Shoulder pain is an extremely common complaint from clients we see in the clinic. We have seen an increase in patients with shoulder pain, particularly related to the rotator cuff, during the COVID-19 pandemic. This is likely due to the rise in working from home, virtual exercise classes and an increase in DIY projects. People are sitting in poor postures for hours on end, or doing things that are otherwise out of the ordinary for them.
Many patients come to see us with similar pain presentations. Essentially they can still move their shoulder, but it is painful to do so. This may have been building up over time, or come on after a particularly strenuous event. This may have been lifting something too heavy, too much gardening or an online HIIT workout. Such presentations are often caused by a loss of capacity, function and fitness of the rotator cuff muscles and tendons.
What is the Rotator Cuff?
The Rotator Cuff is a group of muscles and tendons that surround the shoulder joint. They assist to keep the head of your humerus (ball) inside the shoulder joint (socket). They provide strength and stability during shoulder motion. The Rotator Cuff is made up of 4 muscles, the supraspinatus, infraspinatus, subscapularis, and teres minor.
What is Tendinopathy?
Tendinopathy is a broad term to describe the irritation and inflammation that occurs where a tendon attaches to the bone.
Signs and Symptoms of Rotator Cuff Tendinopathy
- Shoulder pain – most commonly at the front/side of the shoulder and sometimes referring down the arm
- Painful range of motion – lifting the arm out to the side and/or rotating the arm
- Muscle weakness – particularly with lifting and rotating the arm
- Loss of function – difficulty lifting, pushing, reaching overhead or reaching behind the back
Cause of Rotator Cuff Tendinopathy
Tendionpathies usually develop over time. Prolonged heavy lifting, poor postures and repetitive movements (often overhead) are contributing factors. The capacity of the tendon falls below the required capacity to perform tasks (see figure below). This results in the sensation of pain, loss of strength and reduced motion.
It is important to see a physiotherapist for a thorough assessment of your shoulder pain. This helps to rule out neck related shoulder pain, or other conditions such as frozen shoulder. This will determine the best course of treatment.
Why is Exercise Therapy the way forward for Rotator Cuff Tendinopathy?
Recent research has shown that exercise therapy provides equal or better outcomes to patients with rotator cuff tendinopathy than hands on treatment alone, shoulder surgery or a corticosteroid injection. This makes sense given the reason why rotator cuff tendinopathy often occurs – due to a loss of fitness and capacity in the tendon and muscles. If we improve the fitness and capabilities of the muscles and tendons, it follows that shoulder function should improve and pain reduce.
Given that more often than not exercise rehabilitation programs can be performed at home, not only is exercise rehabilitation cost effective, it can also be prescribed and monitored over Telehealth.
It takes time
Research has shown that it takes a minimum of 12 weeks of performing a progressive exercise program to see results in patients with painful, but mobile shoulders. Results being a reduction in pain and an improvement in function.
The key word here is also progressive. Your exercise program needs to progress and change over time in order to improve the capacity and fitness of the rotator cuff. This is where regular review of your exercise rehabilitation program by your physiotherapist comes in.
One size does not fit all
The shoulder is a complex joint that can move throughout a significant range of motion and perform a wide range of activities. As such, not every patient will have shoulder pain that occurs in the same direction, doing the same movement etc. And therefore not every patient should be performing the same exercises. Your physiotherapist will determine which exercises are best for you and your shoulder, and modify and progress these over time.
When it comes to exercise therapy, the other important concept to note is that not all pain needs to be avoided. In order to improve the capacity and fitness of the rotator cuff tendons some exercise may cause some pain or discomfort. The important thing to work out with your physio is what is an acceptable level of pain. This is generally pain that eases after the exercise ceases and does not cause more discomfort later.
If you’re suffering from shoulder pain contact the team to book an appointment to discuss treatment options with a physio.
Chris Littlewood, Stephen May and Stephen Walters – A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy.
Chris Littlewood, Stephen May and Stephen Walters – Epidemiology of rotator cuff tendinopathy: a systematic review.