Hi AJ,

Thanks for the article. I thought this was a really interesting read. I think in terms of dosage this study showed that “normal” tendons respond differently than those with pathology, citing immediate supraspinatus tendon thickening following shoulder exercises and acromiohumeral distance decreasing post exercise that was maintained for 6 hours in the pain group. One of the main takeaways for me was to not further overload the tendon, we want to restore homeostasis without loading to fatigue and feeding into the cycle of intrinsic and extrinsic factors that create pain in the shoulder. Depending to the irritability and stage of the patient, limiting cuff strengthening to once per day or every other day may be more appropriate.

Hey AJ,

Interesting study. With some reflection on my treatment of patient’s with RC tendinopathy, it seems that I may have been overworking them slightly. This study emphasizes that sometimes less is more with this population, especially in the early stages of rehabilitation. In the future, I will likely limit the prescription of RC exercises to once per day and be sure to alter set and rep schemes to not overwork the patient. However, this does bring up some questions in my mind about how we can load the tendon enough for it to adapt without causing harm. How much is too much? Are there any objective changes we should be looking for to determine whether we are consistently overworking the tendon, or if we are loading it appropriately?

I agree with Tyler. I think this study was very helpful for me when considering exercise prescription, particularly early in the plan of care. I think it will be helpful for me when considering education for HEP. I think educating patients on taking appropriate rest breaks both during exercise and between exercise bouts is something I have plenty of room for improvement in. Thanks for this article, its a good “library builder”.