| 17 years clinical experience | 5-star Google reviews | Free taster session | Free parking on site | Sessions available this week |
Rotator cuff pain is the most common shoulder complaint we see. Patients often arrive with a diagnosis of “Subacromial Impingement.” They have been told that a bone spur is rubbing on their tendon, or that there isn’t enough space in the shoulder for the tendon to move.
While the pain is real—a sharp catch when reaching overhead, putting on a coat, or lifting a weight—the explanation is often outdated. Research now shows that the amount of space in the shoulder (the subacromial space) does not correlate well with pain. Many people have “impingement” on MRI scans but have zero pain.
So, why does your shoulder hurt? At Breakthrough Pain & Performance, we view rotator cuff pain as a Functional Stability Issue. The problem is not the size of the tunnel; it is how you are driving the car through it. If the muscles controlling the ball-and-socket joint are uncoordinated, the ball rides up and pinches the tendon. We fix the coordination, creating space dynamically through better movement.
The shoulder is a ball-and-socket joint, but the socket is very shallow, like a golf ball on a tee. To keep the ball centered on the tee while the arm moves, the Rotator Cuff muscles must fire in a perfect sequence.
This is called Joint Centration. When you lift your arm, the Deltoid muscle pulls the ball upwards. The Rotator Cuff must instantly pull the ball downwards and inwards to counteract this. This keeps the ball spinning in the centre of the socket.
In impingement syndrome, this timing is off. The Deltoid fires, but the Rotator Cuff is inhibited (sleepy) or late. The ball rides up, crashing into the roof of the shoulder (the acromion) and crushing the tendon.
Standard physio gives you rubber band exercises to strengthen the cuff. But the cuff isn’t usually weak; it is inhibited. The brain has switched it off. Doing endless repetitions with an inhibited muscle won’t turn it back on. We use Neurological Activation. We find out why the brain inhibited the cuff (often a neck issue or a previous trauma) and reset the signal. Once the cuff fires reflexively, centration is restored, and the impingement disappears.
We live in a forward-facing world. Driving, typing, and scrolling all encourage a posture with rounded shoulders. This leads to chronic shortening of the Pectoralis Major and Minor muscles.
Neurologically, when a muscle on the front of the joint (Pecs) is tight, the brain inhibits the muscles on the back of the joint (Rotator Cuff and Lower Traps) to allow the movement. This is Reciprocal Inhibition.
If your Pecs are locked short, your Rotator Cuff is locked “off.” You can try to strengthen your external rotators in the gym, but you are fighting your own neurology. The brain is keeping the brakes on.
We treat the inhibition by releasing the facilitation. We use P-DTR to reset the tone in the Pectorals. Once the brain stops perceiving the front of the shoulder as short, it releases the inhibition on the back. The shoulder opens up, and the Rotator Cuff regains its power instantly.
You cannot fire a cannon from a canoe. In the shoulder, the arm is the cannon, and the shoulder blade (scapula) is the canoe. If the scapula is unstable, the arm cannot function.
For the arm to go overhead without pain, the scapula must rotate upwards and tilt backwards. If it doesn’t, the roof of the shoulder stays low, and the arm bone crashes into it.
We see many patients with Scapular Dyskinesis—poor movement of the blade. This is often driven by a lazy Serratus Anterior or a tight Levator Scapulae. We re-train the rhythm.
We teach the brain how to coordinate the movement of the scapula with the movement of the arm. By building a stable launchpad, we give the rotator cuff a mechanical advantage.
The shoulder capsule is packed with mechanoreceptors that tell the brain where the arm is. If you have had a previous injury, or if you simply don’t use your full range of motion, this map gets blurry (Cortical Smudging).
If the brain doesn’t know exactly where the arm is, it becomes protective. It limits range and creates pain to stop you from going into positions it deems unsafe.
We use Proprioceptive Enriched Training. We use unstable loads (like water-filled tubes), vibration, and eyes-closed drills to force the brain to pay attention to the shoulder joint. By sharpening the map, we improve the precision of movement, reducing the micro-trauma that causes tendonitis.
Patients with impingement often have a “Painful Arc”—it hurts between 60 and 120 degrees of lifting the arm. Over time, the brain learns to anticipate this pain. It braces before you even reach the painful zone.
This bracing alters your mechanics and ensures the pain continues. We use Neurological Distraction. We might have you perform the movement while doing a complex mental task or looking in a specific direction. This distracts the brain’s threat system. Often, patients find they can lift their arm fully without pain when they aren’t focusing on it. This proves that the pain is largely a “software” habit, which we can then reprogram.
1. The Reset: We release the tight antagonists (Pecs/Lats) using reflex techniques to unblock the Rotator Cuff.
2. The Activation: We wake up the cuff and the scapular stabilisers. We ensure they fire before the prime movers.
3. The Centration: We train the brain to keep the ball in the socket during dynamic movement.
4. The Loading: We strengthen the tendon. Tendons need load to heal, but it must be the right load at the right time.
This clinic is for you if:
We fix the mechanics so the tendon can heal.
