Rotator cuff-related shoulder pain: Is it time to reframe the advice, "You need to strengthen your shoulder”?

Review written by Dr Teddy Willsey info

Key Points

  1. Individuals with rotator cuff-related shoulder pain typically present with deficits in strength, muscle activation, and kinematics compared to pain-free individuals. However, improving these factors may not be necessary to achieve positive clinical outcomes.
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The diagnosis of rotator cuff-related shoulder pain (RCRSP) has evolved into a clinical conundrum. Attempting to identify the pathoanatomical pain-generating source and distinguishing between bursitis, tendinitis, impingement, or a cuff tear can be futile.

Many practitioners have abandoned methods they once relied on, as both advanced imaging and special tests are consistently shown to be hypersensitive and insufficiently specific (1,2). The ambiguity of diagnosis, variability in symptoms, and relative success of non-surgical intervention has led to a deeper investigation and a growing body of evidence supporting conservative treatment (3).

Although there is robust research supporting a wide variety of conservative interventions, including at-home therapy, education, gentle exercise, and manual therapy for shoulder pain, many clinicians are now favoring a “just strengthen it” resistance training approach to treating RCRSP (4).

While exercise therapy is undoubtedly important in the management of RCRSP, there is uncertainty regarding which approach is best and the absolute benefit of exercise compared to non-exercise interventions. It would be wise for clinicians to take a step back in order to better understand the overall mechanism of action and how to best structure their interventions.

Special tests of the shoulder are consistently shown to be insufficiently specific.
Exercises should be chosen in a manner that helps patients reduce the burden of their decreased shoulder function and resume meaningful activities.


The authors of this viewpoint paper utilized 15 papers to inform their writing, while providing 23 additional resources in an appendix containing recommendations for further reading. No data was used in this paper.

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