Shoulder pain remains one of the most frequent reasons patients seek care from a Physical Therapist. Although many diagnoses create symptoms in the shoulder region, rotator cuff tendon pain is one of the most common. Descriptions of tendon pain such as tendinitis are being disproven by the research due to a lack of inflammatory process in the vast majority of painful tendons. Instead terms such as tendinopathy are more widely accepted because they better reflect the nature of the tendon injury. An injured tendon moves through the healing phases with an attempt to improve the tensile strength of the tissue. If our activity levels exceed the tensile strength of the healing tendon additional symptoms may be felt.
Many interventions have been shown in the short term to reduce shoulder pain including spinal and extremity joint manipulation or mobilization and dry needling, but exercise remains the gold standard treatment for rotator cuff tendon pain. Individualized, focused strengthening exercises help promote a healing response (remodeling) in the tendon. As the tendon heals through the exercise stimulus its’ tensile strength improves. In addition, stronger surrounding musculature can help shield the tendons from exercise or activity loads. Currently, it is not known which exercise programs are most effective for shoulder pain.
A recent study in the journal Physiotherapy examined 120 patients with chronic (> 3 months) shoulder pain (Heron et al. 2017). Patients were randomized to one of three loading programs: resisted band exercises, body weight or closed chain exercises, or range of motion exercises. At follow up all 3 programs resulted in reductions in disability but no significant differences were found between groups in the short term. Consistent with previous research, loading of injured tendons with exercise remains an effective method of reducing pain and disability in patients with shoulder pain.
To determine which shoulder exercise is most appropriate for your shoulder pain contact your local Physical Therapist.