Shoulder tendonitis is a common condition that affects the tendons of the rotator cuff or biceps. This can become an be a debilitating issue for many individuals whether they’re elite athletes, weekend warriors, or even people just going about their day-to-day being the best mom/dad/spouse/worker they can be!

As Sports Chiropractors here at Minnesota Movement, we play a crucial role in guiding patients through effective rehabilitation to not only just alleviate their pain, but to restore function, and prevent recurrence as well. Our providers use evidence-based strategies and practical corrective exercises for managing shoulder tendonitis, which ensures a tailored and comprehensive approach to patient care.

Understanding Shoulder Tendonitis

Shoulder tendonitis typically involves inflammation or irritation of one or many of the tendons in the shoulder. This is often caused by repetitive overhead activities, poor posture, or trauma. Common symptoms include pain, swelling, reduced range of motion, and weakness in the shoulder. An accurate diagnosis of the issue at hand is essential to ensuring a great outcome of care. Often this examination involves a combination of patient history, physical examination, and imaging studies if necessary.

Rehabilitation Principles

1. Pain Management
   - Modalities: If traumatic, utilize ice/cold therapy within the first 24-48 hours. If non-traumatic, heat should be used to mitigate pain. Other modalities for pain management of Shoulder Tendonitis can include; manual therapies such as IASTM/Graston, Cupping, Red Light Therapy, and Kinesiology Taping to reduce pain and inflammation in the acute phase.
   - Movement: Encourage patients to explore pain free ranges of motion. Specifically isometric and eccentric exercises to restore neurological firing patterns. These can be performed either assisted, weightless, simply against gravity, or even with light resistance such as an exercise band.

2. Rest and Activity Modification
   - Rest: Depending on severity, we sometimes have to have patients to avoid activities that exacerbate pain, particularly overhead movements which usually require those muscles that are impacted to fire. That said, we don’t want to fully rest. If a movement isn’t outright painful - continue to do it! Or as mentioned above, modify by decreasing load and/or focusing on rehab movements like isometrics and eccentrics.
   - Ergonomics: Educate patients on proper ergonomics and body mechanics to minimize strain on the shoulder. Rather than use the buzzword ‘posture’ and favoring the word ‘positioning’ instead, we want to be conscientious of where our body parts are in space and utilize them with the most effective and efficient patterns. With more computer work, phone usage, etc across our society - we tend to navigate more into internal rotation of our shoulders. So spending more time with external rotation is a great place to start.

3. Range of Motion (ROM) Exercises
   - Passive ROM: Start with gentle passive ROM exercises to maintain joint flexibility without stressing the tendons. This can be performed either with assistance from another person guiding the limb through ranges of motion or with the help of bands, walls, rigs, etc to help navigate into ranges such as overhead positions.
   - Active-Assisted ROM: Progress to active-assisted exercises, such as wall crawls and pulley exercises, as pain decreases. The more we challenge the system, the more we change the system.

4. Strengthening Exercises
   - Isometric Exercises: Begin with isometric exercises to strengthen the rotator cuff and scapular stabilizers without significant movement. Isometric Exercises are where the muscle fibers are actively engaged but without any shortening (or lengthening for that matter) of the muscle tissue. Imagine holding a dumbbell mid-way through the range of motion of a biceps curl. Your biceps fibers are still engaged, but the weight is staying in the same position. Because nothing is actively moving with these exercises, the goal isn’t reps or sets. The goal should be Time Under Tension. Hold each engagement for 10-15 seconds and repeat 6-10 times to get to around 90 seconds of total time.
   - Progressive Resistance: Gradually introduce resistance bands or light weights, focusing on the rotator cuff and scapular muscles. Big takeaway as we add load to any movement is that we should still feel engagement in the correct area. If we load too much too soon, we risk compensation. This might lead to strengthening a bad habit and slow down our progression.

5. Stretching
   - Incorporate gentle stretching exercises to improve flexibility and prevent stiffness, emphasizing the posterior capsule (internal rotators) and pectoral muscles. Again, the goal is to add up Time Under Tension with our stretches. Sure, a 15 second stretch feels nice. But we’re not going to change the tissue with such a short duration of hold. Aim for 90 seconds of total time under tension. If this means that you need to do three 30 second holds - that’s fine!

6. Proprioceptive Training
   - Engage patients in proprioceptive and neuromuscular training to enhance shoulder stability and coordination. Proprioception is essentially knowing where your body (and it’s parts) are in space from within. Think about the stereotypical DUI test where people stand with their arms out to a ‘T’, close their eyes, and try to touch their nose. We can add proprioception to the system by therapies such as IASTM/Graston, Cupping, Kinesiology Tape, or Graphesthesia. With exercises, we can add proprioception with movements that require intent. Movements that force us to focus on getting the right muscles to fire at the right time by adding external feedback are phenomenal for this.

7. Functional Training
   - Tailor exercises to mimic specific activities or sports relevant to the patient’s lifestyle or occupation, ensuring a smooth transition back to normal activities. This seems easy to do in theory, right? If you’re a basketball player just start shooting buckets - simple as that right? Wrong. We still have to progressively add load and keep a keen eye on mechanics as we do so. Not to say that we need to be ultra cautious with this, but we need to consider the risk of re-injury to the area.

8. Education and Prevention
   - Patient Education: This is where the providers at Minnesota Movement shine the brightest! Our goal isn’t to treat you like a piece of meat that needs to be tenderized or mashed into a certain form. We take the time to educate you on not only what is happening but why it’s happening and what to expect as well. We aim to teach patients about the importance of maintaining shoulder health, proper positioning, and the importance of regular exercise.
   - Prevention: From the education and progression of treatment patients can expect to prevent re-occurance or flare ups if they continue with the program of rehab. That said, we can’t bulletproof ourselves against life and sometimes things happen. But the good news is that the team is ready to get back to work with you!

Conclusion

Effective rehabilitation of shoulder tendonitis requires a structured and patient-centered approach. By combining pain management, ROM exercises, strengthening, and functional training in a step-by-step progression, the Sports Chiropractors here at Minnesota Movement can guide patients through a successful recovery. Continuous education and preventive strategies are vital in ensuring long-term shoulder health and minimizing the risk of recurrence.

As always, we stay updated with the latest research and techniques in shoulder rehabilitation in order to enhance our ability to provide the best care for our patients.