Rotator Cuff Tendinopathy: Physiotherapy Treatment Guide in Burlington
- Folarin Babatunde PT PhD
- Aug 7
- 6 min read
Updated: Sep 18
Cogent Rehab Blog
Folarin Babatunde PT PhD MScSEM MScPT BScPT
August 8, 2025
Disorders of the rotator cuff and the tissues around it are the most common causes of shoulder pain in people over 40. One of the most frequent of these is rotator cuff tendinopathy, which happens when the tendon (a bundle of fibers connecting muscle to bone) becomes irritated and sore. With continued irritation, the tendon can begin to break down — a more chronic condition called tendinosis.
People who perform repetitive or overhead arm movements, such as weightlifters, athletes, hairstylists, and manual laborers, are most at risk. Poor posture — especially rounded shoulders from long hours at a computer — can also contribute.
At Cogent Physical Rehabilitation Center in Burlington, our orthopaedic physiotherapists help identify risk factors, reduce pain, and restore shoulder motion and strength.
What Is Rotator Cuff Tendinopathy?
The rotator cuff is a group of four muscles — supraspinatus, infraspinatus, teres minor, and subscapularis — that connect the upper arm bone (humerus) to the shoulder blade (scapula). These muscles stabilize the shoulder and allow raising and rotating the arm.
Tendinopathy occurs when the tendon becomes irritated from overuse, poor posture, or muscle imbalances. If untreated, the tendon fibers can gradually degenerate, increasing the risk of more serious shoulder problems. This differs from a rotator cuff tear, which involves partial or complete rupture of tendon fibers.
For clinical details, see the 2025 Clinical Practice Guideline (CPG) published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT).
Causes and Risk Factors
Rotator cuff tendinopathy may be caused by:
Repetitive arm movements during activities such as hairstyling, painting and weightlifting.
Overhead shoulder motions common with tennis, baseball pitchers, swimmers, volleyball and basketball players.
Weakness or muscle imbalances between the shoulder and scapular stabilizers.
Tightness in surrounding muscles and tissues of the chest, neck or shoulder capsule.
Bony abnormalities that lead to pinching of the tendons (impingement).
Poor posture such as forward-rounded shoulders from prolonged desk work or smartphone use.
Other risk factors include age above 50 years, smoking, diabetes, and lack of preventative strengthening. Learn more about our Sports Physiotherapy programs for athletes and Workplace Health and Wellness consulting for desk workers.
Symptoms of Rotator Cuff Tendinopathy
Rotator cuff tendinopathy usually starts gradually, though symptoms may appear suddenly after a strain.
Pain is felt in the shoulder and sometimes the upper arm, but rarely extends below the elbow. It may be a dull ache at rest but becomes sharp with certain movements, especially:
Reaching behind the back (e.g., fastening a seatbelt).
Overhead activities (e.g., throwing, swimming, reaching into cupboards, combing hair).
Lifting or holding items (e.g., removing a pan from the stove).
Pain is often worse at night and when lying on the affected side. Patients also report shoulder weakness, making daily tasks difficult. If untreated, the pain may spread to the neck.
Pain rarely radiates below the elbow, helping differentiate it from cervical radiculopathy (pinched nerve in the neck). If stiffness is the main issue, frozen shoulder (adhesive capsulitis) may need to be ruled out.
How Is Rotator Cuff Tendinopathy Diagnosed?
A physiotherapist can usually diagnose rotator cuff tendinopathy through a physical exam. This includes:
Reviewing symptoms and daily activities.
Testing shoulder strength and range of motion.
Checking posture and muscle imbalances.
Palpating the shoulder to identify the irritated tendon.
Imaging such as ultrasound or MRI is only recommended if symptoms persist or if a tear is suspected (AAOS).
At Cogent Rehab Burlington, we provide comprehensive shoulder assessments to ensure accurate diagnosis and targeted treatment.
Physiotherapy Treatment for Rotator Cuff Tendinopathy in Burlington
Early treatment is important to prevent tendon degeneration. Physiotherapy can be highly successful in managing rotator cuff tendinopathy, tendinosis, and related conditions such as impingement syndrome.
Your program may include:
Taping
Taping can be used as part of treatment for rotator cuff tendinopathy. When applied to the shoulder joint, shoulder blade (scapula), and surrounding muscles, taping may help improve posture and shoulder movement while also reducing pain. It is typically used as a short-term support to complement exercise and other physiotherapy treatments.
Patient Education
Education is key to recovering from RC tendinopathy. Understanding the condition, why you feel pain, and how your body heals can make a big difference in your recovery. When patients learn more about their symptoms and the healing process, they often feel more in control and more motivated to stay involved in physiotherapy. Your physiotherapist will teach you strategies to manage pain, protect your shoulder, and gradually build strength, so you can return to your normal activities with confidence.
Manual Therapy
Manual therapy may include soft tissue techniques, massage, muscle release, passive stretching, and gentle joint mobilizations. For rotator cuff tendinopathy, these hands-on treatments can be applied not only to the shoulder joint itself but also to the surrounding shoulder girdle, upper back, and neck. The goal is to reduce stiffness, improve movement, and support recovery. Current clinical guidelines emphasize that manual therapy works best when it is combined with a structured exercise program, rather than used on its own.
Exercises Therapy
Exercise therapy for rotator cuff tendinopathy includes a variety of approaches such as scapula-focused movements, motor control exercises, concentric and eccentric strengthening, and even neck, thoracic, and whole-body exercises. Research shows these programs can decrease pain and disability, improve range of motion, and increase muscle strength, endurance, and load tolerance.
Your physiotherapist will tailor the program to your needs, adjusting intensity to safely restore function and prevent recurrence.
Physical Modalities
Modalities including therapeutic ultrasound, acupuncture, laser therapy, shockwave therapy, and TENS are sometimes used in the treatment of RC tendinopathy, Evidence shows that ultrasound and shockwave are not helpful for non-calcific tendinopathy, though shockwave may be effective in cases of calcific tendinopathy. Acupuncture and laser therapy may help reduce pain and disability, especially when combined with exercise. Modalities are generally used as part of a multimodal program rather than as stand-alone solutions.
Physical modalities are sometimes used in the rehabilitation of rotator cuff tendinopathy. The table below summarizes which options may be helpful depending on whether the condition is calcific or non-calcific, and how strong the evidence is for each.
Evidence-Based Use of Physical Modalities for Rotator Cuff Tendinopathy
While some physical modalities may provide short-term relief, they are most effective when used alongside an active rehabilitation program. Exercise therapy remains the cornerstone of treatment for rotator cuff tendinopathy.
Prognosis and Long-Term Outcomes
Most patients improve significantly with physiotherapy within 6–12 weeks, although chronic and severe cases may take 3–6 months. Long-term success depends on adherence to prescribed home exercises.
If untreated, tendinopathy may progress to tendon tears or chronic pain, especially in older adults or athletes returning to activity too soon.
Adults with an RC tendinopathy who have severe and persistent pain and/or disability despite a maximum of 12 weeks of adequate nonsurgical care should be referred to a specialist such as a sports physician, a physiatrist, or an orthopedic surgeon for further assessment and treatment.
Prevention
Rotator cuff tendinopathy is often preventable with proactive care:
Regular strengthening of the rotator cuff and scapular stabilizers.
Postural correction and mobility drills.
Ergonomic adjustments for desk workers.
Sport-specific conditioning and injury prevention programs.
See our sports injury prevention page for more strategies on rotator cuff physiotherapy in Burlington.
Don’t let shoulder pain slow you down
Shoulder pain doesn’t have to hold you back. At Cogent Rehab Burlington, we provide evidence-based physiotherapy in Burlington to relieve pain, rebuild tendon strength, and prevent recurrence for patient with rotator cuff tendinopathy.
FAQs About Rotator Cuff Tendinopathy
1. Can physiotherapy cure rotator cuff tendinopathy?
Yes. Physiotherapy is considered the gold standard treatment and can prevent progression to tendon tears.
2. How long does recovery take?
Mild cases recover in 6–12 weeks, while chronic conditions may take between 3 to 6 months.
3. What are the best exercises?
Strengthening exercises such as banded external rotation, scapular retraction, and eccentric loading are most effective.
4. Do I need imaging?
No. Physiotherapists usually diagnose tendinopathy clinically. Imaging is recommended only if symptoms persist despite physiotherapy or a tear is suspected. Ultrasound is cheaper and comparable to MRI when making a diagnosis of rotator cuff tendinopathy.
5. Can recurrence be prevented?
Yes. Ongoing strengthening, posture correction, and activity modification lower the risk of recurrence.
Sources
Leong HT, Fu SC, He X, Oh JH, Yamamoto N, Hang S. Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis. J Rehabil Med. 2019;51:627-637.
Sripathi P, Agrawal DK. Rotator Cuff Injury: Pathogenesis, Biomechanics, and Repair. J Orthop Sports Med. 2024;6:231-248.
Desmeules F, Roy J-S, Lafrance S, Charron M, Dube M-O, Duouis F, Beneciuk J, et al. Rotator cuff tendinopathy diagnosis, non-surgical medical care, and rehabilitation: a clinical practice guideline. JOPST. 2025;55:235-274.
Chainca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A, Ctapano M et al. Rotator cuff calcific tendinopathy: from diagnosis to treatment. Acta Biomed. 2018;89(1-S):186-196.
Taik FZ, KArkouri S, Tahiri L, Aachari I, Moulay Berkchi J, Hmamouchi I, Abouqal R et al. Effects of kinesiotaping on disability and pain in patients with rotaor cuff tendinopathy: double-blind randomized clinical trial. BMC Muscoloskeletal Disord. 2022;23:90
Savva C, Karagiannis C, Korakakis V, Efstathiou M. The analgesis effect of joint mobilization and manipulation in tendinopathy: a narrative review. J Man Manip Ther. 2021;29:276-287.
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