25/08/2026
Subgrouping in rotator cuff-related pain is not just about pathology.
Two people can have a similar rotator cuff diagnosis on imaging and still have very different clinical presentations and impairments.
When we are considering prescribing rotator cuff exercises for rotator cuff-related pain we first have to understand what role the rotator cuff is playing in the clinical presentation. It may be acting primarily as:
➡ A symptom generator
Pain and irritability may dominate. The priority may be improving load tolerance rather than simply adding more resistance. More load is not always better.
➡ A force producer
If the cuff is intact and innervated, and weakness is limiting function, improving force capacity may be appropriate.
➡ A dynamic stabiliser
If movement control and muscle coordination are impaired, sensorimotor rehabilitation may be the more relevant target.
➡ A structurally or neurologically compromised system
With a denervated cuff or a massive/irreparable tear, simply trying to “strengthen the rotator cuff” is not realistic. Rehabilitation may need to focus more on restoring useful movement (elevation and external rotation) and function than on attempting to normalise specific cuff strength.
And of course, psychosocial factors can modify all of these presentations.
The sequence I find most useful is:
Diagnosis → role of the cuff → key impairment → rehabilitation target → intervention
Subgrouping is only useful when it changes what we do. The aim is to identify the dominant impairment, then choose an intervention that is actually targeting it.
(Slides from the Auckland Tendon Symposium 15/8/2026).
