Therapy for Rotator Cuff Strain

If you’re looking for working with an occupational therapist for rotator cuff strain treatment, we want you to be as informed as possible—so we can truly partner to create the best course of treatment for YOU. 

In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll see the assessment and treatment options your therapist may use, along with the evidence that supports them.

Members of the OT Potential Club can login for detailed clinical decision support on this diagnosis, including a comprehensive assessment search, goal bank, treatment info, handouts, a community forum and more.

Please note that this page is for educational purposes and should not substitute advice from your medical provider. At the bottom of this page, you’ll find therapists near you who can support you in your rotator cuff strain treatment. 

A quick note on why to pursue therapy first for rotator cuff strain

This post focuses on therapy treatment for rotator cuff strain. As with most conditions, conservative treatment like therapy is typically the first course of care. 

Other treatment options like corticosteroid injections, are often considered a second option, as the injections carry risks like tendon weakening and increased risk of tendon rupture. 

The amount of therapy sessions needed will vary based on your initial evaluation. In general the higher your initial disability score the more frequent your sessions. Ultimately our goal is self-management with a personalized prescribed program. (Read more about this below in discharge.) 

Therapist-recommended assessments for rotator cuff pain

As you can see below, evaluating a case of rotator cuff pain involves much more than assessing the shoulder itself. Often, other parts of the arm are involved—even when the pain seems localized to the shoulder. 

Assessments also serve as a point of comparison to track your progress and response to treatment. (Without an accurate and thorough baseline, it can be hard to discern how much the interventions are helping!) Your therapist may perform certain assessments at various intervals over the course of therapy.

Rotator Cuff Specific Assessments

An important note: The Clinical Practice Guideline from AAOS reports that the prevalence of Rotator Cuff Tear (RCT) increases with age. 

Data shows that 54% of asymptomatic patients aged 60 and above have sustained either a partial or complete RCT on MRI.14 

This is important information for you, as the presence of a tear does not equate to an inability to function normally.

  • Patient Rated Outcome Measures → Administer at evaluation, re evaluation, and discharge.
    • QuickDASH 1
    • Patient Specific Functional Scale (PSFS) 2
    • PROMIS measures is a set of person-centered measures that evaluates and monitors physical, mental, and social health in adults and children
  • Observe Posture
  • Upper Quarter Screen
  • Active Range of Motion (ROM) Assessment 
    • Cervical ROM 4
    • Thoracic ROM
    • Shoulder ROM
    • Elbow ROMForearm ROM
    • Wrist ROM
  • Passive ROM Assessment
  • Strength Testing
  • More Special Tests
    • External Rotation MMT (Infraspinatus & Teres Minor)
    • Lift-Off Test
    • Belly Press Test
    • Bear Hug Test
    • Empty Can Test
    • Full Can Test
    • Cervical Rotation Lateral
    • Flexion (CRLF) Test
    • Arm Squeeze Test
    • Scratch Collapse Test
    • ULTTa (Upper Limb Tension Test A)
    • Spurling’s Test
    • Traction Relief Test
    • Arm Abduction Test
  • Differential Diagnoses
    • Labral Tear
    • Adhesive Capsulitis
    • Bursitis
    • Glenohumeral Instability
    • Biceps Tendinopathy

Setting goals for rotator cuff strain

Therapy only works when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you. 

Therapy treatment interventions for rotator cuff strain

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program. 

  • Aerobic Warm Up for endorphin release
  • Manual Therapy
    • Instrument Assisted Soft Tissue Mobilization (IASTM) 10,11,12
      • Recommended Multi-Tool from Hawkgrips can be used on full body
        • Cost: $595
    • Thoracic spine mobilization and extension15,16
    • Myofascial Decompression (cupping)13,17
  • Range of Motion
    • Shoulder
      • Passive
      • Assisted
        • Glenohumeral joint → patient assisted
          • Closed chain
          • Wand exercises
          • Pulleys
          • Sleeper Stretch
          • Four Corner Stretching
        • Scapula → therapist assisted
          • PNF clocks
      • Active
        • Shoulder circles
        • Wall climbs
    • Thoracic Spine → extension with towel or roller
  • Functional Strength
    • Posterior cuff (Infraspinatus and Teres Minor)
      • Prone exercises5,6
      • Seated external rotation
      • Sidelying external rotation 
    • Anterior cuff (Subscapularis)
      • Wings
      • Bear hug
      • Belly Press
    • Superior Cuff (Supraspinatus)
      • Full can
      • Ceiling punch
    • Scapular Stability
      • Focus on serratus anterior and latissimus dorsi to prevent winging6
      • Lower Trapezius → Table Press, Superman
      • Bruggers Exercise
    • Core exercises for painful shoulder
  • Proprioception
    • Table circles
    • Wall circles
    • Overhead bounce on wall
  • Self-Care Home Management and Activity Modification
    • Lifting mechanics
    • Ergonomic positioning and setup
  • Incorporate Functional Tasks based on patient goals and affected ADLs
  • Additional Pain Management Tools
    • Kinesiotape
    • Modalities (heat, ice, ultrasound, iontophoresis, e-stim)
    • Biofreeze
    • Salonpas topical patches
  • Home Program 
  • Patient Education on Disease Pathology 7,8

Discharge suggestions

Every individual is unique, and your response to therapy will also be unique. For some, it is not appropriate to continue therapy until the condition completely resolves. For others, pain may resolve before the entire rehabilitation program is established. In the latter’s case, it is important to remember that pain is a symptom – not a diagnosis, and that strength and endurance deficits must be addressed to prevent recurrences. 

  • Follow your therapist’s discharge recommendations to maintain progress made in therapy. 
  • Continue to use self-management and empowerment strategies to control any remaining symptoms
  • Follow a home exercise program with proximal posture component for an additional 3 months to help establish good habits for body mechanics, even if you feel back to 100%
  • Consult your therapist immediately if your condition worsens, or if you continue to have difficulty with your daily activities after 3 months.

Choosing a therapist for rotator cuff strain

Both occupational therapists and physical therapists can treat rotator cuff injuries In less severe cases, a generalist therapist from either discipline should be able to help you. 

It is important to note that both OTs and PTs can pursue advanced certification as a Certified Hand Therapist. To achieve this rigorous specialization of the hand, wrist, elbow, and shoulder, therapists must log 4,000 hours of experience treating the upper extremity and pass a formal examination. They also must complete various recertification requirements every 5 years. 

Below you can find occupational therapy professionals, who have tagged “hand therapy” as a focus area. The ones with a “CHT” in their credentials are Certified Hand Therapists.

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Conclusion

Hopefully this article has helped you understand what therapy for rotator cuff strain entails, and if you will be a good candidate!

Article by

Rachel Egan, OTR/L, MS, CHT, COMT-UE, is an OT specializing in the upper extremity. In addition to caring for patients as a Certified Hand Therapist and Certified Orthopedic Manual Therapist, Rachel manages operations for 13 NovaCare clinics across Minnesota.

References

Here’s the science that backs the assessment and treatment outlined above. 

  1. Rompe JD, Overend TJ, MacDermid JC. Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire. Journal of Hand Therapy. 2007.
  2. Polson K, Reid D, McNair PJ, Larmer P. Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther. 2010.
  3. Clavert P, Lutz JC, Adam P, Wolfram-Gabel R, Liverneaux P, Kahn JL. Frohse’s arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthopaedics & Traumatology: Surgery & Research. 2009.
  4. Sukari AAA, Singh S, Bohari MH, Idris Z, Ghani ARI, Abdullah JM. Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments. Malays J Med Sci. 2021.
  5. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985.
  6. Taylor SA, Hannafin JA. Evaluation and Management of Elbow Tendinopathy. Sports Health. 2012.
  7. Chourasia AO, Buhr KA, Rabago DP, Kijowski R, Irwin CB, Sesto ME. Effect of Lateral Epicondylosis on Grip Force Development. Journal of Hand Therapy. 2012.
  8. Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999.
  9. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997.
  10. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009.
  11. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007.
  12. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006.
  13. Ma X, Qiao Y, Wang J, Xu A, Rong J. Therapeutic Effects of Dry Needling on Lateral Epicondylitis: An Updated Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2024.
  14. Hegmann KT, Hoffman HE, Belcourt RM, et al. ACOEM practice guidelines: elbow disorders. J Occup Environ Med. 2013.
  15. Andres BM, Murrell GAC. Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon. Clinical Orthopaedics and Related Research®. 2008.
  16. Kazi F, Patil DS, Kazi F, Sr DSP. Effects of the Tyler Twist Technique Versus Active Release Technique on Pain and Grip Strength in Patients With Lateral Epicondylitis. Cureus. 2023.
  17. Tyler TF, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial. Journal of Shoulder and Elbow Surgery. 2010.
  18. Arumugam V, Selvam S, MacDermid JC. Radial Nerve Mobilization Reduces Lateral Elbow Pain and Provides Short-Term Relief in Computer Users. Open Orthop J. 2014.
  19. Zhong Y, Zheng C, Zheng J, Xu S. Kinesio tape reduces pain in patients with lateral epicondylitis: A meta-analysis of randomized controlled trials. International Journal of Surgery. 2020.
  20. Goodman CC. Screening for Medical Problems in Patients with Upper Extremity Signs and Symptoms. Journal of Hand Therapy. 2010.

OT Potential  does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.

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