Rotator Cuff Injury
Rotator cuff problems range from tendinopathy to full-thickness tears. Most are managed conservatively with progressive loading — surgery is a minority pathway.
Common symptoms
- Pain on the outside of the shoulder
- Weakness reaching overhead or behind your back
- Night pain when lying on the affected side
- Painful arc when lifting the arm out to the side
Common causes
- Repetitive overhead loading
- Sudden trauma (fall, catching a heavy load)
- Age-related tendon changes
- Postural and scapular control deficits
When to seek help
Most rotator cuff problems start with pain on the outside of the shoulder, often noticed first when reaching overhead, behind your back, or lying on the affected side at night. The pain can be sharp or dull, and a lot of people describe a "catching" feeling at certain angles.
Worth booking in if:
- the pain has been there for more than three or four weeks
- you’re changing how you use the arm to avoid it
- sleep is being disrupted
- you’ve lost real strength reaching overhead or lifting
- you’ve been told you have a tear and want to know whether you need surgery
How we treat rotator cuff injury
Rotator cuff problems — whether tendinopathy or a partial-thickness tear — respond well to a progressive loading program. The tendons need work that asks them to handle more force over time, not rest.
A typical plan runs twelve weeks. The first few weeks settle the irritation and start gentle isometric (static) work. The middle weeks build heavier resistance work and address the scapular control issues that drove the load in the first place. The final weeks return you to the work or sport tasks that matter to you.
Tear or tendinopathy — does it actually change the plan?
For most non-traumatic rotator cuff problems, the management is similar regardless of what the scan shows. Many people in their fifties and sixties have rotator cuff tears on imaging without knowing it — the tear isn’t the same as the pain. What predicts whether you need surgery is how the shoulder responds to a properly progressed loading program, not the size of the tear on a scan.
When surgery is genuinely on the table
Acute traumatic tears in younger people (under fifty or so) are often best repaired surgically, especially if there’s a clear mechanism (fall, sudden heavy lift, dislocation). Older, atraumatic tears in people whose shoulders still function well don’t usually need repair, even when the tear is large. Decisions in the grey zone are best made with both a physio and an orthopaedic surgeon at the table.
The exercises that actually help
A useful rotator cuff program is heavier than people expect. Pink-band stretches in front of a mirror don’t change much. Eight to twelve repetitions of a meaningful resistance — dumbbells, cables, kettlebells, suspended bands — challenged through the right angles, two to three times a week, will. The kit doesn’t matter; the load does.
Why the shoulder hurts at night
Night pain is the most common complaint with rotator cuff problems, and one of the most frustrating. Lying on the affected side compresses the tendon and irritates the nearby bursa; rolling onto the back can also flare things up depending on the position of the arm. A pillow tucked between the elbow and the body, or hugging a body pillow that supports the arm forward, will often buy you several hours of sleep that you weren’t getting otherwise.
Night pain usually settles a few weeks earlier than daytime pain in most rehabs. When you start sleeping through, you’re often six weeks ahead of where the shoulder feels in the gym, which is one of the more reliable early signs that the tendon is responding to the work.
Common questions about rotator cuff problems
Will my tear get worse if I exercise it?
Properly progressed loading does not make rotator cuff tears worse, on the evidence. What changes the size of a tear is usually a fresh injury, not the resistance training that helps the shoulder cope better with daily life.
Should I get a cortisone shot?
Sometimes useful in the early weeks to settle pain enough that you can engage with exercise. Not a long-term plan on its own. We’ll talk through whether the timing makes sense in your case.
How long until I can lift overhead again at the gym?
Six to twelve weeks for most non-traumatic cases, depending on what you mean by "lift overhead." Pressing a kettlebell over the head is achievable for most people inside three months. Heavy snatches and jerks take longer.
Is it really tendinitis if it’s been there for months?
Probably not, in the strict sense. "Tendinitis" implies acute inflammation; long-standing tendon pain is usually tendinopathy — a structural and biomechanical change rather than active inflammation. The treatment is loading, not anti-inflammatories.
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