Anterior shoulder pain is one of the most common reasons people seek physiotherapy. It is often labelled as a rotator cuff injury or supraspinatus tendon inflammation, and treatment frequently focuses on strengthening that tendon alone.
However, as modern evidence and clinical experience show, this approach can miss a critical part of the picture.
At Kernow Physio, we look at the shoulder as a complete system, not just one painful structure.
Understanding the Anatomy of the Shoulder
The shoulder is a complex joint made up of several key components:
- The scapula (shoulder blade)
- The humerus (upper arm bone)
- The rotator cuff, including the supraspinatus tendon
The supraspinatus muscle originates from the back of the shoulder blade and its tendon travels underneath the collarbone before attaching to the front of the shoulder. As you lift your arm, this tendon has to glide smoothly through a relatively narrow space.
If that space becomes compromised, the tendon can become irritated or inflamed, leading to pain at the front of the shoulder.
The Common Mistake in Shoulder Rehab
A frequent problem we see is rehabilitation that focuses purely on the rotator cuff tendon itself. This often involves lots of resistance band exercises targeting the shoulder in isolation.
While these exercises can be helpful, they are often not enough on their own.
Why? Because the space that the tendon passes through is heavily influenced by the position and movement of the shoulder blade.
The Role of the Shoulder Blade
The shoulder blade is designed to sit flush against the rib cage and move in a smooth, coordinated way as the arm lifts. Ideally, it should:
- Glide around the rib cage first
- Then rotate upward as the arm continues to lift
If the shoulder blade is poorly positioned or unstable, this movement pattern changes. Instead of gliding smoothly, the shoulder blade may elevate, wing, or move too late. This reduces joint space at the front of the shoulder and increases compression on the supraspinatus tendon.
Over time, this can lead to persistent pain and slow recovery.
A Real-World Example
One patient came to clinic with ongoing anterior shoulder pain that had been present for several months. He had already tried massage, acupuncture, and rotator cuff exercises prescribed elsewhere, with little improvement.
On assessment, it became clear that his shoulder blade was not stable against his rib cage. When he lifted his arm, the shoulder blade moved straight upwards instead of gliding around smoothly. This caused excessive compression at the front of the shoulder.
In this case, there was also a history of stroke, which had led to weakness on one side. This information was vital. Simply strengthening the rotator cuff without addressing shoulder blade control was never going to be enough.
Treating the Shoulder as a Whole
Once rehabilitation shifted focus to:
- Improving shoulder blade stability
- Restoring correct movement patterns
- Strengthening the supporting muscles around the scapula
The patient began to make real progress. Everyday tasks like putting on a jacket became easier, pain reduced, and more invasive options such as injections or surgery were avoided.
Why Assessment Matters
Shoulder pain is rarely just about one tendon.
A thorough physiotherapy assessment looks at:
- Shoulder blade position and movement
- Strength and control of supporting muscles
- Past medical history, including neurological events
- How the shoulder functions during real-life movements
This whole-body approach is key to achieving lasting results.
The Takeaway
If you have been struggling with shoulder pain and traditional rotator cuff exercises have not helped, the problem may not be the tendon alone. Shoulder blade function plays a crucial role in creating space, reducing compression, and protecting the rotator cuff.
At Kernow Physio, we treat shoulders as part of a connected system, tailoring rehabilitation to how your body moves, not just where it hurts.
If shoulder pain is limiting your day-to-day life, a detailed assessment can make all the difference.
Need Help With Ongoing Shoulder Pain?
If you’re experiencing shoulder pain that isn’t improving, or you’ve been told you have a rotator cuff injury and things still don’t feel right, you don’t have to struggle on.
Scott takes a thorough, whole-shoulder approach to assessment and treatment, looking beyond the painful area to identify the real cause of the problem.
If you have a similar issue and would like to book an appointment, please get in touch with Scott using the contact form below.