Understanding Rotator Cuff Pain: Causes, Treatment and Evidence-Based Insights

Rotator Cuff-Related Shoulder Pain (RCRSP) is a common complaint for those dealing with shoulder discomfort. It encompasses a variety of conditions affecting the rotator cuff and surrounding structures without involving stiffness or instability in the shoulder. Research shows that early physiotherapy intervention and targeted exercises lead to faster improvements in the first three months compared to doing nothing.

In this blog, we'll break down the causes, symptoms, diagnosis, and evidence-based strategies for managing rotator cuff pain to get you back to doing what your love.

What Is Rotator Cuff-Related Shoulder Pain?

The rotator cuff is made up of four key muscles (supraspinatus, infraspinatus, teres minor, and subscapularis). Their job is to stabilise the shoulder and allow for smooth arm movement. Injuries or overuse of these muscles can lead to pain and dysfunction.

Common conditions associated with RCRSP include:

• Subacromial Shoulder Pain: This is pain that comes from the area just below the bony part of your shoulder. It can make it difficult to lift your arm.

• Tendinopathy (Tendonitis/Tendinosis): This is when the rotator cuff tendons become overused over time, leading to pain, inflammation and weakness in the shoulder.

• Partial or Full-Thickness Tears: This could be from an acute injury or happen slowly over time. These tears can be small (partial) or large (full-thickness).

• Bursitis: This is when a small fluid-filled sac in your shoulder becomes inflamed. This sac helps reduce friction in the joint, so when it’s inflamed, it can cause pain and discomfort.

What Causes a Rotator Cuff Tear?

Sometimes, a rotator cuff tear can happen after a single event, like lifting something heavy or falling. This is known as a traumatic tear. Other times, pain may develop gradually from repetitive activities, like gardening or sports—this is referred to as a degenerative or chronic tear.

How Common Is Rotator Cuff Pain Syndrome?

• Age: Tendinopathy and partial tears are more common in those under 40, while full-thickness tears are more prevalent in those over 50.

• Trauma: Younger individuals may face dislocations or fractures, while older adults may deal with conditions like frozen shoulder or osteoarthritis.

• Repetitive Movements: It is common in sports involving lots of overhead activities like throwing, swimming, or lifting.

What are the Symptoms?

You may be experiencing:

• Dull ache deep in the shoulder

• Difficulty reaching behind your back or overhead

• Weakness or pain when lifting your arm

• Trouble sleeping on the affected shoulder

When Is Imaging Necessary?

Imaging, like ultrasound or MRI, can help identify structural issues, but remember that imaging often shows abnormalities even in people without symptoms!!

Imaging is recommended in cases of:

• Traumatic shoulder pain

• Severe weakness or numbness

• Suspected fractures or dislocations

• Lack of improvement after 3 months of conservative treatment

During your initial consultation, our physiotherapist will assess whether imaging is needed and we can provide a referral for you right away if necessary.

How Physiotherapy Can Help with Rotator Cuff Pain

No two rotator cuff tears are the same, just like no two people are alike. Factors like your symptom history, age, and how the pain affects your daily life all play a role.

The great news? Most rotator cuff tears can improve significantly with effective physiotherapy. Research shows that early physiotherapy and targeted exercises lead to faster improvements in the first three months compared to doing nothing. Early treatment is key, especially for those eager to get back to sports.

Here’s how we can support you:

1. Personalised Assessment: In your first visit, we will ask you lots of questions about your symptoms and how they’re affecting you. We’ll use clinical tests and tailored assessments to diagnose your condition.

2. Pain Relief: We use a range of manual therapy techniques, including soft tissue release, cupping, dry needling, and taping techniques to help manage your pain and support your recovery.

3. Restoring Mobility: Gentle stretches and mobility exercises to improve your shoulder's range of motion, helping you move with less discomfort.

4. Strengthening: We will guide you in progressively strengthening your rotator cuff and surrounding muscles with targeted exercises. This is usually structured over a 12-week program and clinically has shown significant improvements in reducing pain and improving overall function.

5. Reduce Future Injury Risk: Tendons can take up to six months to fully adapt to changes. By gradually increasing the load your shoulder can handle, we help increase your functional capacity, build strength and resilience through your entire shoulder complex, reducing the risk of re-injury.

Let’s Talk Briefly About Surgery

Occasionally, surgery may be necessary for a torn rotator cuff. If you've experienced trauma or have a full-thickness tear, a repair might be advisable and we’d highly recommend an orthopaedic review in addition to physiotherapy for prehab and rehabilitation of your shoulder. For partial tears that don't improve despite physiotherapy and conservative treatment, surgery may be an option if pain and limited function persist.

Get Back to What You Love!

Whether it's playing sports, picking up your kids, or reaching without pain, physiotherapy is an effective way to manage rotator cuff pain. At Kaylana Wellness Collective, we provide personalised care and develop a recovery plan tailored to your unique needs and lifestyle. Ready to feel your best? Book a consultation with our physiotherapist in Hurstville, NSW.

Disclaimer: This blog is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for advice specific to your health needs and injury.