Shoulder tendinopathy: understanding your shoulder pain and getting back to activity

What is shoulder tendinopathy?

Shoulder tendon anatomy

The shoulder is stabilised by a set of four tendons, those of the rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis), plus the long head of biceps tendon.[1] These tendons pass through a narrow space under the acromion and both move and stabilise the joint with every arm movement. Shoulder tendinopathy refers to painful damage to one or more of these tendons, without a tear necessarily being present.

Why do these tendons become painful?

Pain appears when the shoulder tendons are repeatedly loaded beyond their capacity to adapt, particularly during overhead movements. An imbalance between the shoulder blade’s stabilising muscles, too rapid an increase in training volume, or poor sporting technique are the most common causes of tendon overload.

Symptoms and diagnosis of shoulder tendinopathy

Typical pain and its triggers

The pain is usually felt on the front or side of the shoulder, triggered by overhead movements, throwing or cocking the arm, and sometimes simply by carrying a load with a straight arm. It can also show up at night, particularly when sleeping on the affected side, and often comes with a feeling of fatigue or weakness during repeated effort.

Differential diagnosis

Several types of shoulder pain can look like shoulder tendinopathy:

• Shoulder impingement, often behind the tendon overload before it sets in
• Supraspinatus tendinopathy, a more specific form of rotator cuff tendinopathy
• Rotator cuff deficit, worth considering if there’s a clear or persistent loss of strength
• Frozen shoulder, where the loss of mobility is global rather than just painful within a specific arc

Causes and risk factors

Shoulder tendinopathy most often develops from a gradual build-up of strain, rarely from a single traumatic event.

Biomechanical and personal factors

• An imbalance between the shoulder blade’s stabilising muscles and the rotator cuff muscles
• A too-rapid increase in training volume or intensity
• Poor sporting technique that increases the strain with every repetition
• Stiffness in the posterior capsule or a rounded-shoulder posture

Which sports contribute to shoulder tendinopathy?

Any sport that repeatedly or intensively places demand on the shoulder overhead carries a particular risk:

• Swimming, especially front crawl and butterfly
• Tennis and racquet sports
• Volleyball and handball (smashing, serving)
• Throwing sports (javelin, baseball)
• Weight training with heavy overhead presses
• Climbing and overhead-gripping sports

Treating shoulder tendinopathy in rehab with a sports physio

The goal of treatment is to progressively strengthen the cuff tendons and the shoulder blade’s stabilising muscles, while temporarily reducing the load on the shoulder until the pain settles.

1. 1Reducing pain and managing load
2. 2Shoulder and shoulder-blade mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Rotator cuff work
7. 7Correcting sporting technique
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”

Strengthening, the cornerstone of treatment

Strengthening the rotator cuff and the shoulder blade’s stabilising muscles (trapezius, serratus anterior) helps better distribute the strain on the shoulder tendons. This is completed by correcting sporting technique, since inefficient shoulder mechanics increase the strain with every repetition.

In brief

• Strengthening the rotator cuff
• Strengthening the shoulder-blade stabilisers
• Progressive correction of sporting technique
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary and isn’t the most effective solution. It’s better to temporarily adapt your activity by reducing the movements that clearly reproduce the pain, while staying physically active and starting cuff strengthening as soon as possible.

When should you see a specialist for shoulder tendinopathy?

If the pain persists for more than three to four weeks despite adapting your activities, or if it comes with a clear loss of strength or systematically wakes you at night, a medical opinion is recommended to rule out a tendon tear.

Expected recovery timeline for shoulder tendinopathy

Shoulder tendinopathy progresses well in the vast majority of cases with well-run rehab. Clear improvement is usually seen within a few weeks, with a full return to sport following several weeks of progressive strengthening of the rotator cuff and shoulder blade stabilisers.

Preventing recurrence

Once the pain has resolved, a few measures help limit the risk of it coming back:

• Keep up rotator cuff and shoulder blade stabiliser strengthening long-term
• Progress the volume of overhead movements cautiously after a break or a new season
• Pay attention to sporting technique, especially in throwing or racquet sports
• Don’t ignore discomfort that reappears, a sign that the imbalance is creeping back

The HOPP care programmes to treat your shoulder tendinopathy and get back to sport

For lasting recovery, shoulder tendinopathy requires a progressive rebalancing of forces around the joint. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your shoulder is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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