That nagging shoulder pain that flares up when you reach overhead, lift weights, or even just grab something from the back seat of your car—if you’re dealing with tendonitis, you know how frustrating it can be. What starts as a minor annoyance can quickly evolve into something that affects your workouts, your sleep, and your daily activities.
Tendonitis, particularly in the shoulder, is one of the most common conditions we treat at Performance Health. The good news? Modern chiropractic care offers multiple evidence-based treatment options that go far beyond simple rest and ice. Let’s explore how we approach tendonitis and help patients like you return to full function.
Understanding Tendonitis: More Than Just Inflammation
While the “-itis” suffix suggests inflammation, chronic tendonitis is more accurately described as tendinosis—a degenerative condition characterized by collagen disorganization, increased ground substance, and neovascularization within the tendon. This distinction matters because it changes how we approach treatment.
The shoulder is particularly vulnerable to tendon issues due to its remarkable range of motion and the constant demands placed on the rotator cuff muscles. The supraspinatus tendon, which passes through the narrow subacromial space, is especially prone to irritation and degeneration. Repetitive overhead activities, poor posture, muscle imbalances, and previous injuries all contribute to the development of shoulder tendonitis.
Advanced Therapeutic Modalities: The Science Behind Recovery
At Performance Health, we utilize cutting-edge technologies backed by robust clinical research to accelerate healing and restore function.
Extracorporeal Shockwave Therapy (ESWT)
Shockwave therapy has emerged as one of the most effective non-invasive treatments for tendonitis. This modality delivers high-energy acoustic waves to affected tissue, triggering several biological mechanisms:
- Mechanotransduction: The mechanical stimulus activates cellular pathways that upregulate growth factors including VEGF (vascular endothelial growth factor), eNOS (endothelial nitric oxide synthase), and PCNA (proliferating cell nuclear antigen)
- Neovascularization: Enhanced blood vessel formation improves nutrient delivery and waste removal from degenerative tissue
- Collagen remodeling: Shockwaves stimulate fibroblasts to produce new collagen with improved structural organization
- Substance P release: This neuropeptide modulates pain perception while promoting tissue regeneration
Multiple systematic reviews and meta-analyses demonstrate that ESWT produces significant pain reduction and functional improvement in rotator cuff tendinopathy, with effects lasting 12 months or longer. Success rates typically range from 70-90%, with minimal adverse effects.
Low-Level Laser Therapy (LLLT)
Also known as photobiomodulation, laser therapy utilizes specific wavelengths of light (typically 600-1000nm) to penetrate tissue and influence cellular metabolism. The therapeutic mechanisms include:
- Mitochondrial stimulation: Photons are absorbed by cytochrome c oxidase in the mitochondrial respiratory chain, increasing ATP production and cellular energy
- Reactive oxygen species modulation: LLLT optimizes ROS levels, reducing oxidative stress while maintaining beneficial signaling molecules
- Anti-inflammatory effects: Treatment decreases pro-inflammatory cytokines (IL-1β, TNF-α) while increasing anti-inflammatory mediators
- Enhanced tissue repair: Laser therapy upregulates growth factors and matrix metalloproteinases involved in tissue remodeling
Clinical trials show that LLLT significantly reduces pain and improves function in shoulder tendinopathy, with optimal results achieved using appropriate dosing parameters (typically 4-8 Joules per point).
Graston Technique: Instrument-Assisted Soft Tissue Mobilization
The Graston Technique represents a specialized form of manual therapy using stainless steel instruments to detect and treat soft tissue restrictions. This approach is particularly effective for addressing the fibrotic adhesions and scar tissue that develop in chronic tendonitis.
The proposed mechanisms include:
- Mechanical breakdown of adhesions: The instruments create controlled microtrauma that initiates an inflammatory response, paradoxically promoting proper healing
- Neurophysiological effects: The sensory input may activate descending pain inhibition pathways and reduce central sensitization
- Enhanced collagen alignment: The directional strokes applied during treatment may influence collagen fiber orientation during the remodeling phase
Research indicates that instrument-assisted soft tissue mobilization, when combined with exercise, produces superior outcomes compared to exercise alone in treating tendinopathies. Patients typically report improved range of motion and reduced pain within 4-6 treatment sessions.
The Integrated Approach: Why Combination Therapy Works
While each of these modalities is effective independently, we’ve found that combining treatments produces optimal results. Here’s why:
Different therapies target different aspects of tendon pathology. Shockwave therapy excels at stimulating neovascularization and collagen remodeling in deeper tissue structures. Laser therapy provides powerful anti-inflammatory and analgesic effects while enhancing cellular metabolism. The Graston Technique addresses superficial restrictions and improves tissue mobility.
By strategically combining these approaches, we can:
- Accelerate the overall healing timeline
- Address multiple pain mechanisms simultaneously
- Improve treatment tolerance (some patients respond better to certain modalities)
- Enhance functional outcomes
Additionally, we integrate these technologies with joint manipulation, corrective exercise, and movement pattern training to address the underlying biomechanical factors that contributed to the tendonitis in the first place.
Beyond Passive Treatment: Your Active Role in Recovery
While these therapeutic modalities are powerful, lasting recovery requires your participation. We’ll prescribe specific exercises to strengthen the rotator cuff and scapular stabilizers, improve shoulder mechanics, and prevent recurrence. This typically includes:
- Eccentric strengthening exercises (particularly effective for tendon remodeling)
- Scapular stabilization work to optimize shoulder blade position and movement
- Postural correction exercises to reduce stress on the shoulder
- Activity modification strategies to avoid aggravating factors while maintaining fitness
When to Seek Treatment
Don’t wait until shoulder pain completely limits your activities. Early intervention produces faster, more complete recovery. Warning signs that it’s time to seek professional care include:
- Pain that persists beyond 2 weeks despite rest and self-care
- Progressive worsening of symptoms
- Pain that interferes with sleep
- Decreased range of motion
- Weakness with specific movements
- Pain that affects your ability to work or exercise
Your Next Steps
At Performance Health, we’ve helped countless patients overcome tendonitis and return to the activities they love. Our doctors are trained in the latest evidence-based treatments and will develop a personalized plan to address your specific condition and goals.
Shoulder tendonitis doesn’t have to be a chronic problem. With the right combination of advanced therapies and rehabilitative exercise, most patients experience significant improvement within 6-8 weeks.
Struggling with shoulder pain or tendonitis? Contact Performance Health today—we’re happy to answer your questions and help you get back to moving without pain.