Infraspinatus Strain: Overview and Evidence Summary

Condition Overview

An infraspinatus strain occurs when the infraspinatus muscle or its tendon fibers are overstretched or overloaded, leading to pain, localized tenderness, and reduced shoulder function. The infraspinatus is one of the four rotator cuff muscles, responsible primarily for external rotation of the humerus and providing dynamic stability to the shoulder joint. Because it is heavily involved in deceleration and rotational control, the infraspinatus is particularly vulnerable in activities involving rapid or repetitive rotational motions—such as throwing, racquet sports, swimming, and certain occupational tasks.

A strain may develop suddenly, for example during forceful external rotation or when resisting an unexpected load, but many infraspinatus injuries arise gradually through cumulative overload or inadequate recovery. Patients often report deep, posterior shoulder pain that may radiate toward the deltoid or down the upper arm. Unlike supraspinatus tendinopathy, symptoms are usually felt more at the back of the shoulder and aggravated by resisted external rotation or reaching behind the body.

Because the infraspinatus plays a significant role in stabilizing the glenohumeral joint, strain-related inhibition can lead to secondary movement compensations and overload of other structures. Early identification and structured rehabilitation help prevent a minor strain from progressing to chronic dysfunction.

Summary of Current Evidence for Infraspinatus Strain

Evidence-Based Management Discussion

Non-Operative Care as Standard Approach

Infraspinatus strains respond extremely well to conservative care, making non-operative treatment the overwhelming first choice. Education is key: patients should understand that a strain reflects temporary overload rather than tissue failure, and that progressive strengthening is both safe and necessary. Relative rest—meaning reducing or modifying provocative activities—is useful in the early days, but complete inactivity is counterproductive.

Exercise Therapy

Exercise forms the foundation of effective treatment. The goals include reducing pain, restoring external rotation strength, improving tendon and muscle capacity, and optimizing shoulder mechanics. Several forms of loading have demonstrated benefit in rotator cuff and posterior shoulder rehabilitation:

• Isometrics can reduce pain during the acute phase and help maintain baseline muscle activation.

• Eccentric loading supports tendon adaptation and can improve tolerance to stretch under load.

• Heavy–slow resistance promotes muscle hypertrophy and tendon remodeling, particularly in chronic cases.

• Neuromuscular control work helps restore coordinated movement between the rotator cuff and scapular stabilizers, reducing excessive stress on the infraspinatus.

Attention to scapular motion is essential. Poor upward rotation or posterior tilt can increase compressive forces on the rotator cuff, prolonging symptoms.

Manual Therapy

Manual techniques—including joint mobilisations, soft tissue therapy, and trigger point work—can reduce pain sensitivity and improve mobility. They do not repair the tissue but can prepare the shoulder for more effective active training. Techniques targeting surrounding musculature such as the posterior deltoid, teres minor, and upper trapezius may be especially helpful when compensatory tightness is present.

Medications and Injections

NSAIDs may offer symptomatic relief, particularly in the early inflammatory stage. Corticosteroid injections are uncommon for isolated muscular strain and generally reserved for cases where broader rotator cuff pathology contributes to symptoms.

Surgical Considerations

Surgery is almost never necessary for a simple infraspinatus strain. Persistent symptoms warrant imaging to rule out rotator cuff tears, labral pathology, or nerve involvement such as suprascapular nerve entrapment, but the vast majority of cases improve fully with rehabilitation.

References

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

Escamilla, R. et al. “Biomechanics of the Shoulder and Elbow in the Overhead Athlete.” Sports Medicine, 2009 (foundational work widely referenced in contemporary rehab).

Kibler, W., et al. “Scapular Dyskinesis and Its Relation to Shoulder Injury.” Journal of the American Academy of Orthopaedic Surgeons, 2013.

Donatelli, R., et al. “Role of Rotator Cuff and Scapular Muscles During Shoulder Rehabilitation.” Journal of Orthopaedic & Sports Physical Therapy, 2014.

Reinold, M. et al. “Rehabilitation of Rotator Cuff Injuries in Overhead Athletes.” Journal of Sports Health, 2010 and updates.

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.