)

This exercise can be performed using weights in the form of water bottles.

Step 1: Step 2:

Slowly lift your weaker arm out to your Ensure your back and neck muscles
side to the level of your shoulder keeping remain relaxed as you move your arm.
your elbow straight. Control the Do not hunch your shoulder during the
movement as you lower your arm back movement.
down.

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 Shoulder Rotation in lying with weight (aim to perform three rounds of 8
repetitions)

This exercise can be performed using weights in the form of water bottles

Step 1: Step 2:

Lie on your back with your symptomatic Bend your elbow to a right angle and
arm stretched out at approximately 90 then slowly rotate your forearm up and
degrees from the side of your body then lower it back down, keeping control
holding onto a weight. of the weight. Make sure your shoulder
blades remain in contact with the floor
throughout the movement. Relax and
repeat.

Wall push up (aim to perform three rounds of 8 to 12 repetitions)

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 Step 1: Step 2:

Stand up straight facing a wall. Place Drive the heels of your hands into the
your hands onto the wall around wall. Next, bend your elbows out to the
shoulder height but slightly wider. Your side, pivoting on the balls of your feet as
fingers should point directly up to the you move your body in one straight line in
ceiling. Maintain a straight line from the towards the wall Straighten your arms out
top of your head to your heels. again, lifting your body away from the
wall.

Is there anything other than exercise?

Pain medication can help to reduce your sensitivity and help you continue with daily tasks as
well as physiotherapy. Taking a dose of anti-inflammatory medication can help some people,
but this should be discussed with your GP beforehand

It is normal to feel worried about your pain but this can make your symptoms worse. We now
know that stress, anxiety, depression and fatigue can all increase pain sensitivity and make
recovery more difficult. It is important to speak to a health professional about psychological
support if you need help.

There are no recommended surgeries, massage or other passive treatments for tendinopathies.
The tendons need to be retrained to tolerate loading and exercise. Practice is needed.

What if my pain gets worse?

Sometimes, certain exercises may be too intense and flare your plan. This does not mean you
have damaged the tendon. Normally it is just a warning sign from your shoulder to inform you
that you’ve done more than it can tolerate and it wants to do less.

If this happens throughout rehabilitation, don’t panic. Reduce the amount of exercise slightly.
This can be done by reducing how many you do or for how long you do it. Try to avoid resting
completely as this can make your shoulder stiffer and less tolerable to exercise when you
restart.

Things to remember
Therapists are there to support you - don’t feel you have to know everything or have to work
through this alone.

Be consistent – do your exercises regularly as guided, and remember to give yourself

appropriate amounts of rest as well.

Be patient – recovering from a tendinopathy takes time. But if you do it right the first
time, you’ll be much better prepared for self-managing in the future.

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 Stay healthy – exercising as able, sleeping and eating well, as well as being positive
can all affect your pain levels and your general health.

Contact us
If you have any questions or concerns about rotator cuff tendinopathy, please contact the
physiotherapy department on 020 8725 1357 (Monday to Friday, 8.30am to 4.30pm).

For more information leaflets on conditions, procedures, treatments and services offered
at our hospitals, please visit www.stgeorges.nhs.uk

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about our services or the care you have received. You can visit the PALS office between
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Lanesborough wings (near the lift foyer).
Tel: 020 8725 2453 Email: [email protected]

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Reference: THE_RCT_01 Published: November 2020 Review date: November 2022

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