What Type of Exercise Is Best for Rotator Cuff-Related Shoulder Pain?

If you have shoulder pain, you may have been told you have a “rotator cuff problem”, “shoulder impingement” or rotator cuff tendinopathy. These conditions are commonly grouped under the term rotator cuff-related shoulder pain (RCRSP).

Exercise is one of the key treatments for RCRSP, but an important question remains: which type of exercise works best?

Rhys recently presented to our clinical meeting a systematic review and meta-analysis that investigated this question by comparing seven different exercise approaches for people with RCRSP (Zhang et al., 2025).

The researchers analysed 16 randomised controlled trials involving almost 1,000 participants. The studies compared seven different approaches to exercise, including traditional strengthening, eccentric strengthening, concentric strengthening, scapula-focused exercises, motor control exercises, and different exercise loads.

The standout finding was concentric strengthening exercise.

Concentric strengthening involves a muscle shortening while producing force. For example, when you lift your arm against resistance, the shoulder muscles contract concentrically during part of the movement.

Of the exercise approaches studied, concentric strengthening had the highest probability of improving both shoulder function and pain. It performed particularly well for improving shoulder function compared with the other exercise approaches.

Eccentric strengthening and traditional strengthening also appeared to be effective, providing useful alternatives.

Interestingly, when looking specifically at pain, the differences between many of the exercise approaches were relatively small. This suggests that there isn’t necessarily one exercise type that is dramatically better than all others for reducing pain.

We have to consider an important point when applying research findings to individual patients.

A systematic review compares large groups of people and multiple different treatment approaches. Your shoulder, however, has its own history, symptoms, strengths and limitations.

A physiotherapist may consider:

• Which movements aggravate your symptoms
• Your current strength and exercise capacity
• How irritable your shoulder is
• Your work, sporting or recreational demands
• How much load your shoulder can currently tolerate
• Your goals and what you want to get back to doing

Your exercise program can then be adjusted and progressed as your shoulder improves.

The study also compared higher- and lower-load exercise approaches. Perhaps unsurprisingly, simply using a heavier load did not clearly make an exercise program better.

This is good news if lifting weights currently feels difficult.

You don’t necessarily need to start with heavy weights to improve your shoulder. Instead, the load can be matched to your current capacity and gradually increased as your strength and tolerance improve.

This concept of progressive overloading is an important part of rehabilitation.

The main message from this research is positive: exercise works, and there are multiple effective ways to exercise a painful shoulder.

Concentric strengthening appeared to have the strongest overall results in this review, particularly for improving shoulder function. Eccentric and traditional strengthening exercises also performed well.

However, the best exercise program isn’t necessarily the one that ranks first in a research paper. It is one that is most appropriate for your current ability, symptoms and goals — and one that can be progressively increased over time as you get better.

It is also worth noting that the studies included in this review only investigated short- and medium-term outcomes. We therefore need more research to understand whether these differences between exercise approaches remain over the longer term (Zhang et al., 2025).

If shoulder pain is stopping you from sleeping, working, exercising, or doing the activities you enjoy, strengthening should be an important part of your rehabilitation.

You don’t need to find a “magic” exercise. The aim is to find an appropriate starting point, gradually build your shoulder’s capacity, and ultimately return you to the activities that matter to you.

If you’re unsure where to start, a physiotherapist can assess your shoulder and help develop an exercise program that is appropriate for your symptoms, capacity and goals.

While research can tell us which exercise approaches are generally effective, your shoulder is unique. The right exercise, starting point and progression will depend on your symptoms, strength, movement, lifestyle and goals.

This is where physiotherapy can make a real difference. We can assess your shoulder, identify the movements and activities that are currently challenging, and develop a tailored exercise program to help you build strength and confidence safely.

As your shoulder improves, we can progressively adjust your exercises and load so that you’re not just feeling better but getting back to the activities you want and need to do — whether that’s sleeping comfortably, working, exercising, playing sport or simply reaching overhead without pain.

If your shoulder pain is limiting you, book an appointment with the team at Nelson Bay Physiotherapy. We’ll help you understand what’s going on and work with you to develop a rehabilitation plan that is tailored to you.

Zhang, W., Du, M., Xia, L., Hao, F., & Tian, M. (2025). Effects of seven types of exercise in the treatment of rotator cuff-related shoulder pain (RCRSP): A systematic review and Bayesian network meta-analysis. Journal of Orthopaedic Surgery and Research, 20, 1075. https://doi.org/10.1186/s13018-025-06514-4