Understanding Rotator Cuff Pain: Common Causes, Symptoms, and Exercises

If you’ve ever struggled to grab something off a high shelf, brush your hair, or play a game of fetch with your dog outside, it’s possible you’ve felt the effects of some rotator cuff pain. This is a group of four muscles that are key for shoulder joint function. “They work together to position the ball of your shoulder into its socket, so that it can move while remaining stable,” explains Gina Clark, PT, DPT, a physical therapist at Hinge Health.

Rotator cuff pain or injury can make everyday activities (especially those that require reaching and throwing) more challenging. But your rotator cuff muscles are strong and resilient. There’s a lot you can do to keep them healthy, recover from injuries, and prevent shoulder issues in the future. And targeted shoulder stretches and strengthening exercises are key. Here, learn more about what our Hinge Health physical therapists recommend.

Common Causes of Rotator Cuff Pain

Your shoulder is made up of three bones: your upper arm bone (or humerus), your shoulder blade, and your collarbone. The muscles and tendons of your rotator cuff form a covering around the head of your upper arm bone and attach it to your shoulder blade. 

Rotator cuff injuries are a common cause of shoulder pain. Rotator cuff injuries refer to any damage or change in function affecting the rotator cuff, and they can result from acute accidents such as falls, or simply be the result of normal age-related changes in the shoulder. Here are some of the most common types of rotator cuff injuries. 

• Rotator cuff tear. This can be due to an acute injury, or it can happen gradually because of normal, age-related changes.

• Tendinitis. This is inflammation of the shoulder tendons, which is where your rotator cuff muscles attach to the shoulder bone, says Dr. Clark. Tendinitis usually occurs when you do a lot of overhead reaching, pushing, or lifting, or start a new sport with a lot of overhead activity (like swimming, tennis, golf, or even weightlifting) without incorporating the right stretching and strengthening exercises.

• Bursitis. This is inflammation of the bursa, a small fluid-filled sac located between the rotator cuff and the bone on top of the shoulder (acromion). It can contribute to pain and restrict some movements.

• Impingement. This condition occurs when the rotator cuff muscles in the shoulder become squeezed, which can lead to irritation, inflammation, and pain in the muscles and tendons. It also tends to be related to repetitive overhead movements.

Rotator Cuff Injuries: A Hinge Health Perspective

If you have a sore shoulder, you may assume rest is best, especially if you think your rotator cuff pain is due to playing a sport like tennis or softball. But rest can actually do more harm than good. 

“Movement is the best medicine to reduce pain, strengthen surrounding tissue, and improve function,” says Dr. Clark. Research shows that a regular exercise therapy program can help people with rotator cuff injuries reduce pain and improve their quality of life. “You want to strengthen surrounding tissues and muscles so you don’t develop compensatory patterns (adjusting the way your body moves to avoid pain) from rotator cuff weakness,” explains Dr. Clark. The exercises below are a great place to start, or a physical therapist can show you some basic exercises to do at home that can help you maintain shoulder function.

Rotator Cuff Injury Symptoms  

Symptoms of a rotator cuff injury typically include: 

• Pain and tenderness in your shoulder, especially when reaching overhead or behind your back. 

• Shoulder weakness. 

• Difficulty with activities that involve lifting your arm. 

• A cracking or popping sensation when you move your shoulder. 

In some cases, pain can be persistent and may disturb sleep, particularly when lying on your painful shoulder.

Causes of Rotator Cuff Pain 

Below are some common factors that might contribute to rotator cuff problems for some people. It’s important to remember that while certain activities or conditions may increase the likelihood of experiencing shoulder issues, engaging in activities that involve your shoulders does not mean you’ll inevitably experience a rotator cuff injury. There are proactive steps everyone can take to prevent and manage rotator cuff pain effectively. 

• Muscle weaknesses and imbalances. Strengthening exercises are very important, particularly if you do activities that involve your shoulders. Not having enough strength — or having muscle imbalances near your shoulder —  can cause your rotator cuff muscles to undergo additional stress during activities, which may contribute to pain over time. 

• Doing repetitive activities without proper strengthening. People who frequently do activities that involve overhead motions, such as painting, swimming, or throwing, may be more prone to stressing their rotator cuff over time. Activities that involve a lot of shoulder movement are not bad, but strengthening your shoulders and surrounding muscles is important to help prevent rotator cuff injuries. 

• Acute injury. This is often related to sudden, forceful movements like falling on an outstretched arm or lifting something heavier than your body was prepared for.

• Age-related changes. Just as it’s normal to develop wrinkles on your skin as you get older, it’s normal for the structures in your shoulders to change over time. Most of these changes go unnoticed, but some changes may make you more susceptible to injuries. 

Exercise therapy is a crucial component of any treatment plan for muscle and joint pain. The  above rotator cuff exercises are recommended by Hinge Health physical therapists as a great place to start. They can help if you’re recovering from a rotator cuff injury, or simply want to keep shoulder pain at bay. Regular movement ensures that your shoulder remains strong and flexible, allowing you to enjoy daily activities with greater ease and less pain.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Rotator Cuff Pain Treatment

Whether you have rotator cuff pain or a specific injury, you have options when it comes to  treatment. Here’s what Hinge Health physical therapists recommend.   

• Physical therapy. The exercises provided above are a great place to start in building strength and flexibility in your shoulder. But actually working with a physical therapist can be even more effective. Most people think PT is only for people recovering from an injury or surgery. A PT can actually provide you with personalized exercises and activity modifications, tailored to your needs, so you can reduce your pain, build strength, and do your daily activities more comfortably and effectively. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.  

• Modify painful activities. When it comes to rotator cuffs, movement is medicine. Instead of avoiding movement altogether, try to modify your activity levels to find your movement sweet spot — the point between doing too much and too little. To avoid overdoing it, you may need to temporarily modify activities that cause an unacceptable increase in your pain. For example, if overhead activity hurts, try to lift objects close to your body, and limit lifting to below shoulder level, advises Dr. Clark. If you’re a swimmer, try the sidestroke or breaststroke if the crawl is too painful. If you play tennis regularly, maybe avoid competitions for a while, or temporarily play for shorter periods of time.

• Adjust your sleeping position. Ultimately, the best sleeping position is the one that’s most comfortable for you. But if you fall asleep on your side and wake up with shoulder pain, it may help to try a different position when falling asleep. Try sleeping on your back or starting the night by sleeping on your non-painful side to see if you notice any improvements. 

• Use ice and heat. Ice can be particularly helpful if you’ve recently had a rotator cuff injury. It helps reduce inflammation and numb pain by constricting blood vessels. Heat, on the other hand, promotes blood flow and relaxes tight muscles. This may help if you have ongoing rotator cuff pain. Dr. Clark recommends using whichever feels best to you. 

How to Prevent Rotator Cuff Injuries

Rotator cuff pain can be frustrating. While you can’t always avoid an injury, there are steps you can take to try to prevent them from occurring in the first place, especially if you have a history of rotator cuff pain.  

• Stand on a stepstool when you have to reach for something. You don’t have to modify every activity you do to try and prevent injury. But this is a simple modification that will help you avoid having to reach too high and straining your muscles. It can also help you avoid strain if you do overhead motions for a long period of time, like painting a room. 

• Do strengthening exercises. Strengthening exercises build the muscles around your shoulder joint, providing better support and stability. This helps your shoulder withstand the stress of your daily activities, so you’re less likely to experience a rotator cuff injury if you lift something heavy or do a new activity that your body isn’t used to. It can be particularly beneficial to do strengthening exercises from weight-bearing positions as this helps strengthen the small muscles of your shoulders. Some examples: plank shoulder taps, push-ups, bear crawls, and downward dog to plank.  

• Work on your shoulder flexibility. “Range of motion exercises help maintain your shoulder’s mobility and flexibility,” says Dr. Clark. This allows you to move your shoulder more freely and fluidly in your everyday activities, decreasing your likelihood of rotator cuff injuries.   

PT Tip: Snuggle Up With a Pillow   

Tried sleeping on your back and couldn’t get comfortable? If you find that sleeping on your side is the best way for you to get sleep, “try hugging a pillow in front of you or prop it behind your shoulder,” suggests Dr. Clark. This can help reduce strain on the rotator cuff muscles and help you get a good night’s sleep.

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Athwal, S. & Armstrong, A. D. (2022, June). Rotator Cuff Tears. OrthoInfo — American Academy of Orthopedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears/

2. Armstrong, A. D. (2021, July). Shoulder Impingement/Rotator Cuff Tendonitis. OrthoInfo — American Academy of Orthopedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/

3. Christensen, B. H., Andersen, K. S., Rasmussen, S., Andreasen, E. L., Nielsen, L. M., & Jensen, S. L. (2016). Enhanced function and quality of life following 5 months of exercise therapy for patients with irreparable rotator cuff tears – an intervention study. BMC Musculoskeletal Disorders, 17(1). doi:10.1186/s12891-016-1116-6

4. Simons, S. M. & Roberts, M. (2021, April). Patient education: Rotator Cuff Tendinitis and Tear (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/rotator-cuff-tendinitis-and-tear-beyond-the-basics

5. Guffey, J. S., Barymon, D., Doerflein, C., Vo, C., & Bowen, D. (2018). Degenerative Changes in Asymptomatic Subjects: A Descriptive Study Examining the Supraspinatus Using Musculoskeletal Sonography in a Young Population. Journal of Allied Health, 47(2), 152–155.