First things first, what is the rotator cuff?

The rotator cuff is made up of 4 muscles that originate on the shoulder blade (scapula) and insert via their tendons onto the head of arm bone (humeral head).

These four muscles are commonly known as the SITS muscles:

  • Supraspinatus
  • Infraspinatus
  • Teres Minor
  • Subscapularis

These 4 muscles work together to keep the humeral head within the shallow socket of the shoulder blade as it moves in various directions.

What is a rotator cuff injury?

An injury to the rotator cuff falls normally falls into two categories: tears from a traumatic injury, and degenerative tears.

Tears from a traumatic injury often occur with sudden, forceful injuries such as a slip and fall onto a shoulder, elbow, or an outstretched hand. Pain is immediate and shoulder movement and strength can be impacted right away.

Degenerative tears happen slowly and are more commonly associated with aging and use of the muscles of the shoulder that can wear down a portion of a tendon. Often these tears have a more gradual onset of symptoms, but they can get suddenly worse after an increase in activity that requires lifting such as house or yard work, or moving. They can involve symptoms of pain, limited movement of the shoulder, and stiffness.

A third category of rotator cuff tear is the asymptomatic tear. This is when someone has a tear of a rotator cuff tendon but doesn’t show any signs or symptoms. In many research studies, patient’s aged 60 years and older were shown to have asymptomatic rotator cuff tears on MRI in 54% of study participants. This number increases with age.

What are the symptoms of rotator cuff injury?

  1. Pain that prevents you from sleeping on the injured side
  2. Difficulty raising your arm
  3. Recurrent pain with activities
  4. Reduced movement of the shoulder
  5. Muscle weakness

Can physiotherapy help if I have a rotator cuff injury?

Many rotator cuff tears are managed conservatively – meaning, without the use of surgical intervention. Research has shown that physiotherapy can be successful in the treatment of small traumatic rotator cuff tears1, as well as degenerative tears2.

Remember, the rotator cuff is made up of 4 muscles and there is some overlap. A tear to one muscle of the cuff can often be compensated for by increasing the activity of another cuff muscle. With a thorough assessment a physical therapist can determine which exercises are specific to you and your injury, and create a home exercise program for you.

If you do require surgery for your rotator cuff there is still a benefit to a shoulder exercise program while you wait. Programs that start before an operation are referred to as prehab. Some research has shown that there is a benefit in the post-operative period for people who complete a prehab program in the 6 weeks leading up to their surgery. Patients who completed this program reported a significant decrease in pain and faster recovery of shoulder movements after their operation.3

So if you have a rotator cuff tear and are wondering where to start, an assessment with a physiotherapist can start you on your road to recovery.

(1) de Almeida LL, Mendes Júnior AF, Neto JDM, Simoni LF, Lopes KHS, Guimarães PC, Valério BIO, Sciascia A. Pre-Operative Scapular Rehabilitation for Arthroscopic Repair of Traumatic Rotator Cuff Tear: Results of a Randomized Clinical Trial. Int J Sports Phys Ther. 2021 Feb 1;16(1):216-226. doi: 10.26603/001c.18654. PMID: 35656411; PMCID: PMC9135471.

(2) Narvani AA, Imam MA, Godenèche A, Calvo E, Corbett S, Wallace AL, and Itoi E Degenerative rotator cuff tear, repair or not repair? A review of current evidence. The Annals of The Royal College of Surgeons of England. Volume 102, Number 4

(3) Mats C. Ranebo, Hanna C. Björnsson Hallgren, Theresa Holmgren, Lars E. Adolfsson, Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial, Journal of Shoulder and Elbow Surgery, Volume 29, Issue 3, 2020, Pages 459-470, ISSN 1058-2746,