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FOTO Rehab Outcomes Blog

High Load or Low Load for Rotator Cuff Tendinopathy?

Many patients are referred or seek nonsurgical options for their shoulder pain. Tendinopathy is a very common diagnosis that is treated in the clinic. 

Have you wondered about high resistance versus low resistance for these individuals?

Individuals who have Achilles or patellar tendinopathy seem to respond quite well to high-load eccentric resistive exercises. Systemic reviews create confusion around this type of exercise and how it benefits the individual. Some studies show anatomical changes in the tendon itself and other studies show little to no change.

A tendon is a tendon, so have you wondered about resistive exercises for the shoulder? I found the below study interesting. At first glance it seems either exercise has equal benefit.  Like some previous studies on tendinopathies, this study did not really find any structural tendinous changes. Yet, when reading a bit deeper into the article, I pause. There may actually be a difference in DASH  based on whether or not the individual had a corticosteroid injection. I couldn't find actual numbers data, so I just had to view the table comparing the DASH scores with injection or no injection (and I am not sure what the n value).  It looks to me that when an individual has had a corticosteroid injection, low-load exercise may be a better clinical choice. It appears that if an individual has not had a corticosteroid injection, progressive high-load exercise may be a better clinical choice. 

Below you will find a quick view of the abstract.



Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial.



Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated.


To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy.


Randomized controlled trial; Level of evidence, 1.


Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population.


A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically nonsignificant adjusted mean group difference of -1.37 points (95% CI, -6.72 to 3.99; P = .61). Similar nonsignificant results were seen for pain, range of motion, and strength. However, a significant interaction effect was found between the 2 groups and concomitant corticosteroid use (P = .028), with the largest positive change in DASH in favor of PHLE for the group receiving concomitant corticosteroid.


The study results showed no superior benefit from PHLE over traditional LLE among patients with rotator cuff tendinopathy. Further investigation of the possible interaction between exercise type and corticosteroid injection is needed to establish optimal and potentially synergistic combinations of these 2 factors.

 2017 Aug 28;5(8):2325967117723292. doi: 10.1177/2325967117723292. eCollection 2017 Aug.