Movement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
The rotator cuff is four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that stabilise the shoulder. Cuff tears are very common in pain-free older adults and are present in over 60% of people over 80. The structural impingement model has been replaced by “rotator cuff related shoulder pain.” Progressive loading is the evidence-based first-line treatment. Surgery is rarely needed.
Read more: Rotator Cuff Pain: How the Research Changed (And What It Means for You)Shoulder pain is one of the most common complaints we see in the studio. The narrative around it has shifted significantly in the research field in the last decade while many practitioners are still teaching the old model.
If you’ve been told you have “impingement” and need to stop using your shoulder, this one’s for you.
What Is the Rotator Cuff?
The rotator cuff is four small muscles around the shoulder joint:
• Supraspinatus (sits on top of the scapula, abducts the arm)
• Infraspinatus (back of the scapula, externally rotates)
• Teres minor (small muscle below infraspinatus, also externally rotates)
• Subscapularis (front of the scapula, internally rotates)
Their tendons converge to form a cuff around the head of the humerus, providing dynamic stabilisation of the glenohumeral joint (the ball-and-socket joint of the shoulder). Four muscles that keep the ball centred in the socket.
Rotator Cuff Tendinopathy vs Partial Tear vs Full-Thickness Tear
Tendinopathy. Tendon dysfunction without a discrete tear. The older term “tendinitis” implied inflammation, but research has shown tendinopathy is more about disorganised collagen and altered cellular activity than classical inflammation.
Partial-thickness tear. Tearing through some but not all of the tendon thickness. Can be on the bursal side (top), articular side (bottom — more common), or intrasubstance (within the tendon).
Full-thickness tear. Tearing through the entire tendon. Then graded by extent: small (<1 cm), medium (1–3 cm), large (3–5 cm), massive (>5 cm or involving multiple tendons).
Are Rotator Cuff Tears Common in People Without Pain?
Surprisingly common. Teunis et al. (2014) systematically reviewed rotator cuff abnormalities in pain-free shoulders. Findings:
• Cuff abnormalities in 9.7% of pain-free adults under 20
• Cuff abnormalities in 62% of pain-free adults over 80
Many people with full-thickness tears never know they have one. This proves again that imaging findings need to be interpreted alongside the whole clinical picture, not treated as a sentence.
Is Shoulder Impingement Still a Diagnosis?
Not really. For decades, anterior shoulder pain was diagnosed as “subacromial impingement” the assumption being that the supraspinatus was being mechanically pinched under the acromion (the bony shelf on top of the shoulder). Surgical procedures (subacromial decompression) followed.
Then came the CSAW trial (Beard et al., 2018, The Lancet). It was a sham-controlled randomised trial of subacromial decompression. It found no clinically meaningful benefit over placebo surgery.
The current preferred term is RCRSP – rotator cuff related shoulder pain. It reflects a shift toward functional and load-based reasoning rather than purely structural blame.
Do Rotator Cuff Tears Need Surgery?
Most don’t. A growing body of evidence (Kuhn et al. 2013, Lewis 2018, Naunton et al. 2020) supports progressive loading as the primary first-line intervention for rotator cuff related pain, including for many full-thickness tears in older populations.
Surgery has its place: traumatic tears in younger patients, large tears not responding to conservative care, certain functional demands. But it’s no longer the default.
What Exercises Help Rotator Cuff Pain?
Progressive loading is the foundation. A typical sensible progression:
• Isometrics first: external rotation isometrics with the arm at the side, mid-range
• Controlled isotonics: side-lying ER, prone Y-T-W work, supine arm circles with light resistance
• Compound and weight-bearing work: long stretch, planks, pulling work
• Address the scapula and thoracic spine throughout – the cuff doesn’t work in isolation
Frequently Asked Questions
How long does it take a rotator cuff to heal?
Tendinopathy and partial tears often improve significantly within 6–12 weeks of progressive loading, with full tendon remodelling continuing for 6–12 months. Full-thickness tears managed conservatively follow a similar timeline. Surgical recovery typically takes 6–12 months for full return to activity.
Can you exercise with a torn rotator cuff?
Yes, and you should. Progressive loading is the evidence-based first-line treatment. Working with a clinician or experienced movement professional ensures the load is matched to your current capacity and avoids provocation in the early stages.
Should I avoid lifting my arm overhead with rotator cuff pain?
Not necessarily. Total avoidance often makes things worse over time. The goal is to progressively rebuild capacity to lift overhead, starting with positions that are tolerable and gradually expanding range.
What is RCRSP?
RCRSP stands for Rotator Cuff Related Shoulder Pain. It’s the current preferred term replacing older diagnoses like “shoulder impingement.” It captures the functional, multi-factorial nature of cuff pain rather than blaming a single structure.
Can Pilates help rotator cuff pain?
Yes, Pilates is particularly well-suited because the apparatus allows precisely calibrated resistance through full ranges of shoulder motion. Our Sydney CBD studio works with many clients managing rotator cuff issues, building strength progressively in supported positions.
The Bottom Line
The shoulder is one of the most adaptable structures in the body. The job isn’t to wrap it in cotton wool. It’s to load it intelligently, progressively, and over enough time for the tissue to get stronger.
References
Lewis, J. (2018). Rotator cuff related shoulder pain. Manual Therapy, 23, 57–68.