Rotator cuff related pain is one of those frustrating issues that can creep into daily life, making simple tasks like hanging out the washing or reaching for a high shelf feel like a struggle.
The rotator cuff is a group of four muscles and their tendons that stabilise the shoulder joint. The shoulder joint is very mobile with the ability to move in many directions, therefore these muscles must work all together to keep the ball in the socket throughout movement. These muscles work hard to keep your shoulder moving smoothly, but they’re also prone to injury. Whether it’s from repetitive overhead movements, a sudden fall, or simply wear and tear over time, rotator cuff injuries are incredibly common.
In this blog, we’ll break down the most common rotator cuff injuries, their symptoms, how they’re treated, and what you can do to keep your shoulders strong and pain-free. Plus, we’ll share a recent success story of a patient who turned things around with physiotherapy.
Common Rotator Cuff Injuries
1. Rotator Cuff Tendinopathy
This is a fancy term for irritation or degeneration of the rotator cuff tendons. It’s common in people who perform repetitive shoulder movements, such as tradies, painters, swimmers, and tennis players. Over time, the tendons become overloaded, leading to pain, weakness, and difficulty lifting the arm.
Symptoms:
- Pain when lifting the arm or reaching overhead
- Shoulder stiffness, especially in the morning
- Weakness in the affected arm
- Often with repeated movements, the symptoms can warm up and improve
Treatment:
- Rest from aggravating activities (but not total immobilisation!)
- Strengthening exercises prescribed by a physiotherapist
- Manual therapy to improve shoulder mobility
- Deep tissue massage or dry needling to reset the tone of muscle and improve biomechanics
- Ice or heat therapy to manage pain
2. Rotator Cuff Tears
A rotator cuff tear can be partial (where only part of the tendon is damaged) or full-thickness (where the tendon is completely torn). These injuries can happen suddenly from trauma, such as a fall or lifting something too heavy, or they can develop gradually from long-term wear and tear.
Symptoms:
- Sharp or deep pain in the shoulder, especially at night
- Significant weakness when lifting or rotating the arm
- With a full thickness tear, it might not be possible to lift the arm
- Clicking or cracking noises with movement
Treatment:
- Physiotherapy exercises to restore strength and function
- Hands-on treatment to reduce pain and stiffness
- Shockwave therapy can be used to bring blood to the area for healing
- Platelet rich plasma (PRP) injections can help with accelerating healing of a tear
- Surgery in severe cases, but many people recover well with rehab alone
3. Shoulder Impingement Syndrome
Shoulder impingement occurs when the rotator cuff tendons get pinched between the bones of the shoulder, leading to pain and inflammation. This is common in people who do a lot of overhead movements, such as swimmers, weightlifters, and tradespeople.
Symptoms:
- Pain when reaching overhead or behind the back
- A catching sensation in the shoulder
- Difficulty sleeping on the affected side
Treatment:
- Postural corrections and movement retraining
- Strengthening the rotator cuff and scapular muscles
- Soft tissue release and stretching to reduce tension
- Activity modifications to avoid irritating movements
- Cortisone injections for persistent inflammation (if necessary)
4. Calcific Tendinitis
This condition occurs when calcium deposits build up in the rotator cuff tendons, leading to severe pain and restricted movement. The cause isn’t fully understood, but it’s more common in people aged 30–50 and can come on quite suddenly.
Symptoms:
- Intense, often sharp shoulder pain
- Difficulty moving the arm due to stiffness
- Pain that worsens at night
Treatment:
- Physiotherapy to maintain movement and strength
- Shockwave therapy to break down the calcium deposits
- Anti-inflammatory medications
- In rare cases, needle aspiration or surgery
Physiotherapy: Your First Line of Defence
Many people worry that a rotator cuff injury means surgery, but the good news is that most cases respond well to physiotherapy. A structured rehab program can help reduce pain, restore movement, and prevent future injuries.
Physiotherapy treatment typically includes:
- Manual therapy to reduce tone in muscles and improve joint mobility
- Exercise-based rehab to strengthen the rotator cuff and surrounding muscles
- Postural correction to prevent excessive strain on the shoulder
- Activity modification to reduce aggravation while still keeping active
- Shockwave therapy to promote healing and break down calcifications in chronic cases
- Dry needling to release tight muscles and improve blood flow
- Joint mobilisations to restore normal movement patterns
- Biomechanical assessments to identify and correct movement dysfunctions that may be contributing to shoulder pain
Case Study: A Journey Back to Shoulder Health
James, a 52-year-old carpenter, came to our clinic with ongoing right shoulder pain that had been getting worse over the past six months. He struggled with lifting tools overhead and even had trouble putting on his shirt in the mornings. An ultrasound confirmed he had a partial rotator cuff tear.
Initially, James was worried he’d need surgery, but after a chat with our physiotherapist, he committed to a structured rehab program. Over 10 weeks, we worked on:
- Progressive strengthening exercises to rebuild his shoulder stability
- Manual therapy to release tight surrounding muscles
- Shockwave therapy to accelerate tendon healing
- Dry needling to reduce muscle tension
- Joint mobilisations to restore pain-free range of motion
- Education on movement patterns to avoid further aggravation
By the end of his rehab, James was pain-free, back to full function, and lifting tools again with no issues. Best of all, he avoided surgery and is now maintaining his shoulder health with a home exercise program.
Preventing Rotator Cuff Injuries
Here are some simple ways to protect your shoulders and keep them strong:
- Strength training: Keep your rotator cuff and shoulder muscles strong with targeted exercises.
- Posture awareness: Avoid slouching, especially if you work at a desk.
- Warm-up before activity: Stretch and activate your shoulders before workouts or heavy lifting.
- Listen to your body: Don’t push through pain—rest and modify activities as needed.
Final Thoughts
Rotator cuff injuries can be frustrating, but with the right treatment, most people make a full recovery without needing surgery. Physiotherapy is a game-changer when it comes to reducing pain, restoring function, and preventing future issues.
If you’re struggling with shoulder pain, don’t wait—book an appointment with X Physio and get on the path to recovery!
References and Further Reading:
- Physio Works – Rotator Cuff Injuries: https://www.physioworks.com.au
- Australian Physiotherapy Association – Shoulder Pain: https://australian.physio
- Sports Medicine Australia – Rotator Cuff Rehabilitation: https://sma.org.au