The central nervous system--an additional consideration in 'rotator cuff tendinopathy' and a potential basis for understanding response to loaded therapeutic exercise

Man Ther. 2013 Dec;18(6):468-72. doi: 10.1016/j.math.2013.07.005. Epub 2013 Aug 6.


Tendinopathy is a term used to describe a painful tendon disorder but despite being a well-recognised clinical presentation, a definitive understanding of the pathoaetiology of rotator cuff tendinopathy remains elusive. Current explanatory models, which relate to peripherally driven nocioceptive mechanisms secondary to structural abnormality, or failed healing, appear inadequate on their own in the context of current literature. In light of these limitations this paper presents an extension to current models that incorporates the integral role of the central nervous system in the pain experience. The role of the central nervous system (CNS) is described and justified along with a potential rationale to explain the favourable response to loaded therapeutic exercises demonstrated by previous studies. This additional consideration has the potential to offer a useful way to explain pain to patients, for clinicians to prescribe appropriate therapeutic management strategies and for researchers to advance knowledge in relation to this clinically challenging problem.

Keywords: Exercise; Pain; Rehabilitation; Rotator cuff tendinopathy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Central Nervous System / physiopathology*
  • Exercise Therapy*
  • Humans
  • Nociception / physiology
  • Pain Management / methods*
  • Pain Measurement
  • Rotator Cuff*
  • Tendinopathy / physiopathology*
  • Tendinopathy / rehabilitation*