A 16 yr old male has a supraspinatus tandinitis he us district level cricket player he has pain in abuduting arm above 90degree and also in external rotation since last 3 weeks what physiotherapy treatment should be given to him
Reading File
Finding Sources
Finding Sources
Searching PubMed
supraspinatus tendinitis physiotherapy rehabilitation
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Reading File
Reading File
I have enough information from the textbook plus the PubMed search to give a comprehensive, well-structured answer. Let me now compile the full physiotherapy management plan.
Physiotherapy Management: Supraspinatus Tendinitis in a 16-Year-Old Cricket Player
Clinical Picture
This adolescent athlete presents with the classic painful arc (60°–120° of abduction) and pain on external rotation — consistent with supraspinatus tendinopathy / rotator cuff impingement syndrome. As a cricket player (bowling, throwing, batting), repetitive overhead loading is the primary mechanism. At 3 weeks duration, this is acute-to-subacute and highly amenable to conservative physiotherapy.
Phase 1: Acute Pain Control (Week 1–2)
Goal: Reduce pain and inflammation
| Modality | Details |
|---|---|
| Rest & Activity Modification | Avoid overhead bowling/throwing/batting; relative rest from provocative activities (abduction >90°, external rotation) |
| Cryotherapy | Ice pack 15–20 min, 3–4×/day to the subacromial region |
| NSAID pharmacotherapy | Short-term oral NSAIDs (in coordination with physician) for pain control |
| TENS / Interferential Therapy | IFT or TENS over the shoulder for analgesic effect, 15–20 min/session |
| Ultrasound Therapy | Pulsed therapeutic ultrasound (1 MHz, 0.5–1.0 W/cm², pulsed mode) to the supraspinatus tendon — promotes tissue healing |
| Kinesiotaping | Supraspinatus offloading tape to reduce impingement during daily activity |
| Posture correction | Correct forward head and rounded shoulder posture (common in adolescent cricketers) to reduce subacromial space compression |
Phase 2: Restoration of Mobility (Week 2–4)
Goal: Restore full pain-free range of motion
- Pendulum (Codman) exercises — gravity-assisted, pain-free shoulder mobilisation
- Passive and active-assisted ROM — pulley exercises, wand exercises for forward flexion and external rotation within pain-free range
- Cross-body stretch — posterior capsule stretching (tight posterior capsule is a major contributor to supraspinatus impingement)
- Sleeper stretch — specifically targets posterior capsule tightness common in throwing athletes
- Grade I–II joint mobilisations — glenohumeral inferior and posterior glides to restore joint play (Maitland technique)
Phase 3: Strengthening — Rotator Cuff & Scapular Stabilisers (Week 3–8)
Goal: Restore dynamic stabilisation of the glenohumeral joint
This is the most critical phase for a throwing athlete. Based on current evidence (Pavlova et al., Br J Sports Med 2023), progressive resistance loading is the most effective intervention for tendinopathy.
Rotator Cuff Strengthening
| Exercise | Muscle Targeted |
|---|---|
| Side-lying external rotation (theraband/dumbbell) | Infraspinatus, teres minor |
| Internal rotation with resistance band | Subscapularis |
| Empty can / Full can exercise (below 90° initially) | Supraspinatus — isometric → isotonic progression |
| Side-lying abduction | Supraspinatus, deltoid |
Progression rule: Start with isometric contractions in pain-free positions → concentric/eccentric loading → sport-specific loading.
Scapular Stabiliser Strengthening
Scapular dyskinesia is extremely common in overhead athletes and worsens impingement:
- Scapular retraction and depression exercises (rows, prone Y/T/W)
- Serratus anterior activation — wall push-up plus, protraction exercises
- Lower trapezius activation — prone extension with arm at 130°
- Middle trapezius — prone horizontal abduction at 90°
Phase 4: Neuromuscular Control & Sport-Specific Rehabilitation (Week 6–12)
Goal: Return to cricket-specific overhead function
- Proprioceptive training — rhythmic stabilisation, perturbation training, unstable surface exercises (e.g., ball-on-wall)
- Closed kinetic chain shoulder exercises — press-ups, wall slides
- Plyometric progression — medicine ball wall throws (starting below shoulder height, progressing to overhead)
- Gradual return-to-bowling protocol:
- Catching and fielding first (no overhead throw)
- Short-distance throwing with low intensity
- Progressive increase in intensity and distance
- Full bowling action only when pain-free through full ROM with normal strength
Adjunct Modalities
| Modality | Evidence |
|---|---|
| Extracorporeal Shockwave Therapy (ESWT) | Systematic review (Xue et al., BMC Musculoskelet Disord 2024 — PMID 38704572) supports ESWT for rotator cuff tendinopathy — consider for recalcitrant cases at 3–4 weeks if no improvement |
| Subacromial corticosteroid injection | Short-term pain relief; use only if refractory to physio; avoid in adolescents unless necessary |
| Dry needling | May help with trigger points in periscapular muscles |
Key Precautions in a 16-Year-Old
- Avoid aggressive loading of a skeletally immature shoulder — the humeral physis and lesser tuberosity apophysis are still open at 16; avoid heavy overhead pressing
- No steroid injections unless absolutely necessary — risk of tendon weakening and growth plate effects
- Address biomechanics — assess bowling action for faulty mechanics (e.g., hyperangulation at ball release) — a major modifiable risk factor for supraspinatus overload in cricketers
- Load management — total weekly bowling workload should be monitored and reduced during rehab
Expected Timeline
| Phase | Duration | Goal |
|---|---|---|
| Acute management | 1–2 weeks | Pain ↓ 50–70% |
| ROM restoration | 2–4 weeks | Full pain-free ROM |
| Strengthening | 4–8 weeks | Normal strength symmetry |
| Return to sport | 8–12 weeks | Full unrestricted cricket |
Sources:
- Textbook of Family Medicine 9e — Shoulder Impingement and Rotator Cuff Disease, p. 815
- Pavlova AV et al. Effect of resistance exercise dose for tendinopathy — Br J Sports Med 2023 [PMID 37169370]
- Xue X et al. ESWT for rotator cuff tendinopathy — BMC Musculoskelet Disord 2024 [PMID 38704572]
- Cooper K et al. Exercise therapy for tendinopathy — Health Technol Assess 2023 [PMID 37929629]
This is a shared conversation. Sign in to Orris to start your own chat.