Rotator Cuff Injuries: More Than Just Shoulder Pain
by osteopath Carien Boshoff
Experiencing shoulder pain when reaching overhead, lifting weights, getting dressed or sleeping on your side?
The rotator cuff plays an important role in shoulder movement and stability. When these muscles or tendons become irritated or injured, everyday activities can become uncomfortable.
Let's explore what the rotator cuff does, common injuries and how they may be managed.
What is the rotator cuff?
The rotator cuff consists of four muscles and their associated tendons that surround the shoulder joint. Together, they help stabilise the shoulder and control arm movement.
These muscles include:
• Supraspinatus: Assists with lifting the arm away from the body.
• Infraspinatus: Helps rotate the arm outwards.
• Teres minor: Assists with outward rotation.
• Subscapularis: Helps rotate the arm inwards.
These muscles work together to support everyday movements such as reaching, lifting, pushing and pulling.
What are common rotator cuff injuries?
Rotator cuff conditions can involve tendon irritation, changes in tendon structure or tears. Common presentations include:
1. Rotator cuff tendinopathy
A tendon related condition associated with pain and reduced tolerance to loading.
Symptoms may develop following changes in exercise, repetitive activities or increased physical demands.
2. Partial thickness tears
Occur when part of the tendon thickness is disrupted. These may develop gradually or following an injury.
3. Full thickness tears
Extend through the entire thickness of a tendon and may occur following trauma or age related tendon changes. Some cause significant weakness, while others produce minimal symptoms. Importantly, not all shoulder pain indicates a rotator cuff tear.
What causes rotator cuff related shoulder pain?
Shoulder pain often develops through a combination of factors, including:
• Sudden increases in exercise or training load
• Repetitive overhead movements
• Changes in work or sporting demands
• Reduced shoulder strength or load tolerance
• Age related tendon changes
• Falls or direct injuries
For example, returning to heavy overhead exercises after time away from the gym may place greater demands on the shoulder than it is currently accustomed to. However, shoulder pain is rarely explained by one movement or posture alone.
What are the common symptoms?
Rotator cuff related shoulder conditions may cause:
• Pain around the front or outside of the shoulder
• Discomfort when reaching overhead or behind the back
• Pain when lying on the affected shoulder
• Reduced strength or movement
• Difficulty lifting, carrying or performing sporting activities
These symptoms can overlap with other shoulder and neck conditions, making clinical assessment important.
Does shoulder pain always mean something is torn?
No. Research has shown that structural changes in rotator cuff tendons can also be present in people without shoulder pain. This means imaging findings do not always reflect the severity of someone's symptoms. Pain can also be influenced by activity levels, strength, sleep and individual factors. Therefore, assessment should consider both physical findings and how symptoms affect everyday function.
How are rotator cuff injuries assessed?
An osteopath will consider your symptoms, medical history, activity levels and functional goals.
Assessment may include:
• Shoulder range of motion
• Rotator cuff strength testing
• Relevant orthopaedic tests
• Neck and upper back assessment
• Functional movements such as reaching and lifting
Imaging, such as ultrasound or MRI, is not always required. However, it may be recommended when a significant tear is suspected, following trauma or when symptoms are not improving as expected.
How are rotator cuff injuries managed?
Management depends on the type of injury, symptom severity and individual goals.
For many non traumatic rotator cuff conditions, conservative management may include:
1. Education and activity modification
Temporarily adjusting aggravating activities while maintaining comfortable movement where possible.
2. Hands on osteopathic treatment
Manual therapy may be considered for short-term symptom relief alongside education and active rehabilitation.
3. Exercise and rehabilitation
Progressive strengthening of the rotator cuff and surrounding muscles to improve strength, movement and
tolerance to activity.
4. Gradual return to activity
Progressively increasing exercise, work or sporting demands according to symptoms and functional capacity.
5. Referral when appropriate
Further medical assessment may be required for suspected significant tears, marked weakness or persistent symptoms.
Should you stop exercising with shoulder pain?
Not necessarily.
Complete rest is not always required. For many rotator cuff related conditions, modified activity and progressive strengthening are important parts of management.
For example, someone experiencing discomfort during overhead pressing may temporarily reduce the weight or modify the movement while continuing other tolerable exercises. Exercise should be individualised, with progression guided by symptoms and function.
Where does osteopathy fit into rotator cuff management?
As osteopaths, we assess shoulder pain by considering movement, strength, activity demands and how symptoms affect daily life.
Depending on your presentation, management may involve hands on treatment where appropriate, education, activity modification, individualised rehabilitation exercises, and referral for further investigation when indicated.
Take home message
Rotator cuff related shoulder pain is common, but it doesn't always mean something is torn or permanently damaged. For many conditions, education, appropriate activity modification and progressive strengthening are important components of management.
An osteopath can assess your shoulder, discuss possible contributing factors and help determine whether conservative management or further medical assessment may be appropriate.
References
American Academy of Orthopaedic Surgeons. (2025). Management of rotator cuff injuries: Evidence-based clinical practice guideline. https://www.aaos.org/quality/quality-programs/upper-extremity-programs/rotator-cuff-injuries/
Australian Health Practitioner Regulation Agency. (2020). Guidelines for advertising a regulated health service. https://www.ahpra.gov.au/Resources/Advertising-hub/Advertising-guidelines-and-other-guidance/Advertising-guidelines.aspx
Desmeules, F., Roy, J.-S., Lafrance, S., Charron, M., Dubé, M.-O., Dupuis, F., Beneciuk, J.M., Grimes, J., Kim, H. M., Lamontagne, M., McCreesh, K., Shanley, E., Vukobrat, T., & Michener, L. A. (2025). Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: A clinical practice guideline. Journal of Orthopaedic & Sports Physical Therapy, 55(4), 235–274. https://doi.org/10.2519/jospt.2025.13182
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