Part of Rotator cuff tendinopathy
The worst exercises for a rotator cuff problem, and the rule that beats a list
Warning signs, and when to get help
What are the worst exercises for the rotator cuff?
Judged by what the sources actually publish, there is no such list. The two clinical practice guidelines written for this condition do not name banned exercises, and the closest thing in print is a list of directions.
That list comes from the 2026 update of the Dutch guideline. It asks for movements such as reaching, lifting the arm forward and lifting it out to the side above shoulder level to be limited, along with turning the arm in and out to the very ends of its range. The same section asks people to move within their comfort zone and to keep away from activity that is too long, too heavy or too frequent, and to set work up so it is not above shoulder level, with regular breaks and aids where they exist.
Where those lines sit matters as much as what they say. They are the guideline's answer to a question about preventing shoulder pain coming back in people at work, not a treatment plan for a shoulder that hurts today. The guideline supplies its own caution with them: the search behind that question found 683 papers and none of them met its selection criteria, so the panel wrote from clinical reasoning and expert opinion instead of trials. Everything here that comes from the Dutch update comes out of that section, so read it as considered opinion.
Both guidelines were written for a cuff that hurts, not for one that has been repaired. The 2025 physical therapy guideline states in its own scope that it covers tendinopathy with or without calcifications and partial-thickness tears, and that it excludes other rotator cuff diagnoses such as full-thickness tears, while the Dutch update deals with the non-surgical treatment of this shoulder. So neither document is the authority on what a repaired tendon, or a tendon that is fully off the bone, can carry. That answer comes from the team that operated, or the team managing the tear.
Taken as limits, not bans, those directions are the sensible ones to watch. Loaded work at the top of the range, and the very ends of turning the arm in and out, are the positions an irritable cuff most often cannot tolerate yet, which is why they come up in surgical clinics as well as physiotherapy ones. What a list of directions cannot do is tell a cuff that is intact from one that is torn through, or a shoulder before an operation from a shoulder six weeks after one. Those readers need a different instruction, and the sections below say where it comes from.
The NHS puts the same idea into four do-not lines on its shoulder pain page. Do not stop using the shoulder altogether, because that is what stops it getting better. Leave out whatever clearly aggravates it. Do not invent strenuous exercises of your own, and keep away from heavy gym equipment for now. And do not sit slouched.
Australia's healthdirect adds two lines of its own, under lowering the chance of a cuff problem, not treating one: avoid repetitive overhead activities, and avoid lifting heavy objects above the height of your shoulder.
Notice what is missing from all of them. No exercise names. Nothing about dips, nothing about upright rows, nothing about the lifts that fill the search results. A page handing you a numbered list of forbidden movements has gone further than any source it is standing on.
The rule that beats a list
A list can only ever judge the handful of movements somebody chose to write down. A rule judges the one in front of you.
Ask somebody before loading this shoulder at all if either of these is you, whatever the rule says. With a heart condition or high blood pressure, check with your doctor before you start. If you have high blood pressure, breathe steadily through every repetition and never hold your breath. This page is written for adults, so a teenager with a painful shoulder needs seeing by a doctor or physio before they load anything overhead.
Here it is in a sentence: note how sore the shoulder is and how far it will move before you start, do the movement at a load and a range you can move smoothly, without hitching the shoulder up or swinging the arm, then compare the shoulder the next morning against that note. No worse the next morning, with the night pain no worse, means the shoulder tolerated it. Clearly worse the next morning, or night pain back after it had settled, means the load was too much. Drop back to the last version that passed, or to a lighter and shorter one if there was none, rather than dropping the movement altogether. That is the rule the rotator cuff tendinopathy program already runs on, including the stage you start at and when you move up.
One reader the rule does not fit is the one whose cuff has been repaired. A repair is tendon stitched back onto bone, and that join heals to a timetable, not to how the shoulder feels. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation after arthroscopic rotator cuff repair describes a 2 week period of strict immobilization, protected passive movement through weeks 2 to 6, active movement restored after that, and progressive strengthening beginning at week 12, with the whole staging adjusted for the size of the tear, the quality of the tissue and the person (Thigpen and colleagues, 2016). That framework is a consensus of shoulder therapists, not a trial, and a large or multi-tendon repair is usually held longer at every stage. Those are weeks on a calendar, not a response to a good morning, and your own surgeon's dates may be later than any of them.
Symptoms are a poor guard on that timetable. That surprises most people. In a meta-analysis of 14 studies and 861 shoulders followed for at least a year after a cuff repair, pain and function improved whether or not imaging showed the repair still intact, and the differences between the intact repairs and the retears were not clinically important (Russell and colleagues, 2014). A comfortable morning is not evidence that a repair is holding. So after surgery the dates in your plan decide what you load, and a sudden pop or tearing feeling with new weakness is a reason to ring the team that operated rather than to retest the movement tomorrow.
You will use that rule more than anything else here, so where it comes from should be clear. It is physiotherapy practice, not a guideline recommendation. Neither clinical practice guideline for this shoulder publishes a 24 hour rule, and we found no trial that compared judging a session by the next morning with judging it any other way. The nearest published version of it is not a guideline at all: New Zealand's Healthify, in its self-care advice for shoulder pain, accepts a small increase in pain while exercising as long as it goes away within 30 minutes and the shoulder is no worse the next day. Use the 30 minutes as well as the morning, because an ache that has not settled by then counts against the session too.
Physios read the morning instead of the set for a reason. The evidence on painful against pain-free exercise for this shoulder, set out on the rotator cuff tendinopathy program, does not make the pain you feel during the exercise the thing that decides the outcome.
During the session itself, two things mean stopping that exercise rather than finishing the set: pain that is sharp or catching, and pain that builds with each repetition. Ordinary discomfort that eases soon after you finish is not in that category.
One trial here points the opposite way from a ban list. In the SELF study, 86 NHS patients with rotator cuff tendinopathy were randomized, and one group did a self-managed program built around a single exercise, chosen because it was the most symptomatic shoulder movement for that person. There was no significant difference between that group and usual physiotherapy at three, six and twelve months (Littlewood and colleagues, 2016). The trial was small, and 26 of the 86 were left out of the analysis for missing their three month data, so it settles nothing on its own.
It does make the case that the most painful movement can be the exercise itself, not the thing to avoid. The lists assume the opposite.
Is this movement out, or does it just need changing?
Three outcomes, and only one of them is a ban.
Out for now is the rare one. It belongs to a movement that still gives sharp or catching pain when you try it light, and to anything your surgical team has restricted. Stop at the first sharp or catching pain rather than working through it to be sure, try it lighter on another day instead of straight away, and if two lighter attempts still catch, leave it there and ask a physio instead of testing it again. Out for now is not out forever.
Changed is where nearly everything lands. The things you can change, roughly in the order worth trying: the load, the range, the angle, the grip, the number of sets, and how often in the week it comes round. Change one of them at a time. Change two and a sore morning tells you nothing about which one did it. The same goes for testing: one new movement in a session, and let a morning pass before you repeat it.
Left alone covers more than people expect. A movement that gives no pain during it and no extra soreness the next morning is not made safer by removing it, and removing it costs you capacity you will need later. Two shoulders are outside that, and in both of them a painless movement is not a cleared one: a cuff that has been repaired, where the clearance is the date in your plan, and a cuff with a known full-thickness tear, where the loading decisions sit on rotator cuff tear treatment without surgery and with the team managing it. If this shoulder started hurting with a fall, a pull or another injury and the arm has been weak since, nothing here is left alone either, because that shoulder needs examining the same day before anything is sorted into these three boxes.
The positions that most often need changing
These are the ones that come up again and again in clinic, with what usually changes about each. All of it assumes a shoulder nobody has operated on. If yours has been, the only list that counts is the one your surgical team gave you, and the changes below are not a way round it.
Loaded pressing above shoulder height. Overhead and shoulder presses put the arm at the top of its range while it is carrying weight, which is the direction the Dutch update asks to be limited. What changes first is the height, not the lift: press to below shoulder height, drop the load, and use a grip with the palms facing each other rather than forward if that feels better. Programming the way back up is the subject of the gym and overhead lifting with a rotator cuff injury.
Weighted raises past shoulder height. Lateral and front raises load the cuff at the end of its lever. Stop at shoulder height for now and cut the weight sharply, which usually means a smaller dumbbell than feels dignified.
Anything that takes the arm behind the line of your body under load. Dips, deep bench pressing with a wide grip and chest flyes at the bottom of the range all do this. Less range at the bottom is the usual fix, with a narrower grip on the bench, and shoulder pain on the bench press goes through that lift on its own.
Hard end-range stretching, in and out. Cranking the arm into the last few degrees of turning inward or outward is the other direction the Dutch update names. Gentle movement in a comfortable range, yes. Hanging off a doorframe, no.
Long unbroken spells of overhead work. Not an exercise, and still the thing that decides how most people's evening goes. The Dutch update's workplace advice is to set the work up so it is not above shoulder level, take regular breaks and use aids where they exist. Breaking an hour overhead into shorter blocks with the arms down in between does more than any exercise swap on this list.
Lying on the sore shoulder all night. Nor is this an exercise, and over 24 hours it is often the biggest single load on the shoulder. How to sleep with rotator cuff pain covers what that means and what it does not.
What load has to do with the problem in the first place, and what the evidence says about posture and the shape of the bone, is on what causes shoulder impingement.
Should I rest the shoulder completely?
No. The NHS is unusually blunt about this one: stopping using the shoulder completely can stop it getting better. Its own do list is to stay active and keep the shoulder gently moving, to use pain relief so you can keep moving, and to keep the exercises going for 6 to 8 weeks to stop the pain coming back. It also sets an expectation about timing: keep the self-care going a full 2 weeks before the pain eases at all, on its own estimate. Worth knowing before you decide a week has failed.
Complete rest also has a cost that nobody feels until later. The tendon's problem is capacity, and rest does not build capacity. The 2025 physical therapy guideline recommends an active exercise program as a first treatment for these shoulders, and the Dutch update asks for gradual exercise within sport and work to build what the cuff can carry. In the GRASP trial, which randomized 708 adults with these shoulders across four treatment arms, there were no serious adverse events (Hopewell and colleagues, 2021). So loading a painful cuff sensibly is not a dangerous act, in the shoulders that trial studied.
The small print on who those 708 were draws the same boundary the guidelines do: GRASP excluded anyone with a history of significant shoulder trauma, giving dislocation, fracture and a full-thickness tear needing surgery as its examples, and anyone who was being considered for surgery. A safety record built on that group says nothing about a repaired tendon or a tear from an injury.
The exception that matters most sits the other way round. After a rotator cuff repair, a spell of protected rest, usually in a sling, is the treatment and not neglect: the consensus framework above opens with 2 weeks of strict immobilization before any protected movement starts. The NHS line about not stopping using your shoulder is written for a shoulder nobody has operated on. If you are inside the protected period your surgeon set, nothing on this page is a reason to come out of the sling early or to start lifting the arm yourself.
Two general checks apply before you load any shoulder, operated on or not. With a heart condition or high blood pressure, check with your doctor before you start. If you have high blood pressure, breathe steadily through every repetition and never hold your breath, which on a press means picking a weight you can move while breathing out rather than bracing against a held breath.
After shoulder surgery, and who needs to ask first
After shoulder surgery, including a rotator cuff repair, or after a shoulder fracture or dislocation, follow your surgeon's or physio's plan, and do only the movements and range they have cleared. Many plans allow only passive movement at first, where the arm is moved for you and its muscles stay relaxed. Rotator cuff repair rehab is where that stage lives, and nothing on this page replaces a restriction you were given. The same holds after a shoulder replacement and after surgery on the labrum or the long head of the biceps. This page is written for adults, so a teenager with a painful shoulder needs seeing by a doctor or physio before they load anything overhead.
Surgeons genuinely differ about the dates, and that is not untidiness. The restrictions follow what was found and what was done: how big the tear was, which tendon it was, the quality of the tissue it was stitched into, and the person it belongs to. Two people who had the same named operation on the same morning can be given different dates for coming out of a sling, for lifting the arm under its own power, and for carrying anything with it. Reaching behind your back and turning the arm outward are usually held back longer than the rest, because a repair of the tendon at the front of the shoulder, and most replacements, go through the tendon those two movements stretch.
Nothing on this page sets any of those dates and no page can. If the paperwork has gone missing, ring the team that operated and ask, rather than reconstructing a timeline from the internet.
One more reader should ask before loading anything here: if you have had a corticosteroid injection into this shoulder, ask whoever gave it how soon to load the shoulder again and how hard. Injections for this condition are given alongside exercise rather than instead of it, and the GRASP trial tested the two together (Hopewell and colleagues, 2021). What it does not settle is the gap between the injection and the loading on any one person's shoulder, which depends on what was injected and where, so the team that gave it is the one to ask.
If your shoulder pain came on suddenly with an injury, not gradually, this page is not the right starting point either. Neither is it the place to work out which diagnosis you have: rotator cuff tear or tendonitis sets out what separates them and what does not. How long a cuff problem usually takes is on how long rotator cuff tendonitis takes to heal.
See a doctor or physio if the shoulder is getting worse or has not improved after 2 weeks, as the NHS advises, if it is very hard to move the arm, or if you have taken movements out and have no idea how to get them back. A physio watching you do the movement is worth more than another fortnight of guessing on your own.
When stopping is not enough
A page about avoiding exercises needs this part most, because some of what follows is not an exercise problem at all, and taking an exercise out will not touch it.
An arm that has been weak since a fall or a sudden pull needs medical advice the same day, with the story of how it happened and the fact that the arm has been weak since. Sudden, very bad shoulder pain, or suddenly not being able to lift or move the arm at all, is also the same day. New numbness, pins and needles that do not settle after you stop, or weakness that is getting worse: same day again. A shoulder that is hot, red and swollen, or shoulder pain with a fever, means going to an emergency department the same day.
If you have had shoulder surgery, three of these go somewhere else, because the team that operated is both the right door and the fastest one. A sudden pop or tearing feeling in the shoulder that brings sharp pain, new weakness or trouble lifting the arm: stop and contact your surgical team the same day. Movement or strength you had already got back going backwards instead of forwards, over days rather than in a single moment: contact them within a day or two and ask to be seen, rather than waiting for the next routine appointment, because whether the repair is holding is a question only they can answer. And if the shoulder is hot, red and swollen since your operation, or you have shoulder pain with a fever, or the redness, warmth, swelling or pain is not getting better or is getting worse, contact your surgical team straight away, day or night, or the ward you went home from, and if you cannot reach them, go to an emergency department the same day. An infection in an operated shoulder does not wait for a physiotherapy appointment.
Two more are not load problems at all. Shoulder or arm pain with shortness of breath, sweating or feeling sick can be a heart attack, and so can chest pain or tightness that spreads to the arm, neck or jaw, and both mean calling emergency services straight away.
If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked. If you faint while exercising, call emergency services, even if you feel fine again quickly.
Night pain that is constant, that no rest or change of position eases at all, and that keeps getting worse needs checking within a few days, and sooner, within a day or two, if you have had cancer, now or in the past, or are losing weight without trying.
The warning list below gives all of them with how fast to act on each. Act on the one that matches you before you change anything about the exercises, and nothing in that list means you will not exercise the shoulder again.
One sign in the list below appears three times, at three different speeds. Pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse is a same-day matter if you are being treated for cancer now, a within-a-day-or-two matter if you have had cancer at any time or are losing weight without trying, and otherwise needs checking within a few days. If you cannot tell which of those you have, treat it as the more urgent one.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- Emergency: the shoulder is hot, red and swollen, or you have a fever or feel unwell. This can be a joint infection, which needs treatment quickly. Go to an emergency department the same day, and call emergency services if you feel very unwell.
- Emergency: the shoulder feels as if it has slipped out of place, looks a different shape or suddenly locks so you cannot move the arm, or the pain is severe after a fall or an injury. Go to an emergency department straight away, without driving yourself, and do not try to put the shoulder back in yourself.
- Emergency: your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
Get help now, day or night
- Since your operation, the shoulder is hot, red and swollen, you have shoulder pain with a fever, or the redness, warmth, swelling or pain in your shoulder is not getting better or is getting worse, for example the shoulder pain keeps building both when you move and when you rest. This can be an infection in the shoulder joint. Contact your surgical team straight away, day or night, or the ward you went home from, and if you cannot reach them, go to an emergency department the same day.
Get help today
- Same day: sudden, very bad shoulder pain, or you suddenly cannot lift or move your arm at all. Get medical help the same day.
- Same day: the pain started after a fall, a pull or another injury, especially if the arm has been weak since, for example you cannot lift it out to the side or hold it up. This can be a broken bone or a torn tendon. Get medical advice the same day, and say how it happened and that the arm has been weak since, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury.
- Same day: a sudden pop or tearing feeling in the shoulder that brings sharp pain, new weakness or trouble lifting the arm. Stop and contact your surgical team the same day, or get medical advice the same day if you have not had surgery.
- Same day: since your operation, the arm has lost movement or strength it had gained, so lifting or turning it is weaker or much more painful than it was a week or two ago, or you notice clicking, grating or a new catch in the shoulder. A repair can pull off the bone without a pop, and when it does the usual sign is lift that was coming back and has gone again, sometimes with little new pain. Rest the arm, leave out any exercise that makes it worse, contact your surgical team the same day and ask whether the repair needs checking. If you cannot reach them, get urgent medical advice.
- Same day: pins and needles or numbness in the arm that does not go away, no feeling in part of the arm, or weakness that is getting worse. Get medical advice the same day. For pain spreading down the arm from your neck, ask for an urgent appointment with your doctor. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- Same day: severe pain in both shoulders that has come on recently. Get medical advice the same day.
- Same day: you are over 50 and have aching and stiffness in both shoulders, often in the neck or hips too, that is worst in the morning and lasts more than 45 minutes after you get up. This can be an inflammatory condition (polymyalgia rheumatica) rather than a rotator cuff problem. If you also get a new headache, pain or tenderness at your temples or on your scalp, or jaw pain when you eat or talk, get medical advice the same day, and if your vision changes, call emergency services. Even without those extra signs, see your doctor within a few days about the aching and stiffness.
- Same day: pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: since your shoulder operation, movement or strength you had got back is going backwards instead of forwards, or the arm feels weaker than it did a few weeks ago. Contact your surgical team and ask to be seen within a day or two, rather than waiting for your next routine appointment, because they may want to check whether the repair is holding.
- Within a day or two: new shoulder pain and you have had cancer, now or in the past, or you are losing weight without trying. See your doctor within a day or two and mention it.
- Within a day or two: pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: night pain is common with this condition, but get checked within a few days if the pain is constant, no rest or change of position eases it at all, and it keeps getting worse.
- Within 2 weeks: shoulder pain that is getting worse, or that has not improved after 2 weeks, or it is very difficult to move your arm or shoulder. Book an appointment with a doctor or physiotherapist, as the NHS advises.
- Within 2 weeks: pain at night that stops you sleeping, which may be worse than during the day. Book an appointment with a doctor, an urgent care doctor or a physiotherapist, as Healthify New Zealand advises.
Common questions
What exercises should I avoid with a rotator cuff injury?
Fewer than the lists suggest, and the honest answer is a rule rather than a set of names. If you have had shoulder surgery, including a rotator cuff repair, or after a shoulder fracture or dislocation, follow your surgeon's or physio's plan, and do only the movements and range they have cleared. Many plans allow only passive movement at first, where the arm is moved for you and its muscles stay relaxed. Otherwise the movements that fail most often are the loaded ones above shoulder height, the ones that take the arm behind the line of your body, and the stretches pushed to the very end of turning the arm in or out. The 2026 update of the Dutch guideline limits those directions rather than banning exercises, in its advice on keeping shoulder pain from coming back at work, and it reaches that advice by expert opinion, because its own search found 683 papers and none met its selection criteria. Judge each movement by the next morning rather than by the name: a shoulder that is no worse, with the night pain no worse, tolerated the load. That next-morning rule is physiotherapy practice rather than a guideline recommendation, although New Zealand's Healthify publishes the same test in its self-care advice for shoulder pain: a small increase in pain while exercising is acceptable as long as it goes away within 30 minutes and the shoulder is no worse the next day.
What are the worst exercises for a torn rotator cuff?
There is no published list for a torn cuff either, and which tear you have changes who should be answering. If you have had shoulder surgery, including a rotator cuff repair, or after a shoulder fracture or dislocation, follow your surgeon's or physio's plan, and do only the movements and range they have cleared. Many plans allow only passive movement at first, where the arm is moved for you and its muscles stay relaxed. For a partial-thickness tear, the 2025 physical therapy guideline puts that tear inside the same scope as tendinopathy, so this page applies as written. For a full-thickness tear, the loading decisions belong on rotator cuff tear treatment without surgery. A tear from an injury is urgent rather than a question about exercise selection: the pain started after a fall, a pull or another injury, especially if the arm has been weak since, for example you cannot lift it out to the side or hold it up. This can be a broken bone or a torn tendon. Get medical advice the same day, and say how it happened and that the arm has been weak since, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury.
Is it bad to push through rotator cuff pain?
Some discomfort during the exercises is usual and is not a sign of harm, and the program on the rotator cuff tendinopathy page sets out what it accepts and what it does not. Pushing through is a different thing, and the Dutch update's own advice is to move within your comfort zone and to keep away from activity that is too long, too heavy or too frequent. Two signals mean stopping that exercise rather than finishing the set: pain that is sharp or catching, and pain that builds with every repetition. One more ends the session for good that day: a sudden pop or tearing feeling in the shoulder that brings sharp pain, new weakness or trouble lifting the arm. Stop and contact your surgical team the same day, or get medical advice the same day if you have not had surgery.
Should I rest my rotator cuff completely?
No, and the NHS is direct about it: do not completely stop using your shoulder, because that can stop it getting better. Its advice is to stay active and keep gently moving the shoulder, to avoid the things that clearly make it worse, and to keep shoulder exercises going for 6 to 8 weeks to stop the pain returning. Resting a tendon does not build the capacity it is short of, which is why the first treatment for this problem is a graded strengthening program rather than a sling. A repaired cuff is the other way round for a while: there a sling and protected rest are part of the aftercare, and the consensus framework for rehabilitation after an arthroscopic repair opens with 2 weeks of strict immobilization (Thigpen and colleagues, 2016). If you have had shoulder surgery, your surgeon's or physio's plan comes first and overrides everything here.
Can I stretch a painful rotator cuff?
Gentle movement into a comfortable range, yes. If you have had shoulder surgery, stretch only what your surgeon's or physio's plan allows and no further, because after a repair of the tendon at the front of the shoulder, and after most shoulder replacements, turning the arm outward is usually held back longer than the other directions. Stretching hard into the end of turning the arm in or out is one of the directions the 2026 Dutch update asks to be limited, and it is a common way to leave a cuff sorer the next morning for nothing in return. Stiffness that is clearly limiting you in every direction, including when somebody else moves your arm for you, is a different problem, and frozen shoulder is the page for that. If the stretch is leaving you with pins and needles or numbness in the arm that does not go away, no feeling in part of the arm, or weakness that is getting worse, get medical advice the same day.
References
- NHS. Shoulder pain. Page last reviewed 22 May 2023. https://www.nhs.uk/symptoms/shoulder-pain/
- Lambers Heerspink FO, Veen EJD, Dorrestijn O, et al. Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association. Part 1: preventive measures, diagnostics, and non-surgical treatment of subacromial pain syndrome. Acta Orthopaedica. 2026;97:91-98. https://doi.org/10.2340/17453674.2026.45365
- Littlewood C, Bateman M, Brown K, Bury J, Mawson S, May S, Walters SJ. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clinical Rehabilitation. 2016;30(7):686-696. https://doi.org/10.1177/0269215515593784
- Desmeules F, Roy JS, Lafrance S, et al. Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: a clinical practice guideline. Journal of Orthopaedic and Sports Physical Therapy. 2025;55(4):235-274. https://doi.org/10.2519/jospt.2025.13182
- Hopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 x 2 factorial, randomised controlled trial. The Lancet. 2021;398(10298):416-428. https://doi.org/10.1016/S0140-6736(21)00846-1
- Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox RB III. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016;25(4):521-535. https://doi.org/10.1016/j.jse.2015.12.018
- Russell RD, Knight JR, Mulligan E, Khazzam MS. Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. Journal of Bone and Joint Surgery. American Volume. 2014;96(4):265-271. https://doi.org/10.2106/JBJS.M.00265
- Kulkarni R, Gibson J, Brownson P, Thomas M, Rangan A, Carr AJ, Rees JL. Subacromial shoulder pain. BESS/BOA Patient Care Pathways. Shoulder and Elbow. 2015;7(2):135-143. https://doi.org/10.1177/1758573215576456
- American Academy of Orthopaedic Surgeons. Shoulder impingement/rotator cuff tendinitis. OrthoInfo. https://www.orthoinfo.org/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/
- healthdirect. Rotator cuff injury. https://www.healthdirect.gov.au/accidents-and-injuries/rotator-cuff-injury
- Healthify He Puna Waiora. Shoulder pain. https://healthify.nz/health-a-z/s/shoulder-pain
- NHS. Heart attack. Page last reviewed 31 March 2026. https://www.nhs.uk/conditions/heart-attack/
Written and checked by the PocketPhysio editorial team. Last updated 2026-11-05.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.