By Mike Ho, Physiotherapist
Physiotherapy Exercises for Shoulder Tendonitis
Shoulder tendonitis, or nowadays known as shoulder tendinopathy, is a common condition characterised by inflammation or irritation of the tendons surrounding the shoulder.
The tendons that are usually affected in this condition are the rotator cuff tendons, and therefore, this condition is often also known as rotator cuff tendonitis/tendinopathy.
It is quite common to see or hear shoulder tendonitis or tendinopathy interchanged, however there are some differences. The main difference between the two is typically in the timeframes.
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Tendonitis - is usually an acute episode with associated pain and inflammation
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Tendinopathy - is typically more of a chronic condition, characterised mostly by pain
When you have rotator cuff tendonitis/tendinopathy, it can result in pain, stiffness and limited range of motion in the shoulder.
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Deeper dive into the rotator cuff:
Before we go any further, it may be beneficial to discuss what the rotator cuff is. The rotator cuff is actually a group of four muscles.
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Supraspinatus muscle
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Infraspinatus muscle
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Subscapularis muscle
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Teres minor muscle
They all originate from different points of the shoulder blade and insert into the humeral head in the shoulder joint. The four muscles transition into tendons, blend into the actual capsule of the shoulder joint and envelop the whole head of the shoulder.
The shoulder joint is one of the most mobile joints in the body and allows for movement in all different directions. As a result of all this mobility, we need something to counteract this to provide a little bit of stability within the joint. This is where the rotator cuff muscles come into play. When all four muscles contract, they help keep the humeral head inside the socket to provide stability when we move the arm around.
When the rotator cuff muscles or tendons become affected, this whole intricate system that balances mobility and stability is interrupted and this is when we start to see symptoms arise.
What are the symptoms of shoulder tendonitis?
Symptoms of shoulder tendonitis often include:
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Pain in the shoulder, particularly when lifting the arm or reaching overhead
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Stiffness or decreased range of motion in the shoulder
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Weakness in the shoulder muscles
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Pain that worsens at night or with certain movements
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Swelling or tenderness around the shoulder joint
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What are the causes of shoulder tendonitis/tendinopathy?
Trauma
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Accidents or falls onto the shoulder
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Impact into the shoulder in sports
Overuse
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Excessive loading of the arm in sports (e.g. - tennis or baseball)
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Repetitive reaching or overhead lifting (e.g. - landscapers or mechanics)
What are Things I Should Avoid with Shoulder Tendonitis?
To prevent worsening of symptoms and promote healing, it's essential to avoid or limit activities that exacerbate shoulder tendonitis, such as:
- Overhead lifting or reaching
- Repetitive shoulder movements, especially those involving lifting heavy objects
- Sleeping on that side of the shoulder
- Ignoring pain and continuing activities that aggravate the condition
What can I do for my shoulder tendinitis?
During the initial phase, a period of relative rest of the shoulder where we avoid provocative movement/positions is important.
This can help settle the inflammatory process and allow us to move into the rehabilitation phase. The rehabilitation phase is going to make up the bulk of the recovery process.
In this phase, a focus will be centred on mobility and also on strength to increase the capacity of the tendons to withstand the demands of your activities.
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Some examples of PHYSIO SHOULDER TENDONITIS exercises that may be included are:
Thoracic stretches
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Bow and arrow stretch - sitting with your feet on the floor, reach forward with one arm as you pull your elbow back with the other arm, like you are pulling back on a bow. This will rotate the spine and you should feel a stretch in between your shoulder blades.
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WHY? Stiffness in the upper back can lead to changes in biomechanics of the shoulder and overloading of certain muscles and tendons.
Rotator cuff activation exercises
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Isometric external and internal rotation of the shoulder - standing side on to a wall, holding your arm by your side and having the elbow bent at 90 degrees, rotate the whole arm outwards and inwards against the wall so that there is a static and constant force being applied to the shoulder. Press just enough to feel the muscles engage but not enough to bring on your pain. Hold for 30-45 seconds and repeat 3-4 times, 3-4 times a day.
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WHY? These can be a nice starting point when pain is the main barrier and function of the shoulder is quite limited.
Scapula stabilisation exercises
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Cable rows - pulling back with your arms against a cable with resistance where the goal is to squeeze the shoulder blades back and hold for 1-2 seconds.
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WHY? Because the rotator cuff muscles originate from the shoulder blade, it is important that we incorporate exercises involving the scapula to help stabilise the whole system.
General shoulder strengthening
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Floor presses - laying flat on the floor and holding on to a weight, press straight up towards the ceiling and return back down so that the elbow is resting on the floor. Ensure the movement is smooth and that you are working with a weight that is tolerable.
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WHY? General shoulder strength exercises are important as it allows us to train the shoulder through range and restore back function.
The list above is just an example of some of the exercises that one of our physiotherapists may include in your program. As each individual is different with varying functions and goals, it is important to get a proper assessment first before, so that we can develop a program specific to your needs.
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How long does it take to settle shoulder tendonitis?
The duration of treatment for shoulder tendonitis varies depending on the severity of the condition and individual factors. With consistent adherence to physiotherapy exercises and treatment recommendations, many people experience significant improvement within a few weeks to a few months.
However, it's essential to continue practising good shoulder health habits even after symptoms subside to prevent recurrence.
What happens if I ignore shoulder tendonitis?
Ignoring shoulder tendonitis can lead to worsening symptoms and potential complications.
Without proper treatment, inflammation and irritation of the tendons may progress, causing chronic pain and functional limitations in the shoulder joint.
In severe cases, untreated shoulder tendonitis may increase the risk of tendon tears or other shoulder injuries, ultimately requiring more invasive interventions such as surgery.
Many may also believe that complete rest can be enough to fix this issue; however, as we begin to load the tendons in our activities again, it is very common to see the pain come back again. Therefore, strengthening of the shoulder is paramount to long-term success of this condition.
Shoulder tendonitis can be a challenging condition to manage and is often a condition that can become chronic, but with the right approach, relief is possible. By working closely with a physiotherapist and following a tailored treatment plan that includes targeted exercises and self-care strategies, you can alleviate pain, improve mobility, and regain function in your shoulder. Don't wait to seek help—take proactive steps towards better shoulder health today.
If you or someone you know has shoulder tendonitis and wants to get on top of their pain, contact us and get in to see one of our experienced physiotherapists
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