Shoulder pain and rotator cuff

Rehabilitation of Rotator Cuff Tears in the Older Adult.

The occurrence of pain and loss of function involving the shoulder has been reported as being as high as 50% of the population. Shoulder pain is often reported as being persistent and recurrent, lasting for multiple years in many sufferers (Lewis 2008).
Pathology of the rotator cuff
and sub-acromial bursa is considered to be the principal cause of pain and symptoms arising from the shoulder (Lewis 2008).
The incidence of rotator cuff related injuries increases with age, with reports of between 40-50% being present in people aged over 50yrs old, and is the shoulder problem most common in an older population (Ainsworth 2004).

It may be surprising to know that there does not appear to be a significant difference between the incidence of tears between groups of people with and without shoulder symptoms (Ainsworth et al 2007). It is believed that under-loaded tendon in a sedentary population may lead to asymptomatic degeneration and cuff tears, which will increase with age (Lewis 2015).

The rotator cuff contributes to stabilization and movement of the glenohumeral joint (shoulder) (Ainsworth 2007). Therefore should the function of the rotator cuff be in gradual decline, there may come a point where the function of the shoulder is affected and symptoms start to show themselves. The deltoid muscle which surrounds the shoulder and is used for power and speed, can cause the humeral head to be drawn further upwards in the absence of a functioning rotator cuff which then irritates the subacromial bursa which is a prime cause of shoulder discomfort symptoms. There can sometimes be an incident which appears to spark off symptoms such as lifting heavy shopping bags, or an increase in gardening activity, but often people report an insidious, recurrent discomfort which gradually increases in duration and level over a prolonged period of time.

Many patient with rotator cuff tears are managed successfully non-operatively (Ainsworth 2004). Conservative management should always be the first mode of treatment for rotator cuff disease.

Rehabilitation constitutes
  • Patient education
  • Pain reduction
  • Tendon load management
  • Re- injury prevention
  • (Lewis 2010)

In the degenerated tendon with age related tendinopathies, reducing pain allows for the muscles around the shoulder to function more effectively again, which then assists restoring normal movement and function through re-education of the muscle system. The tendons then need a graduated reloading programme. To maximize the benefit of this routine, load duration and intensity of activity placed on the rotator cuff tendons must be carefully controlled, structured and monitored. Following a detailed examination of your shoulder and its function, your physiotherapist will develop a treatment program that may include exercises, manual therapy, dry needling and cryotherapy.

Failure of an exercise programme to achieve a desired outcome may necessitate use of medication, injection therapy and possible surgical intervention (Lewis 2010).
For advice about the physiotherapy management of rotator cuff dysfunction in Cannington, Queens Park, East Cannington, Roleystone, Forrestfield and Bentley or to make an appointment contact Carousel Physiotherapy today.


Ainsworth, R., Lewis J. S. (2007). Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review Br J Sports Med 41:200–210.

Ainswoth B., 2004 rehabilitation of patients with massive cuff tears.

Lewis J.S. (2009). Rotator cuff tendinopathy/subacromial impingement
syndrome: is it time for a new method of assessment? Br J Sports Med;43:259–264.

Lewis J.S., (2010). Rotator cuff tendinopathy: a model for the continuum
of pathology and related management Br J Sports Med ;44:918–923