Neck & Shoulder

What It Is

Line drawing of the shoulder blade from behind, shown bare and then with the rotator cuff muscles running from it to the top of the upper arm bone. — The rotator cuff muscles run from the shoulder blade to the top of the arm, holding the joint steady as you move.

One of the most common types of physical complaint is pain in the shoulder. The shoulder is made up of several joints, tendons and muscles that all work together to give the arm a large range of movement. Since so many different structures make up the shoulder, it is vulnerable to a number of different problems. The rotator cuff is one of the more frequent sources of pain in the shoulder (AAOS, n.d.b).

Typically the patient with a rotator cuff tendinopathy will have difficulty and pain lifting their arm above their head, placing their arm behind their back (for example putting on a coat, or reaching for a bra strap), and sleeping on the affected side. The pain is often worst at night (AAOS, n.d.b).

Rotator cuff tendinopathy is often known as supraspinatus tendinopathy, because it commonly affects the "supraspinatus" muscle (Rees et al., 2021). However, rotator cuff tendinopathy can in theory apply to any of the rotator cuff muscles.

Rotator Cuff Tendinopathy Anatomy

The shoulder is made up of three bones: the upper arm bone (humerus), the collarbone and the shoulder blade. The shoulder is a ball-and-socket joint: the ball at the top of the upper arm bone fits into a shallow socket in the shoulder blade. Your arm is kept in the socket partly by the rotator cuff. The rotator cuff is made up of four muscles that join together as tendons and form a covering around the head of the humerus. The rotator cuff connects the humerus to the shoulder blade and helps you to rotate and lift your arm (AAOS, n.d.a).

There is a lubricating sac known as the bursa that lies between the rotator cuff and the bone on the top of the shoulder (the acromion). The bursa allows the rotator cuff tendons to glide smoothly whenever you move your arm (AAOS, n.d.b).

One rotator cuff muscle is particularly vulnerable. This is called the supraspinatus. The tendon of the supraspinatus attaches to the humerus (arm bone) and this tendon can become over-used, or degenerate, which can cause rotator cuff tendinopathy.

Causes of Rotator Cuff Tendinopathy

There are many different causes and contributing factors, and these include

Bone spurs on the acromion (the bony point of the shoulder), which can rub on (impinge on) the tendon and bursa when you raise your arm (AAOS, n.d.b).
Over-use of the tendon and shoulder in sports, particularly sports that involve using the arm overhead (AAOS, n.d.b).
Repetitive lifting or overhead work (AAOS, n.d.b).
General degenerative (age-related) changes around the shoulder.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Rotator Cuff Tendinopathy

Treatment usually focuses first on restoring normal movement with stretching, then on strengthening the rotator cuff muscles as the pain improves (AAOS, n.d.b). I can guide you through this with exercise, hands-on work and advice on your posture and activities. See the My Approach tab for how I work.

1. Rehab

One of the first things the doctor or physical therapist will probably suggest is rest from aggravating activities, such as avoiding overhead activities or sports which may be causing the problem (AAOS, n.d.b). Overhead and racket sports are commonly problematic. Try not to stop using your shoulder completely, though: the NHS advises staying active and gently moving your shoulder, while avoiding things that seem to make it worse (NHS, 2023).

2. Pain Relief Medication

The NHS suggests painkillers such as paracetamol and ibuprofen (an anti-inflammatory) for shoulder pain so that you can keep moving, and a pharmacist can advise whether tablets or a cream or gel would suit you best (NHS, 2023). (This medicine information comes from the NHS website, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

If your shoulder pain is getting worse, or has not started to feel better after 2 weeks, see your family doctor or nurse practitioner, or come back to me (NHS, 2023).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid injection: if rest, medicines and physical therapy are not relieving your pain, an injection of a local anaesthetic and a steroid (cortisone) may help. The steroid is usually injected into the bursa beneath the acromion to reduce inflammation (AAOS, n.d.b; Rees et al., 2021).

How I can help (see the My Approach tab)

Stretching and strengthening for the rotator cuff and shoulder blade
Hands-on work for the shoulder, neck and upper back
Advice on posture and your work or sport set-up

Tips

People who use their arms a great deal for overhead movements are particularly vulnerable to rotator cuff problems (AAOS, n.d.b).
This is a common problem in young athletes who play overhead sports such as swimming, baseball, tennis and volleyball (AAOS, n.d.b).
Pain can develop after a minor injury, but sometimes it comes on without any obvious cause (AAOS, n.d.b).
Repetitive lifting or overhead work, such as construction, painting and paper hanging, leaves you prone to rotator cuff problems (AAOS, n.d.b).
If you start having pain when serving a tennis ball or throwing a ball, you might be in the early stages of tendinopathy (AAOS, n.d.b).
Mild pain that is present both when you use the arm and when you rest could be an early sign of rotator cuff tendinopathy (AAOS, n.d.b).

Treatment

My Approach

Line drawing of the upper back and shoulders from behind as the arm lifts out to the side and overhead, with an arc tracing the shoulder's range and the shoulder and upper back muscles shown. — Getting the arm moving comfortably through this range comes first; building strength through it comes next.

Rotator cuff tendon pain usually responds best to the right amount of load: not complete rest, and not pushing through pain. My aim is to settle the shoulder, then build strength in the rotator cuff and shoulder blade muscles so it copes with reaching, lifting, work and sport again.

I start by assessing how your shoulder, shoulder blade, neck and upper back move, testing the strength of your rotator cuff, and asking about your work, sport and what brings the pain on. I also try simple changes, like supporting your shoulder blade with my hands or with tape, to see what eases the pain for you.

When It's Sore

Cutting back what provokes it, such as reaching overhead, heavy carrying and fast pushing or pulling, rather than stopping everything
Gentle holds, like pressing your hand against a wall or doorframe, which often ease pain
Hands-on work for tight chest, upper back and shoulder blade muscles; chest wall work needs your informed consent and a written consent form
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Taping to support your shoulder blade in the short term, and I'll show you how to tape it yourself

As It Settles

Stretching to restore normal shoulder movement, and cross-fibre work on the tendon once it's past the early irritable stage (never on a calcified or acutely painful tendon)
Shoulder blade control, wall push-ups and rows, then turning-out work to strengthen the rotator cuff
Building to overhead, faster and work- or sport-specific movements, including gym-based progressions if you lift
A little discomfort during exercise is fine, but pain shouldn't rise at night, at rest or over the next 24 hours; if it does, we ease back
A home programme between visits, and a look at your posture and your desk, work or sport set-up

If you get sudden, severe pain or can't move your arm, get urgent help (see When to Get Urgent Help).

What to Expect

Typical Course

Typical course: Early on, most people come once or twice a week, then weekly, with a reassessment at about 4 to 6 weeks, then less often as you manage more on your own. Most people notice improvement over about 6 to 12 weeks of regular exercise, though long-standing tendon pain can take several months.

What I Focus On

Load Management

Isometric Holds

Shoulder Blade Control

Progressive Cuff Strength

Posture & Set-Up Review

Please read

When to See a Doctor First

When to Get Urgent Help

Get urgent medical help if you have sudden or very bad shoulder pain, you cannot move your arm, the pain started after a fall or injury, or you feel feverish or unwell (NHS, 2023).

Call 911 or go to the emergency room at your nearest hospital if your arm or shoulder has changed shape or is badly swollen after an injury, there is no feeling in your arm, or your arm is cold to the touch. These can be signs of a broken or dislocated bone or a ruptured tendon (NHS, 2023).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.a) Rotator cuff tears. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/rotator-cuff-tears/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.b) Shoulder impingement/rotator cuff tendinitis. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/ (Accessed: 7 October 2026).
NHS (2023) Shoulder pain. Available at: https://www.nhs.uk/conditions/shoulder-pain/ (Accessed: 7 October 2026).
Rees, J.L., Kulkarni, R., Rangan, A. et al. (2021) 'Shoulder pain diagnosis, treatment and referral guidelines for primary, community and intermediate care', Shoulder & Elbow, 13(1), pp. 5–11. doi: 10.1177/1758573220984471

Massage therapy · Kitchener–WaterlooRotator Cuff Tendinopathy

What It Is

Rotator Cuff Tendinopathy Anatomy

Causes of Rotator Cuff Tendinopathy

Self-Care & Treatment

How to Treat Rotator Cuff Tendinopathy

1. Rehab

2. Pain Relief Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooRotator Cuff Tendinopathy

What It Is

Rotator Cuff Tendinopathy Anatomy

Causes of Rotator Cuff Tendinopathy

Self-Care & Treatment

How to Treat Rotator Cuff Tendinopathy

1. Rehab

2. Pain Relief Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Shoulder Impingement Syndrome

Frozen Shoulder

Sports Massage

Rotator Cuff Tear

Book a session