Supraspinatus Tendinopathy: Overview and Evidence Summary

Condition Overview

Supraspinatus tendinopathy is one of the most frequent causes of shoulder pain, especially during overhead activity or lifting the arm away from the body. The supraspinatus tendon sits at the top of the rotator cuff complex and plays a major role in initiating arm elevation and helping stabilize the humeral head. Because it passes through a narrow anatomical space beneath the acromion, it is particularly vulnerable to mechanical overload, friction, and degenerative changes.

Most cases develop gradually rather than from a single traumatic incident. Repetitive overhead activity, reduced tendon vascularity with age, and postural or movement-related load patterns all contribute to the development of tendinopathy. Patients frequently describe a dull ache deep in the shoulder, pain when reaching overhead, and discomfort lying on the affected side. Unlike tears, strength loss in isolated supraspinatus tendinopathy is typically mild and related more to pain inhibition than structural failure.

Modern research views supraspinatus tendinopathy not as a simple “inflammation” but as a combination of tendon overload, collagen disorganization, biochemical changes, and altered shoulder muscle coordination. This is why treatment is no longer centered around rest alone but on rebuilding tendon capacity and optimizing shoulder mechanics.

Most individuals respond extremely well to conservative care. Well-targeted exercise therapy can reduce pain, restore strength, and improve functional capacity without the need for injections or surgery. For therapists, the goal is to help the patient gradually load the tendon in a way that stimulates adaptation, restores balanced movement, and supports long-term resilience.

Summary of Current Evidence for Supraspinatus Tendinopathy

Evidence-Based Management Discussion

Non-Operative Care as Standard Approach

The preferred and most effective management strategy for supraspinatus tendinopathy is non-operative treatment. Education forms the foundation: patients benefit from understanding that tendinopathy reflects tendon overload rather than “tearing apart,” and that gradual loading is not only safe but essential for recovery.

Load modification is typically necessary early on. This does not mean complete rest but reducing or altering activities that provoke symptoms while establishing an exercise base. Sudden withdrawal of all activity may actually worsen symptoms by reducing tendon capacity.

Exercise Therapy

Exercise shows consistent, meaningful benefits. The tendon responds positively to controlled mechanical loading, which stimulates collagen remodeling and improves tensile capacity. Several exercise strategies have evidence:

• Eccentric training can reduce pain and improve strength by applying load during tendon lengthening.

• Heavy–slow resistance (HSR) provides progressive tendon loading at tolerable velocities and loads.

• Motor control training helps normalize scapular motion and reduce excessive compressive stress on the supraspinatus tendon.

• Rotator cuff and scapular strengthening improves joint stability and reduces overload on the supraspinatus.

Mild discomfort during exercise is acceptable, provided it settles within a reasonable timeframe. Progression should be gradual and guided by symptoms and functional tolerance.

Manual Therapy

Joint mobilisations, soft tissue techniques, and passive range-of-motion interventions can reduce pain sensitivity and improve movement quality. While these methods do not directly repair tendon tissue, they help patients engage more comfortably with active rehabilitation, which ultimately drives long-term improvement.

Medications and Injections

NSAIDs may provide early symptom relief but do not address the underlying tendon adaptation issue. Corticosteroid injections offer short-term pain reduction and can be useful in cases where pain limits participation in rehabilitation. However, they should be used sparingly, as repeated injections may negatively impact tendon integrity.

Biologic interventions such as platelet-rich plasma continue to be studied. Current evidence is inconclusive, and no strong recommendation exists for routine use in supraspinatus tendinopathy.

Surgical Considerations

Surgery is seldom required for isolated supraspinatus tendinopathy. When conservative care is comprehensive—targeted loading, motor control work, manual therapy as needed, and lifestyle modification—most individuals recover without surgical intervention. Persistent symptoms that fail to improve over several months warrant further investigation to rule out partial tears or other shoulder pathology.

References

American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries: Clinical Practice Guideline. 2025.

Desmeules, F., et al. “Rotator Cuff Tendinopathy: Diagnosis, Non-Surgical Management, and Post-Operative Rehabilitation.” American Physical Therapy Association, 2025.

Dean, B., et al. “Pathogenesis of Tendinopathy: Current Concepts and Basic Science.” Shoulder & Elbow, 2017.

Littlewood, C., et al. “Exercise for Rotator Cuff Tendinopathy: A Systematic Review.” British Journal of Sports Medicine, 2012 (with subsequent updates).

Lewis, J. “Rotator Cuff Tendinopathy: A Model for the Continuum of Pathology and Rehabilitation.” Journal of Orthopaedic & Sports Physical Therapy, 2015.

Malliaras, P., et al. “Achilles and Patellar Tendinopathy Loading Programs: A Systematic Review Comparing Clinical Outcomes and Physiological Effects.” Sports Medicine, 2013.
(Foundational framework for tendon loading principles applied clinically to supraspinatus and other tendinopathies.)

Disclaimer:
The information provided in this article is intended for educational purposes only and is designed for qualified massage therapists, manual therapists, and rehabilitation professionals. It is not a substitute for formal medical training or clinical judgment, nor does it constitute medical advice, diagnosis, or treatment. Although every effort has been made to ensure accuracy and reflect current evidence at the time of publication, research and clinical guidelines may change over time.

Readers should always work within the legal scope of their professional practice and follow regional regulatory requirements. Any hands-on techniques described should only be performed by appropriately trained and licensed professionals. Individuals experiencing pain or symptoms should be referred to a suitably qualified healthcare provider for assessment. Niel Asher Education does not accept responsibility for any injury, loss, or damage resulting from the use or misuse of information contained in these materials.