dawnmedDawnMed Journal of Medical ScienceISVolume 2, Issue 4MultidisciplinaryEnglish2026NNY20261020Orthopedic SurgeryRotator Cuff–Related Shoulder Pain in the Overhead Athlete: A Phase-Based Rehabilitation and Return-to-Sport FrameworkEnglishY4858Abdulrahman MAlquraynis¹EnglishNAbdullah KAbusoliman²*EnglishYAlanoud HAlruqi³EnglishYYazeed AAsery⁴EnglishYReem AAlshehri⁵EnglishYEyad SAlhashim⁶EnglishYAbdulaziz AAlnuwaysir⁷EnglishYAhmed AAlzahrani⁶EnglishYLuay MAlmutair⁸EnglishYIbrahim EAlmaski⁶EnglishYSuliman AAlluhib²EnglishYRazan MAlbalawi⁹EnglishYIbtisam AMohammed¹⁰EnglishYAli MAlqahtani¹¹EnglishYAhmed AHejazi¹²EnglishYBackground: Rotator cuff–related shoulder pain is among the most common problems in athletes whose sport demands repeated overhead loading. Rehabilitation is first-line care, yet clinicians have little guidance on how to sequence it or on when an athlete is ready to compete again.Aim: To provide clinicians with a practical framework for assessing rotator cuff–related shoulder pain in the overhead athlete, staging rehabilitation and structuring the return-to-sport decision.Methods: This clinical practice review draws on seven clinical studies of rehabilitation in overhead athletes and four guideline, consensus and narrative sources. Outcome values were extracted from the published tables of each study and compared with published minimal clinically important differences where these were available. The review is not systematic and does not aim for exhaustive coverage.Results: Trials comparing exercise with no treatment or a weak comparator reported benefit. On patient-reported outcomes, no comparison between two active programmes produced a difference that was both statistically significant and larger than the published minimal clinically important difference: physio-yogic versus scapular recruitment exercise, p=0.180; scapular dyskinesis–based versus multimodal therapy, 5.98 points on the Shoulder Pain and Disability Index against published thresholds of 8 to 20.6 points; kinesiotaping added to rehabilitation versus rehabilitation alone, all differences below threshold. After arthroscopic supraspinatus repair in 17 Olympic volleyball athletes, all returned to their pre-injury level, at a mean of 6.9 months to sport and 12.4 months to performance. None of the 22 return-to-sport criteria drawn from current guideline and consensus sources is a validated threshold for the overhead shoulder.Conclusion: Supervised, progressively loaded exercise appears to be the effective component of rehabilitation in these athletes, and no specific exercise programme has outperformed another credible programme on patient-reported outcomes. Clinicians are better served by a framework for sequencing and progressing rehabilitation, with explicit return-to-sport criteria, than by a fixed protocol.EnglishRotator Cuff; Athletic Injuries; Shoulder Pain; Return to Sport; Exercise Therapy; Shoulder Impingement Syndrome.https://dawnmed.com.sa/abstract?id=45References1619Cools AM, Maenhout AG, Vanderstukken F, Decland;egrave;ve P, Johansson FR, Borms D. The challenge of the sporting shoulder: from injury prevention through sport-specific rehabilitation toward return to play. Ann Phys Rehabil Med. 2021;64(4):101384. doi:10.1016/j.rehab.2020.03.009Desmeules F, Roy JS, Lafrance S, Charron M, Duband;eacute; MO, Dupuis F, et al. Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: a clinical practice guideline. J Orthop Sports Phys Ther. 2025;55(4):235and;ndash;274. doi:10.2519/jospt.2025.13182Schwank A, Blazey P, Asker M, Mand;oslash;ller M, Hand;auml;gglund M, Gard S, et al. 2022 Bern consensus statement on shoulder injury prevention, rehabilitation, and return to sport for athletes at all participation levels. J Orthop Sports Phys Ther. 2022;52(1):11and;ndash;28. doi:10.2519/jospt.2022.10952Wen M, Hu X, Bao G. Scapular dyskinesis-based exercise therapy versus multimodal physical therapy for subacromial impingement syndrome in young overhead athletes with scapular dyskinesis: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2025;17(1):204. doi:10.1186/s13102-025-01254-8De Mey K, Danneels L, Cagnie B, Cools AM. Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome. Am J Sports Med. 2012;40(8):1906and;ndash;1915. doi:10.1177/0363546512453297Porcellini G, Ziroglu N, De Santis E, Micheloni GM, Tarallo L, Giorgini A. Midterm clinical outcomes after arthroscopic rotator cuff repair in Olympic volleyball players: return to sports and return to performance. Orthop J Sports Med. 2023;11(8):23259671231186820. doi:10.1177/23259671231186820Saadatian A, Babaei Khorzoghi M, Sahebozamani M, Karimi MT. The impact of OKC exercises and TRX exercises on shoulder joint proprioception in overhead athletes with shoulder impingement syndrome: a randomized controlled trial. Phys Treat. 2022;12(2):77and;ndash;84.Cha JY, Kim JH, Hong J, Choi YT, Kim MH, Cho JH, et al. A 12-week rehabilitation program improves body composition, pain sensation, and internal/external torques of baseball pitchers with shoulder impingement symptom. J Exerc Rehabil. 2014;10(1):35and;ndash;44. doi:10.12965/jer.140087Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853and;ndash;864. doi:10.1136/bjsports-2016-096278Chawla JK, Chandra I, Sharma R, Verma S, Kumar P, Sharma V, et al. Integrating physio-yogic exercises for rotator cuff tendinopathy in Indian overhead athletes: a comprehensive approach. J Lifestyle Med. 2024;14(1):46and;ndash;53. doi:10.15280/jlm.2024.14.1.46Dabija DI, Jain NB. Minimal clinically important difference of shoulder outcome measures and diagnoses: a systematic review. Am J Phys Med Rehabil. 2019;98(8):671and;ndash;676. doi:10.1097/PHM.0000000000001169Heald SL, Riddle DL, Lamb RL. The Shoulder Pain and Disability Index: the construct validity and responsiveness of a region-specific disability measure. Phys Ther. 1997;77(10):1079and;ndash;1089.Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum. 2009;61(5):623and;ndash;632.Williams JW Jr, Holleman DR Jr, Simel DL. Measuring shoulder function with the Shoulder Pain and Disability Index. J Rheumatol. 1995;22(4):727and;ndash;732.Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927and;ndash;932. doi:10.1016/j.jse.2009.03.021Qureshi H, Omer A, Khan A, Rauf U, Ahmad U, Ur Rehman MM. The effects of functional kinesiotaping on acromio humeral distance, pain, quality of life and disability in overhead athletes with rotator cuff tendinopathy: a randomized control trial. Adv Rehabil. 2024;38(4):25and;ndash;33. doi:10.5114/areh.2024.144634