Rotator Cuff Tendinitis / Bursitis
Shoulder Impingement
Protection → Controlled Motion → Return to Function
What Shoulder Impingement Is
Impingement is a space problem. The rotator cuff tendons and the bursa get pinched in the narrow gap under the acromion (the bony roof of the shoulder).
- Primary — anatomical or mechanical factors that physically decrease the subacromial space.
- Secondary — mechanical compression because the shoulder is hypermobile or unstable, letting the ball ride up and translate too far.
Involved tissues: The supraspinatus and infraspinatus tendons, the long head of the biceps, and the subdeltoid and subacromial bursae — these are the structures getting pinched.
The two pillars of treating impingement: first, AVOID the impingement position while you work — don't keep pinching the tendon. Second, restore scapulohumeral rhythm — getting the shoulder blade to move correctly with the arm is THE priority. Everything below serves those two goals.
Why the shoulder blade is the key
If the shoulder blade doesn't rotate upward and set a good platform as you lift, the space stays crowded and the tendon keeps getting pinched. Weakness of the scapular pivoters — the serratus anterior and lower trapezius especially — is a core driver. A tight posterior capsule also matters: it pushes the humeral head up and forward, adding to the pinch. So this protocol is really about clearing space: fix the blade, open the tight capsule, and get the cuff to center the ball.
⚠️ Screen Before You Start — Get Assessed First If You Have:
- ●Numbness or tingling down the arm
- ●The arm giving out or going weak
- ●Pain radiating below the elbow (mechanical shoulder pain refers to the outer upper arm, not past the elbow)
- ●Night pain unrelated to position
- ●Pain worsening week over week
This is education, not a diagnosis, and doesn't replace hands-on care.
🌡️ Finding your stage
Take your movement temperature before each session. Where does pain show up as you move? Early in the range, before end-range = Protection phase. As you reach end-range = Controlled Motion. Only with overpressure past end-range = Return to Function. Re-check every session — today's behavior sets the stage, not the calendar.
Phase 1 · Acute
Protection Phase
🌡️ Pain before end-range · painful arc · reactive tissue
Goal: Calm the irritated tendon and bursa, begin correcting posture — all WITHOUT provoking the pinch.
Manual treatment: Grade I and II joint mobilization for pain relief; passive range of motion within the pain-free range.
Frequency: Daily as tolerated · short, pain-free sessions.
A. Calm It Down
SoftWave Therapy
Video coming soon- Dose
- As scheduled in clinic
- How
- Applied to the irritated cuff tendon and bursa to calm symptoms and stimulate the healing response.
- Watch for
- The anchor of the early phase — works on the tissue without you moving into the pinch.
Protect & Anti-Inflammatory Measures
Video coming soon- Dose
- Ongoing
- How
- Relative rest from the aggravating overhead activity, ice as needed, and activity modification to stay out of the painful arc.
- Watch for
- Identify and stop the repetitive overhead motion that's driving it — that's often the whole trigger.
Posture Education
Video coming soon- Dose
- All day
- How
- Begin correcting the forward-head, rounded-shoulder posture that tips the acromion forward and crowds the space. Sit and stand tall, chest open.
- Watch for
- Posture is a real intervention here, not an afterthought — rounded shoulders shrink the very space that's pinched.
Gentle Cross-Friction
Video coming soon- Dose
- 1–2 min
- How
- Gentle friction massage across the involved tendon to promote healing and mobility.
- Watch for
- Gentle in this phase — you advance the intensity later.
B. Gentle Motion (avoid the pinch)
Codman's Pendulum
Video coming soon- Dose
- 2–3 min
- How
- Bend at the hips, let the arm hang relaxed, and drive gentle circles with the hips and body sway. Uses gravity to ease the joint without loading it.
- Watch for
- Arm is dead weight. This gently distracts the joint and opens the pinched space.
Passive Range of Motion — Within Pain
Video coming soon- Dose
- 5–10 reps each plane
- How
- Move the arm (or have it moved) through flexion, abduction, and rotation, staying strictly within the pain-free range.
- Watch for
- STOP before the painful arc — don't push through the pinch.
C. Gentle Activation — Isometrics
Sub-Max, Multi-Angle Rotator Cuff Isometrics
Video coming soon- Dose
- 5-sec holds · 10 reps each · 20–30% effort
- How
- Elbow at side, gentle holds into external rotation, internal rotation, flexion, extension, and abduction — pressing against a wall or your other hand, at several pain-free angles.
- Watch for
- Keep the effort gentle and the shoulder DOWN (no shrugging). Stay out of the impingement position.
Protection-phase precaution — the clinical pearl: AVOID the impingement position with exercise. Do NOT work into the painful overhead-and-inward arc that pinches the tendon (roughly 60–120° of elevation, especially with the arm rotated inward). Scapulohumeral rhythm is the priority — if the shoulder blade isn't moving well, don't force elevation.
✅ Ready for the next phase when:
The resting and night pain settle, the painful arc shrinks, and you can move through more range before symptoms show up.
Tracking Your Progress
The weekly stability check: am I better, the same, or worse than last week?
Better
Stay the course; progress as the painful arc shrinks and pain moves later in your range.
Same
Change something: the dose, the drill, or the intensity.
Worse
Drop back a phase, let it settle, reassess. Check you're not sneaking into the impingement position.
The Rules That Govern This Protocol
- 1Avoid the impingement position while you work.
- 2The shoulder blade leads — scapulohumeral rhythm is the priority at every phase.
- 3The universal rule: no lasting increase in pain after a session.
Movement You Love Is Therapy. This protocol is general education based on course rehabilitation materials and standard principles. It is not medical advice, diagnosis, or treatment, and does not create a provider–patient relationship. If pain is severe, worsening, or unexplained, see a licensed provider.