Give a physiotherapy treatment protocol for supraspinatus tendinitis in 16 yr old male he is district level cricketer and he has pain in abduction above 90 and external rotation movement
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supraspinatus tendinitis physiotherapy rehabilitation
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rotator cuff tendinopathy exercise therapy young athlete
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supraspinatus tendinitis shoulder physiotherapy exercises
The library doesn't have a dedicated sports physiotherapy/rehabilitation textbook, but I have enough evidence from PubMed and my clinical knowledge to compile a comprehensive, sport-specific protocol. Let me now compile the full treatment protocol.
Physiotherapy Treatment Protocol: Supraspinatus Tendinitis
Patient: 16-year-old Male | District-Level Cricketer
Presentation: Pain on shoulder abduction >90° and external rotation
Clinical Assessment Summary
| Parameter | Findings |
|---|---|
| Painful arc | Abduction 70°–120° (classic impingement arc) |
| Painful movement | External rotation |
| Likely mechanism | Overhead bowling/throwing → subacromial impingement of supraspinatus at greater tuberosity |
| Positive tests expected | Neer's, Hawkins-Kennedy, Empty Can (Jobe's test), painful arc test |
| Key consideration | Adolescent athlete — growth plates present; avoid aggressive loading early |
Phase 1 — Acute/Pain Control Phase (Week 1–2)
Goals: Reduce pain and inflammation, protect tissue, maintain pain-free ROM
Modalities
| Modality | Parameters | Frequency |
|---|---|---|
| Cryotherapy (ice pack) | 15–20 min, over subacromial region | 3–4× daily |
| Transcutaneous Electrical Nerve Stimulation (TENS) | 80–100 Hz, sensory level | 20 min/session, once daily |
| Ultrasound therapy | 1 MHz, 1.0–1.5 W/cm², pulsed (1:4), longitudinal over supraspinatus | 5–7 min, daily × 6–8 sessions |
| Phonophoresis | Diclofenac gel + US as above | Alternative to plain US |
Activity Modification
- Complete rest from bowling and overhead throwing
- Avoid overhead lifting, sleeping on affected side
- Sling only if pain is severe at rest (short-term, max 3–4 days)
Manual Therapy
- Gentle Grade I–II Maitland glenohumeral joint mobilisation (inferior and posterior glides)
- Soft tissue release: upper trapezius, posterior shoulder capsule
Exercises — Pain-Free Range Only
- Codman/pendulum exercises: 2 sets × 1 min, 2–3×/day
- Active-assisted ROM: shoulder flexion and abduction below 60° (pain-free range)
- Scapular clock exercises (seated)
Phase 2 — Sub-Acute/Restoration Phase (Week 3–5)
Goals: Restore full pain-free ROM, begin rotator cuff strengthening, improve neuromuscular control
Electrotherapy (as needed for residual pain)
- Interferential therapy (IFT): 80–120 Hz, 15–20 min
- US: reduce to alternate days if pain improving
Manual Therapy
- Grade III–IV Maitland mobilisation of GH joint: posterior and inferior glides to restore ER and abduction
- Posterior capsule stretching (sleeper stretch)
- Scapular mobilisation and thoracic spine manipulation (if thoracic stiffness present)
Strengthening Exercises
Progress from isometric → isotonic → sport-specific
Isometric (Week 3)
- Isometric ER, IR, abduction at 0° (submaximal, pain-free)
- 3 sets × 10 reps, 10-sec hold
Isotonic — Theraband/Light Dumbbells (Week 4–5)
| Exercise | Dosage |
|---|---|
| Theraband ER at 0° abduction | 3 × 15 reps |
| Theraband IR | 3 × 15 reps |
| Side-lying ER (key for supraspinatus) | 3 × 15 reps |
| Prone horizontal abduction (scaption) | 3 × 15 reps |
| Scaption (elevation in scapular plane, 30° anterior to frontal plane) | 3 × 12 reps — avoid >90° until pain-free |
| Serratus anterior activation (wall push-up plus) | 3 × 15 |
| Lower trapezius — prone Y exercise | 3 × 12 reps |
Scaption is the most important exercise — it directly loads supraspinatus in its optimal mechanical plane with minimal impingement risk.
Flexibility
- Cross-body horizontal adduction stretch (posterior capsule)
- Sleeper stretch: 3 × 30 sec hold
- Pectoralis minor stretch
- Cervical spine mobility (if restricted)
Phase 3 — Strengthening and Sport-Specific Phase (Week 6–10)
Goals: Full strength, power, and endurance of rotator cuff; begin sport-specific preparation
Criteria to progress: Full pain-free ROM, >80% strength symmetry on clinical testing
Progressive Loading Program (Evidence-based — BJSM 2023, PMID 37169370)
- Progress from concentric-eccentric to eccentric-focused loading (superior for tendinopathy remodelling)
- Gradually increase resistance every 1–2 weeks (10% rule)
| Exercise | Week 6–7 | Week 8–10 |
|---|---|---|
| Dumbbell ER/IR | 1.5–2 kg → 3 kg | 3–4 kg |
| Cable diagonal PNF patterns (D1/D2) | Begin light resistance | Sport-speed tempo |
| Prone shoulder extension | Bodyweight | Add resistance |
| Push-up plus (full range) | 3 × 15 | 3 × 20 |
| Shoulder press (below shoulder height initially) | Begin at Week 7 | Full range by Week 9 |
| Plyometric ball catch (wall) | Light 1 kg med ball | Progress weight/distance |
Neuromuscular / Proprioception
- Rhythmic stabilisation on unstable surfaces (wobble cushion)
- Closed kinetic chain weight-bearing through shoulder (quadruped position)
- PNF diagonal patterns with theraband
Phase 4 — Return to Cricket Protocol (Week 10–14)
Goals: Gradual, progressive return to bowling and throwing
Clearance criteria before return-to-throw:
- Full pain-free ROM equal to contralateral side
- Rotator cuff strength ≥90% symmetry (ER:IR ratio 0.66–0.75)
- Scapular control adequate (no winging, dyskinesia)
- Negative Neer's, Hawkins, and painful arc tests
Interval Throwing Program (Weeks 10–14)
| Week | Activity |
|---|---|
| 10 | Short toss 10–15 m, easy pace, flat (no bowling) — 2 sessions |
| 11 | Extend to 20–25 m, 50% effort, 3 sessions |
| 12 | 30 m, 70% effort; introduce bowling run-up without delivery (shadow bowling) |
| 13 | Easy net bowling, off short run, max 10–15 deliveries/session |
| 14 | Graduated net bowling — full run-up, 25–30 deliveries, full intensity |
Each session must be pain-free during and 24 hours after. If pain recurs, step back one week.
Biomechanical Assessment
- Video analysis of bowling action: check for arm-ball/wrist position at release, front-arm pull, and trunk rotation — common causes of shoulder overload in young cricketers
- Ensure proper elbow height at delivery stride (above shoulder level reduces impingement risk)
Adjunct Considerations
Kinesio Taping
- Supraspinatus offloading technique (Y-strip from origin to insertion) during return-to-sport phase
- Scapular facilitation tape to correct scapular depression/winging
Core and Kinetic Chain Training
- Bowling power originates from the lower limb and trunk — weak core overloads the shoulder
- Include: hip strengthening, rotational core (Pallof press), single-leg stability
Nutrition (Adolescent Athlete)
- Adequate protein intake (1.4–1.7 g/kg/day) for tendon remodelling
- Vitamin C and collagen supplementation (pre-exercise) — emerging evidence for tendon healing
- Ensure no caloric deficit (common in adolescent sport)
Red Flags / Escalation Criteria
Refer for orthopaedic review if:
- No improvement after 6–8 weeks of structured physiotherapy
- Suspicion of partial-thickness rotator cuff tear (weakness >50%, significant night pain)
- Inability to achieve pain-free ROM by Week 6
- Evidence of os acromiale or ACJ pathology on imaging
Outcome Measures to Track Progress
| Tool | Frequency |
|---|---|
| DASH (Disabilities of Arm, Shoulder, Hand) score | Baseline, Week 4, discharge |
| NPRS (Numeric Pain Rating Scale) | Every session |
| ROM measurement (goniometer) | Weekly from Week 2 |
| Shoulder strength (HHD or isokinetic) | Week 4, Week 8, discharge |
| Functional return-to-sport criteria | Week 10 pre-clearance |
Summary Timeline
| Phase | Duration | Key Focus |
|---|---|---|
| 1 — Acute | Week 1–2 | Pain relief, protect, gentle ROM |
| 2 — Sub-acute | Week 3–5 | ROM restoration, early strengthening |
| 3 — Strengthening | Week 6–10 | Progressive loading, sport conditioning |
| 4 — Return to Cricket | Week 10–14 | Interval throwing, full bowling |
Typical return to competitive cricket: 10–14 weeks with full compliance. Rush-back risks re-injury and progression to partial tear.
References:
- Zhang W, et al. (2025). Effects of seven types of exercise for rotator cuff-related shoulder pain — network meta-analysis. J Orthop Surg Res [PMID: 41276811]
- Pavlova AV, et al. (2023). Resistance exercise dose for tendinopathy. Br J Sports Med [PMID: 37169370]
- Cooper K, et al. (2023). Exercise therapy for tendinopathy — mixed-methods evidence synthesis. Health Technol Assess [PMID: 37929629]
- Roberts and Hedges' Clinical Procedures in Emergency Medicine — Subacromial anatomy and injection approach
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