Why exercise for shoulder tendinitis?
According to the guidelines published by the French National Authority for Health (HAS) in 2023, treatment of rotator cuff tendinopathy is first and foremost medical and functional. First-line care: no immobilization, continuing tolerable activities, analgesics and, if needed, a short course of anti-inflammatory drugs, along with education and advice. If symptoms persist after 4 to 6 weeks, physical therapy is started (grade B). It relies in particular on progressive strengthening of the rotator cuff and shoulder muscles, restoring range of motion, and learning a self-administered exercise program. In non-torn tendinopathy, surgery has not shown any benefit.
Program principles
The HAS sets out the minimum content of the physical therapy program. It is organized around four areas:
- Avoid immobilization: during the painful phase, reduce movements that trigger pain but continue tolerable activities;
- Strengthen progressively the rotator cuff and all the shoulder muscles (scapulothoracic muscles and deltoid), with active centering of the humeral head;
- Restore movement: regain and maintain range of motion, correct the posture of the spine and shoulder girdle, and train neuromuscular control;
- Build independence: learn a self-administered exercise program, address fear of movement (kinesiophobia), then reintegrate everyday and work tasks, the ultimate goal of any functional rehabilitation.
The clinician's role
When a patient presents with a painful shoulder, other diagnoses must be considered: osteoarthritis, infectious, tumoral, or rheumatic causes, and referred pain. The clinical examination includes an examination of the cervical spine (see our article on neck pain). The HAS recommends shoulder X-rays if symptoms persist after 4 to 6 weeks, as well as before any injection, and referral to a shoulder specialist if symptoms do not improve. Setting the starting dose and adjusting progression: tendinopathy illustrates the value of an individualized program over a generic exercise handout.
Rotator cuff tendinopathy belongs to the family of musculoskeletal disorders, the leading recognized occupational disease in France according to the INRS, the French occupational safety institute. It can be recognized under table 57 of the general social security scheme, which covers disorders caused by certain work movements and postures.
Frequently asked questions
Should the shoulder be rested in case of tendinitis?
Not completely. The HAS recommends not immobilizing the shoulder, continuing tolerable activities, and maintaining work depending on its demands and the degree of limitation. Movements that provoke pain are reduced, without stopping moving the shoulder.
Which exercises for rotator cuff tendinitis?
The program defined by the HAS combines progressive strengthening of the rotator cuff and shoulder muscles, active centering of the humeral head, work on range of motion, posture, and neuromuscular control, and a self-administered exercise program. The precise choice of exercises and their dosing depend on the physical therapist's initial assessment.
Is pain during exercise a signal to stop?
It should be reported and monitored. According to the HAS, the pace, duration, and frequency of sessions are adapted to how symptoms evolve and are reassessed regularly. Pain that worsens or persists warrants discussing it with the clinician to adjust the load.
How long does it take to recover from shoulder tendinitis?
According to the HAS, clinical improvement is expected after 6 weeks to 3 months of physical therapy. If symptoms do not improve, referral to a shoulder specialist is useful.
Are injections useful?
They are among the options set out by the HAS when symptoms persist after 4 to 6 weeks: one or two corticosteroid injections, at least 3 weeks apart, after shoulder X-rays. Repeating them is not useful if there is no lasting improvement. Hyaluronic acid and platelet-rich plasma injections have not been shown to be effective in subacromial pain syndrome.
Does shoulder tendinitis require surgery?
In non-torn rotator cuff tendinopathy, surgery has not shown any benefit, according to the HAS. It is only considered after a well-conducted medical and functional treatment has failed.
Editorial review in progress by MYA's editorial committee.
Editorial content intended to inform health professionals. It does not constitute individual medical advice and does not replace assessment by a professional.