Rotator Cuff Q&A:

Shoulder pain is one of the most common complaints we see in the clinic, and the rotator cuff is often the culprit. Whether you’re a weekend warrior, a pickleball champ, or someone who reaches overhead for a living, rotator cuff issues can disrupt your normal daily activities. 

Here are some of the most common rotator cuff questions we get:

1. What is it even called?

Let’s clear this up first: it’s rotator cuff, not “rotator cup” or “rotary cuff” (yes, we’ve heard it all!). The term refers to a cuff of muscles and tendons that surround the shoulder joint to hold it securely in place while allowing a full range of motion.

2. What is the rotator cuff, really?

The rotator cuff is a group of four small but mighty muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. Their main job is to stabilize the ball-and-socket joint of your shoulder and help with smooth, controlled motion when lifting or rotating your arm.

3. Why does my shoulder hurt at night?

If you’re waking up because of shoulder pain, particularly when lying on your side, the rotator cuff is a likely culprit. Inflammation or small tears can make the area sensitive to compression and movement. Poor/reduced circulation while lying down can also make things worse.

4. Do I need an MRI to know if it’s torn?

Not necessarily. As physical therapists, we can assess function and symptoms through specific clinical tests. While imaging can confirm a tear, research shows many people over 40 have rotator cuff tears without pain. Additional research indicates that bout 20-30% of people over the age of 60 have a rotator cuff tear. The question isn’t “is it torn?”, but rather, “is it limiting your life?”.

5. Can I fix a rotator cuff tear without surgery?

In many cases — yes! Physical therapy can be incredibly effective. We focus on reducing pain, restoring mobility, and strengthening the shoulder muscles that support and compensate for the tear. If the tear is massive and function is severely limited, surgery may be considered, but rehab is always part of the journey.

6. Is it okay to keep lifting weights?

It depends on the severity of your symptoms and how your shoulder responds. It’s not “no pain, no gain”, but rather, “know pain, know gain”. You should not lift weights through sharp pain. Modifying your routine to avoid aggravating movements while strengthening the right muscles is key. PTs can guide you through safe progressions to stay active without causing more harm.

7. How long does it take to heal?

Recovery depends on the extent of the injury. Mild strains may improve in a few weeks with consistent rehab. More significant tears or post-surgical cases can take 3–6 months (or more). Patience, consistency, and listening to your physical therapist is key!

8. What’s the best way to prevent a rotator cuff injury?

• Strengthen your rotator cuff and postural muscles.
• Keep your thoracic spine (upper back) mobile.
• Don’t skip warm-ups or cooldowns.
• Avoid repetitive overhead activities without proper conditioning.

Final Thought:

The rotator cuff is an important group of muscles to help you with your day-to-day activities, that often is overlooked when it comes to strengthening. If something feels off, don’t wait. Early intervention can save you from months of pain or even surgery!

By Hannah Ford, PT, DPT, KEOMPT