Physio Bangkok/Conditions
Rotator Cuff Physiotherapy in Bangkok
Rotator cuff related shoulder pain comes from the group of muscles and tendons that steady and turn your shoulder, and it’s often labelled impingement or rotator cuff tendinopathy. At Aspire Physio Bangkok, near Asok, our physiotherapists settle the pain, then rebuild your shoulder’s strength with progressive exercise on the gym floor, the approach current guidelines recommend first. The clinic is on the 2nd floor of Jasmine Building, Sukhumvit Soi 23, a short walk from Asok BTS and Sukhumvit MRT, and your first consultation is free. Book through our contact page or call 082-281-8009.
- Free first consultation
- Licensed physiotherapists
- English and Thai
- Sukhumvit 23, near Asok BTS
Your physio team
Licensed physiotherapists who assess and treat you themselves, in English or Thai, from treatment through to the gym floor.
At a glance
| Also called | Shoulder impingement, subacromial pain syndrome, rotator cuff tendinopathy |
|---|---|
| How common | Rotator cuff problems account for more than half of shoulder conditions |
| First-line treatment | An active exercise programme, given the top evidence grade (A) in the 2025 JOSPT clinical practice guideline |
| Typical programme | About 12 weeks, with further improvement possible up to 24 weeks |
| Scan needed at first? | Usually not. Imaging is considered after trauma, for a suspected full-thickness tear, or if you’re not improving within up to 12 weeks |
| Decompression surgery | No better than placebo surgery in two randomised trials |
What rotator cuff related shoulder pain is
Your rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) whose tendons wrap around the ball of your shoulder joint and keep it stable while you lift and turn your arm [1][2]. Rotator cuff problems account for more than half of all shoulder conditions [1].
Rotator cuff related shoulder pain is the umbrella term clinicians now use for several labels you may have heard: shoulder impingement, subacromial pain syndrome, rotator cuff tendinopathy, and partial or full-thickness tears that cause symptoms [3]. The names changed because our understanding of what causes the pain changed [2].
Why “impingement” is falling out of favour
The old explanation was that the bony roof of the shoulder (the acromion) pinched the tendons as you lifted your arm. Surgeons treated this by shaving away bone and soft tissue in an operation called arthroscopic subacromial decompression [4].
Placebo-controlled trials have since tested this. The UK CSAW trial randomly assigned 313 people to decompression, to a placebo operation where the surgeon looked inside the joint but removed nothing, or to no treatment. At six months, decompression was no better than the placebo operation, and both operations gave only a small benefit over no treatment that wasn’t clinically important [4]. A Finnish trial of 210 people found decompression gave no benefit over diagnostic arthroscopy at 24 months [5]. An international BMJ guideline panel now makes a strong recommendation against this surgery for adults with shoulder pain that has lasted more than 3 months and didn’t start with an injury [6].
So the current view is that the pain is less about bone pinching tendon and more about load. Symptoms tend to appear when the load on your shoulder outgrows what the cuff can handle. That can happen quickly, like a burst of gardening after months off, or slowly as daily demands creep up [2].
Who gets it
It’s common in people who use their arms overhead, including swimmers, tennis and volleyball players, painters and construction workers [7]. Age-related changes in the tendon, repetitive movements that fatigue the shoulder, occupational demands, smoking and genetics are all thought to contribute [1]. Being over 55 and feeling that your job is highly demanding are linked with pain that lasts longer [1]. Tears also become more common as you get older [8], but scans often show the same tendon changes in people with no pain at all [2].
Symptoms
Most people describe pain over the top and outer side of the shoulder [8] that can spread into the upper arm [2]. It’s usually worse when you use the arm, especially lifting it or working overhead [8][9]. Common patterns:
- A painful arc: pain that peaks partway through lifting your arm out to the side [8].
- Pain reaching overhead, such as getting something off a high shelf or washing your hair [7].
- Pain reaching behind your back or lifting objects away from your body [2].
- Night pain, often worse lying on the sore side, which can disturb your sleep [7][10].
- Weakness or an arm that tires quickly. Pain itself can reduce strength and change how your shoulder blade moves [1].
No single clinical test settles the diagnosis. An international panel of physiotherapy experts agreed that the most useful signs are symptoms brought on by loading the arm and by overhead activity, checked with active and resisted movement testing [9]. That’s why your first visit centres on your history and how your shoulder responds to movement and load.
Could it be frozen shoulder?
Frozen shoulder can feel similar at first, but its hallmark is a marked loss of movement, especially lifting the arm forwards and turning it outwards [11]. With rotator cuff related pain, the shoulder hurts to use but usually keeps its full range when someone else moves it for you [8]. The two are managed differently [11], so it’s worth knowing which you have. See our frozen shoulder treatment page for more.
When to see a doctor first
See a doctor first, or go to an emergency department, if any of these apply:
- Sudden weakness after a fall or injury. If you can’t lift your arm after a fall or heavy lift, especially with a snapping feeling, you may have an acute tendon tear [10]. UK shoulder surgery guidance classes this as a red flag that needs urgent surgical assessment [8].
- A change in shape or major swelling after an injury, which can mean a dislocation or broken bone [12][8].
- Fever, chills or feeling unwell with a painful shoulder. A suspected joint infection needs same-day emergency care [1][8][12].
- An unexplained lump, or a history of cancer with new shoulder pain [1][8].
- Pins and needles or numbness that won’t go away, or an arm that feels hot or cold to touch [12].
- Severe pain in both shoulders [12].
- Shoulder pain with chest pain or other symptoms that could point to your heart or internal organs [1].
Our physiotherapists screen for these at your first visit and will tell you if you need to see a doctor. We can recommend clinics nearby.
Your first consultation is free. A physiotherapist will assess you properly and explain what’s going on, with no pressure to book more.
The phases of rotator cuff rehab
Rehab follows a loading progression. Your physio raises the load as your shoulder shows it can cope, so the timeframes below are typical ranges and the right-hand column decides when you move on.
| Phase | Typical timeframe | What you notice | What rehab focuses on | We move on when you can… |
|---|---|---|---|---|
| 1. Settle and start loading | Typically weeks 0 to 6. You may see little change in the first 6 weeks [2][8] | Pain lifting, reaching and at night. The arm may feel weak. | Adjusting the tasks that flare it without resting the arm completely [2]. Low-load cuff and shoulder blade work, which can include isometric holds. Hands-on treatment for short-term relief if needed [1]. | Do your exercises with tolerable pain that settles back to its usual level before the next session [13]. |
| 2. Build strength | Typically weeks 6 to 12 [8][13] | Less pain day to day, better sleep, more confidence lifting. | Progressive resistance in rotation (turning the arm in and out) and elevation (lifting forwards and to the side), plus shoulder blade strength, with load added every couple of weeks [13]. | Reach overhead with little pain and handle your current loads easily without flare-ups [2]. |
| 3. Heavier, higher, back to full activity | Typically weeks 12 to 24, sometimes longer [2][13][12] | Daily tasks feel normal. The gaps are heavy, fast or repeated overhead work and sport. | Heavier and overhead loading, power, endurance and sport or work-specific drills. Trunk and legs too if you throw, swim or play racket sports [1]. | Meet the demands of your sport or job: pain under control, full active range, enough strength, power and endurance, and confidence to return [1]. |
In a Swedish trial of 102 people whose earlier non-surgical care had failed and who had been referred to orthopaedic specialists, a 12-week programme of rotator cuff and shoulder blade strengthening meant only 20% still chose surgery, against 63% in a group doing general movement exercises [13]. Participants were also advised to keep up their home exercises for another two months after the programme ended [13].
You move to the next phase when your shoulder handles the current one, and we drop back a step if it flares.
How we treat rotator cuff pain
Find the cause
Your first session is with a licensed physiotherapist who takes a full history, screens for red flags and checks your neck, since guidelines recommend screening the neck in anyone with shoulder pain [1]. We test active and resisted movement to see which positions and loads bring on your pain [9], and look at what your shoulder needs to handle for work and sport. Most people don’t need a scan to start rehab. Guidelines advise against imaging to confirm rotator cuff tendinopathy at the start, and reserve it for cases after an injury, a suspected full-thickness tear, or no improvement within up to 12 weeks of good care [1]. We don’t do scans at the clinic, but we can recommend clinics nearby if you need one.
Settle the pain
Early on, the aim is to calm the shoulder without stopping it moving. We’ll help you adjust the tasks that flare it, like stepping closer to things instead of reaching out, and breaking big jobs into smaller chunks [2]. Manual therapy can help in the short term: the 2025 guideline supports soft tissue work and joint mobilisation of the shoulder and spine to reduce pain, alone or alongside exercise [1]. Taping may ease pain for a while in some people, though the evidence is mixed [1]. We use hands-on care to make exercise more comfortable while your strength builds.
Build the strength
Exercise is the first-line treatment. The 2025 JOSPT clinical practice guideline gives an active exercise programme its top evidence grade (A) as the initial treatment for rotator cuff tendinopathy [1]. Our physios work on the gym floor, so you move from the treatment room to supervised loading in the same building, often in the same session when appropriate. Your programme typically includes:
- Low-load holds and movements for the cuff early on, which can include isometrics (pushing into a band or a wall without moving the arm). They’re a comfortable way in for many people, though evidence that isometrics give special pain relief in the shoulder is limited [1].
- Progressive strengthening in rotation and elevation, with load added as you adapt [13]. Exercise that progresses and adds resistance has better evidence than exercise that stays easy [1].
- Shoulder blade strength for the middle and lower trapezius, rhomboids and serratus anterior [13].
- Heavier, overhead and sport or work-specific loading later, built around your capacity and load tolerance [1].
No single exercise type has been clearly shown to beat the others, and heavier loading hasn’t been proven better than lighter loading for pain [1]. What matters is a programme that fits you and keeps progressing. We use a simple pain rule: some discomfort during exercise is fine as long as it stays tolerable and settles by your next session [13][2]. If it doesn’t, we lower the load.
After cuff repair surgery
If you’ve had a rotator cuff repair, your rehab is different and follows your surgeon’s protocol. See our post-surgery rehab page.
How long it takes and how many sessions
It varies with how long you’ve had the pain, how irritable it is and what you need your shoulder to do. The 2025 guideline uses 12 weeks of good non-surgical care as the point to review progress [1], and the Swedish trial programme above ran for 12 weeks [13]. An NHS guide says it can take at least 12 weeks for symptoms to improve, with further gains possible up to 24 weeks, and you may not see much change in the first six weeks [2]. Recovery isn’t always complete. Exercise gives results at least as good as surgery, but some people keep some symptoms or have them come back [3].
In the Swedish trial, people had five to seven supervised visits over 12 weeks and did their exercises at home once or twice a day in between [13]. A UK guideline describes an initial 6-week block of physiotherapy, with a further 6 weeks if you’re improving [8]. Supervised exercise hasn’t been shown to beat a well-taught home programme [1], so we coach you to run most of it yourself and use sessions to check your technique and progress your loads.
If your pain stays severe after up to 12 weeks of good care, guidelines recommend referral to a sports physician or orthopaedic surgeon [1], and we’ll tell you. After your first session, your physio gives you a plan with an estimated number of sessions and how we’ll measure progress. We can’t promise a timeline, but you’ll know what we’re aiming for.
What you can do at home
- Keep the arm moving. Resting it for too long can reduce the cuff’s capacity, so keep using it for normal tasks within comfort [2][12].
- Pace the heavy jobs. Break tasks like gardening or cleaning into smaller chunks, and step closer to things instead of reaching out [2].
- Use the pain rule. Mild, tolerable discomfort during exercise is normal. If extra pain lasts more than a few hours, ease off next time [2].
- Protect your sleep. Rest the sore arm on a pillow, or put a pillow behind your back so you don’t roll onto that side [2].
- Use heat or cold for comfort. A wrapped cold pack or hot water bottle for up to 20 minutes can take the edge off [12].
- Hold off on heavy gym work for now. Don’t make up your own strenuous exercises or jump onto heavy equipment before your physio has set your starting loads [12].
Your physio sets your specific exercises and loads after the assessment.
Cost and insurance
Your first consultation is free. Treatment sessions start from ฿1,600. If you have health insurance, you can claim with your insurer, and we’ll supply the documents your provider asks for. It’s worth checking your policy’s physiotherapy cover before you start. See our insurance claims page for how claiming works.
Your physiotherapists
Your knee is treated by one of our licensed physiotherapists: Boom Namsak, who is both a physiotherapist and a strength coach, Gino Udomthanakij, or Som Benjaprasertsri. They all work in English and Thai, and they all coach the gym-floor part of your rehab themselves.
Common questions
Is shoulder impingement the same as a rotator cuff problem?
Mostly, yes. Shoulder impingement is an older name for what clinicians now call rotator cuff related shoulder pain, an umbrella term that also covers rotator cuff tendinopathy and partial tears. The name changed because research showed the pain isn’t mainly caused by bone pinching the tendon. Treatment now focuses on building your rotator cuff’s tolerance to load with progressive exercise.
Do I need surgery to shave the bone in my shoulder?
For most people, no. Two placebo-controlled trials found that subacromial decompression worked no better than a placebo operation, and an international BMJ guideline panel recommends against it for long-standing shoulder pain that didn’t start with an injury. A progressive exercise programme is the first-line treatment. If your pain stays severe despite good rehab, we’ll refer you to a specialist to discuss other options.
Do I need an MRI or ultrasound scan?
Usually not at the start. Guidelines advise against scans to confirm rotator cuff tendinopathy in early management, and tendon changes are common in people with no pain. A scan is worth considering after a significant injury, if a full-thickness tear is suspected, or if you haven’t improved after up to 12 weeks of good rehab. We don’t scan at the clinic, but we can recommend clinics nearby.
Can physiotherapy help a partial rotator cuff tear?
Yes, in many cases. Research suggests a well-built exercise programme gives results at least as good as surgery for partial-thickness tears, and for full-thickness tears that came on without an injury. A tear after a fall with sudden weakness is different. That needs prompt medical review, because UK shoulder surgeons recommend urgent surgical assessment for acute traumatic tears.
Should my rotator cuff exercises hurt?
A little discomfort is fine. Your exercises need enough load to make the cuff stronger, so mild, tolerable pain during a session is normal. What matters is that it settles back to your usual level by the next session. If extra pain lingers for more than a few hours, we lower the load and keep you going.
Will massage, dry needling or taping fix my shoulder?
On their own, probably not. Guidelines support manual therapy such as soft tissue work and joint mobilisation for short-term pain relief, and taping has mixed evidence. There isn’t enough research yet to judge dry needling for rotator cuff pain. We use hands-on care to make exercise easier, and strengthening drives the long-term result.
How is rotator cuff pain different from frozen shoulder?
Frozen shoulder stiffens the joint itself, while rotator cuff related pain hurts with use but usually leaves your full range intact when someone else moves the arm for you. The hallmark of frozen shoulder is a marked loss of movement, especially lifting the arm forwards and turning it outwards. The two are treated differently, so your physio checks this at your first visit.
How much does rotator cuff physiotherapy cost, and can I claim on insurance?
Your first consultation is free, and treatment sessions start from ฿1,600. We don’t bill insurers directly. You pay at the clinic, then claim back using the dated receipts, consultation report and treatment plan we provide. Some insurers need a doctor’s referral first, and we can recommend clinics nearby.
References
Show 13 references
- Desmeules F, Roy JS, Lafrance S, et al. Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: a clinical practice guideline. J Orthop Sports Phys Ther. 2025;55(4):235-274. doi.org/10.2519/jospt.2025.13182
- Leicestershire Partnership NHS Trust. A guide to rotator cuff related shoulder pain. Patient leaflet no. 589, edition 1. 2021. www.leicspart.nhs.uk/wp-content/uploads/2024/08/589-Rotator-cuff-relat
- Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther. 2016;23:57-68. doi.org/10.1016/j.math.2016.03.009
- Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-338. doi.org/10.1016/S0140-6736(17)32457-1
- Paavola M, Malmivaara A, Taimela S, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ. 2018;362:k2860. doi.org/10.1136/bmj.k2860
- Vandvik PO, Lähdeoja T, Ardern C, et al. Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. BMJ. 2019;364:l294. doi.org/10.1136/bmj.l294
- American Academy of Orthopaedic Surgeons. Shoulder impingement/rotator cuff tendinitis. OrthoInfo. Accessed October 2026. www.orthoinfo.org/diseases--conditions/shoulder-impingementrotator-cuf
- Kulkarni R, Gibson J, Brownson P, et al. Subacromial shoulder pain. Shoulder Elbow. 2015;7(2):135-143. doi.org/10.1177/1758573215576456
- Requejo-Salinas N, Lewis J, Michener LA, et al. International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: a Delphi study. Braz J Phys Ther. 2022;26(2):100395. doi.org/10.1016/j.bjpt.2022.100395
- American Academy of Orthopaedic Surgeons. Rotator cuff tears. OrthoInfo. Accessed October 2026. www.orthoinfo.org/diseases--conditions/rotator-cuff-tears
- Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331(7530):1453-1456. doi.org/10.1136/bmj.331.7530.1453
- NHS. Shoulder pain. Page last reviewed 22 May 2023. www.nhs.uk/symptoms/shoulder-pain/
- Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. 2012;344:e787. doi.org/10.1136/bmj.e787
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Book a knee assessment
Aspire Physio Bangkok is at Jasmine Building, 2nd Floor, Sukhumvit Road, Soi 23, a short walk from Asok BTS and Sukhumvit MRT. We’re open Monday to Friday 7am to 8pm, and Saturday and Sunday 8am to 4pm. Bookings are required in advance. Book your free first consultation through our contact page or call 082-281-8009.