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What Is Rotator Cuff Tendinopathy?
Rotator cuff tendinopathy refers to degeneration or irritation of the tendons in the rotator cuff — a group of four muscles and their tendons that stabilise the shoulder joint and enable arm movement. Unlike a rotator cuff tear, tendinopathy is more of a chronic, overuse condition rather than an acute injury.Rotator cuff tendinopathy affects people of all ages, particularly those involved in repetitive overhead activities or sports. Whether you're an athlete, a manual labourer, or simply someone experiencing unexplained shoulder pain, understanding this condition is the first step toward effective treatment and recovery.
The Tendinopathy Continuum: Understanding the Timeline
Rotator cuff tendinopathy doesn’t happen overnight — it evolves over time. The progression of tendon injury follows what’s called the tendinopathy continuum, a model that helps guide appropriate treatment at each stage:
1. Reactive Tendinopathy (Early Stage)
This is the tendon’s initial response to overload, often after a sudden increase in activity, new exercise, or unaccustomed movement (painting house, moving house, deep cleaning). The tendon becomes swollen and painful but structurally remains intact. It's a short-term, adaptive phase meant to protect the tendon from further injury.
Good news: With proper load management (reducing and/or modifying activity), this stage is reversible and recovery is typically quick — often within 2–4 weeks.
2. Tendon Dysrepair (Intermediate Stage)
If overload continues without proper rest or rehab, the tendon begins to show signs of disorganisation in its collagen fibers and a breakdown in tendon structure. Pain becomes more consistent, and the tendon may become thicker and less efficient.Recovery takes longer: often 6–12 weeks, and requires structured rehab and significant activity modification.
3. Degenerative Tendinopathy (Chronic Stage)
In this final stage, there is significant tendon degeneration and potential for small partial tears. It’s more common in older adults or individuals with longstanding symptoms.This stage may take several months (3–6 months or more) to improve with rehabilitation, and full recovery can be slower. In some cases, surgical options are considered.
Causes and Risk Factors
- Repetitive overhead activities (e.g. swimming, tennis, painting)
- Poor shoulder mechanics
- Age-related tendon degeneration (more common over 40)
- Weak or imbalanced shoulder and upper back muscles
Signs and Symptoms
- Pain or aching in the shoulder, especially when lifting the arm
- Weakness when reaching or lifting objects
- Pain at night, especially when lying on the affected side
- Limited range of motion due to pain or stiffness
- A “catching” or “clicking” sensation during movement
If you’re experiencing any symptoms of Rotator Cuff Tendinopathy, book in to see one of our excellent Physiotherapists to get you back to pain free and doing what you love.
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