Alec Tinker Osteopath in Yorkshire – Back pain, Rehabilitation, Sports Injuries

Rotator cuff disease/Sub acromial pain syndrome

Anatomy and pathophysiology

The rotator cuff is made up of 4 muscles that are responsible for dynamic stabilisation of the gleno-humeral joint (shoulder joint). The supraspinatus, infraspinatus and subscapularis tendons merge together as they insert onto the humerus and the teres minor attaches onto the back of the humerus.rotator cuff

It is thought that the cause of rotator cuff injuries is a degenerative process taking place in the tendon which can be the result of many different factors. Evidence has shown that pre-existing degenerative changes in the deeper fibres of the tendon followed by acute micro-trauma is often the primary cause of rotator cuff tears.  However it is thought that the main pain generator of rotator cuff disorders is the subacromial bursa. Bursas are fatty, fluid filled sacs that reduce friction around joints, and there are 17 of these in the shoulder. When joint injuries occur they often get inflamed and swell up.

Assessing the shoulder

Because of the way the tendons merge together it is difficult to differentiate between them. Also the anatomy of the shoulder can vary greatly from person to person. When it comes to assessing shoulders we look for movement that is painful, fearful or grossly asymmetrical. There is an increased risk of injury if there is 10% difference in left and right shoulder movement or a 20% difference between active and passive movement.


There is a large amount of evidence suggesting that exercise therapy is effective at treating rotator cuff injuries. A recent study found that 75% of patients improved and avoided surgical repair by performing rotator cuff strengthening, soft tissue massage and joint articulation exercises.

Rehabilitation programme

Phases Goals
Phase 1
  1. Relieve pain
  2. Restore normal range of motion
Phase 2
  1. Improve strength
  2. Restore ability of the rotator cuff to stabilise the shoulder during movement
Phase 3
  1. Task-specific rehab exercise
  2. Functional exercises integrating the kinetic chain



All types of exercise reduce pain. So the first bit of advice is to keep that shoulder moving as much as you can. Work on a pain scale 0-10, 10 being the worst pain imaginable. If you’re getting above 4/10 stop doing whatever you’re doing.

Principles of exercise

Target Load % of 1 RM Reps Sets Rest (mins) Speeds Freq per week
Motor control 10-30% 25+ 3-5 0-1 variable 5-10+
Strength Nov 60-70%

Adv 80%

6-12 1-3 2-3 moderate Nov 2-3



Endurance 30-50% Nov 15-20

Adv 25+

3-6 1-2 variable Nov 3-6

Adv 4-8

Power Upper 30-60%

Lower 60%

1-5 1-3 3-5 explosive Nov 1-2

Adv 3-4


3 motor control exercises

  1. Back of the hand wall press – standing next to a wall press the back of your hand into it.

    image taken from

  2. External rotation- bend arm to 90 degrees and press into the wall or use your other hand to resist.
  3. Belly press- push the hand into the belly. 

Range of motion exercises

  1. Laying on your side with arm by your side slowly raise is up and over towards your head then take it back down. First without weight and once this becomes easy use a 1-2kg weight or tin can.
  2. Prone Y’s. Laying on your front, raise your arm up and then back down. First without weight and then with weight.

Once you’re able to do the exercises above comfortably you can start increasing the weight, reducing the frequency and doing other exercises that incorporate other muscles not just the rotator cuff. Be patient and don’t move on to more intense exercises until you are certain it is time.

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