What Is It?
The shoulder complex depends on coordinated neuromuscular function across four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis), the scapular stabilisers, and the glenohumeral joint capsule. When this coordination breaks down — through overload, trauma, or progressive deconditioning — a range of presentations emerge.
Rotator cuff tendinopathy (formerly impingement syndrome) is the most common, involving degenerative changes in the tendon with associated pain on overhead activities and loading. Adhesive capsulitis (frozen shoulder) involves progressive glenohumeral joint stiffness with severe ROM restriction. Acromioclavicular joint injuries typically follow a fall or direct contact. Biceps tendinopathy presents as anterior shoulder pain with resisted elbow flexion or supination.
Common Causes
- Repetitive overhead loading (throwing sports, swimming, trade work) exceeding tendon capacity
- Weak scapular stabilisers (lower trapezius, serratus anterior) leading to altered humeral head mechanics
- Tight pectoralis minor pulling the scapula into anterior tilt and reducing subacromial space
- Reduced thoracic extension limiting overhead shoulder mobility
- Traumatic labral or rotator cuff tears (fall, dislocation, contact sport)
- Hormonal factors and systemic conditions such as diabetes and thyroid dysfunction (adhesive capsulitis)
- Sustained desk posture with internal rotation and protraction of the shoulder girdle
How Myotherapy Can Help
- Soft tissue therapy — pectoralis minor, infraspinatus, teres minor, subscapularis, and upper trapezius to restore normal muscle length and tone
- Dry needling — directly into rotator cuff trigger points for pain modulation when manual therapy alone cannot reach depth
- Joint mobilisation — glenohumeral and thoracic mobilisation to restore ROM and reduce joint pain
- Exercise rehabilitation — evidence-based rotator cuff and scapular stabiliser programmes (external rotation, lower trapezius, serratus anterior loading); the primary long-term intervention for tendinopathy
- Postural correction — addressing thoracic kyphosis and scapular positioning to reduce mechanical irritation
Expected Outcomes
Rotator cuff tendinopathy responds well to a combined manual therapy and exercise programme over 8–12 weeks. Pain with overhead activities is often the first to reduce; strength and endurance improve progressively. Adhesive capsulitis follows a longer natural history (6–24 months to full resolution) — myotherapy cannot change this timeline significantly but can improve pain and functional ROM throughout each phase. Side effects of treatment may include post-session muscle soreness and temporary increased stiffness (typically resolving within 48 hours).
Likely Symptom Changes
Early sessions: reduction in resting shoulder pain and improved muscle length in pec minor and upper trap. Mid-treatment: improved pain-free ROM for overhead and reaching activities. Later sessions: strength and endurance improvements become the primary measure of progress. Pain during exercise is common early in rehabilitation — this should reduce progressively over weeks, not increase.
References
- Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57–68.
- Abdulla, S. Y., et al. (2015). Is exercise effective for treatment of supraspinatus tendinopathy in adults? A systematic review. British Journal of Sports Medicine, 49(20), 1316–1323.
- Page, M. J., et al. (2016). Manual therapy and exercise for rotator cuff disease. Cochrane Database of Systematic Reviews, Issue 6.
- Manske, R. C., & Prohaska, D. (2010). Diagnosis and management of adhesive capsulitis. Current Reviews in Musculoskeletal Medicine, 1(3–4), 180–189.
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