1. Introduction / Plain Theory

Rotator cuff tendinopathy refers to pain and dysfunction caused by degenerative or overload changes in one or more of the tendons that stabilise and move the shoulder joint.

The rotator cuff consists of four muscles — supraspinatus, infraspinatus, subscapularis, and teres minor — that work together to centre the humeral head within the shoulder socket (glenoid) during arm movement.

Over time, repetitive stress, mechanical imbalance, or poor vascular supply can lead to microscopic tendon degeneration (tendinosis) rather than acute inflammation.
This results in pain, weakness, and reduced efficiency in shoulder movement.

Rotator cuff tendinopathy is highly prevalent, particularly in individuals aged 40–70 years, manual workers, and athletes performing repetitive or overhead movements.

2. Typical Symptoms and Functional Impact

• Dull, aching pain deep in the shoulder and upper arm, often worse with lifting or reaching overhead.

• Pain when lying on the affected side, especially at night.

• Weakness or fatigue when lifting, throwing, or carrying objects.

• Stiffness or discomfort when reaching behind the back.

• Gradual onset of symptoms without a specific injury.

Functional impact:
Rotator cuff tendinopathy can significantly reduce upper limb function — affecting sports performance, manual work, or simple daily activities such as dressing, driving, or carrying children.
If untreated, chronic overload may progress to partial or full-thickness tendon tears and persistent shoulder dysfunction.

Red flags:
Sudden loss of movement or strength after an audible “pop,” visible bruising, or trauma should be medically assessed for possible rotator cuff tear or fracture.

3. Contributing Factors / Underlying Causes

Rotator cuff tendinopathy develops when tendon loading exceeds tissue adaptation capacity.
Common contributing factors include:

• Repetitive overhead activity (e.g. sports, trades, painting, weight training).

• Postural imbalance: rounded shoulders, thoracic kyphosis, or forward head posture.

• Scapular dyskinesis: poor shoulder blade control altering tendon loading.

• Muscle imbalance: overuse of deltoid and upper trapezius; underuse of rotator cuff and lower scapular stabilisers.

• Reduced thoracic and rib mobility: limiting shoulder elevation and rotation.

• Age-related changes: reduced tendon elasticity and blood flow.

• Systemic factors: smoking, diabetes, metabolic or inflammatory disorders.

From an osteopathic perspective, rotator cuff overload often arises from global mechanical imbalance, not just local weakness.
Tension patterns in the spine, ribs, neck, and even diaphragm influence shoulder loading and tissue recovery.

4. Osteopathic Approach

Osteopathic care for rotator cuff tendinopathy focuses on improving mobility, circulation, and coordination throughout the shoulder girdle and associated regions.

An osteopathic assessment may include:

• Detailed evaluation of shoulder, scapular, thoracic, and cervical mobility.

• Palpation of rotator cuff tendons and surrounding myofascial structures.

• Gentle articulation and mobilisation to restore fluid joint mechanics.

• Myofascial and soft-tissue techniques to reduce tension and improve blood flow.

• Functional and indirect techniques to calm local sensitivity and promote self-healing.

• Postural and breathing retraining to reduce load on the shoulder complex.

• Guidance on gradual reloading, ergonomic awareness, and recovery pacing.

In chronic cases, osteopathic treatment can complement exercise-based rehabilitation by enhancing tissue adaptability and reducing compensatory strain, improving long-term outcomes.

5. Scientific Evidence & References

Research supports manual therapy combined with exercise as the gold standard for managing rotator cuff tendinopathy.
Evidence shows that improving scapular control, thoracic mobility, and tendon loading tolerance enhances recovery and prevents recurrence.

Osteopathic and physiotherapy-based approaches have demonstrated benefits in reducing pain, restoring strength, and improving overall shoulder function, particularly when applied early and progressively.

References

1. Lewis JS. Rotator cuff tendinopathy: a model for the continuum of pathology and related management. Br J Sports Med. 2010;44(13):918–923. Link

2. Littlewood C, Malliaras P, May S. What are the key components of exercise programmes for rotator cuff tendinopathy? A systematic review and meta-analysis. Br J Sports Med. 2012;46(9):702–710. Link

3. Hanratty CE, et al. Manual therapy, exercise therapy, or both for subacromial shoulder pain: systematic review and meta-analysis. BMJ Open. 2017;7(12):e018151. Link

4. Desmeules F, et al. Efficacy of exercise therapy in the treatment of rotator cuff tendinopathy: systematic review and meta-analysis. J Orthop Sports Phys Ther. 2015;45(7):523–538. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for shoulder pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Ginn KA, Cohen ML, Herbert RD. Does hand-behind-back range of motion correlate with shoulder internal rotation strength? Br J Sports Med. 2006;40(6):518–523. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for rotator cuff tendinopathy: network meta-analysis. Front Pain Res. 2024;15:1507390. Link