Accessibility Skip to Global Navigation Skip to Local Navigation Skip to Content Skip to Search Skip to Site Map Menu

Pain education and  rehabilitation for persistent shoulder pain

About the research

Gisela SoleShoulder pain associated with rotator cuff syndrome (sub-acromial pain syndrome) is common in middle-aged and older adults, often leading to long term shoulder pain, stiffness and weakness, and limitations in terms of self-care, physical activity, and work-related tasks. Rehabilitation guidelines for rotator cuff syndrome have generally focused on potential pathology and impairment of local shoulder structures (“local pathology model”). However, changes in the nervous system, including the brain, also contribute towards the pain experience.

A “neuroscience” approach - or psychologically-informed approach for rehabilitation has been proposed for patients with other persistent or chronic musculoskeletal pain. This approach entails patient pain education and graduated programs for exercise and physical activity. The approach considers the patient’s understanding and beliefs of causes of the pain from a neurophysiological perspective, including possible influences of aspects of the patient’s life on the pain experience. It thus is broader than just “treating the shoulder” as in the “local pathology model”.

This research aims to explore the use of pain education integrated into rehabilitation of patients with rotator cuff syndrome. Specific objectives include:

  • Exploring patients’ understanding and experiences of their rotator cuff-related pain.
  • Determining patients’ acceptability of and perceptions of the usefulness of pain education in the management of shoulder pain.
  • Exploring physiotherapists’ current use of advice and patient education for the management of patients with rotator cuff-related pain.

The research pathway follows past studies from our research group exploring effects of experimental shoulder pain on function, such as on electromyography and strength of shoulder muscles, and throwing accuracy. In the long term, this research will explore the role of pain education as part of physiotherapy management for patients with rotator cuff-related pain. 

Research funding

Sole G, Ribeiro D, Perry M, Swain N, Wassinger C (2017). Feasibility of neuroscience-informed physiotherapy for persistent shoulder pain. Jack Thomson Arthritis Grant: $23,699

Sole G, Perry M, Ribeiro D, Swain N, Wassinger C (2017). My shoulder has a brain: patient and physiotherapists’ perspectives of a psychologically-informed rehabilitation approach for shoulder pain. Physiotherapy New Zealand Scholarship Trust Fund: $4,206

Sole G, Ribeiro D, Jayakaran P, Wassinger C (2015). A neuroscience approach to pain management for patients with rotator cuff syndrome: a case series. Physiotherapy New Zealand Scholarship Trust Fund $2,990; New Zealand Manipulative Physiotherapists Association: $4,670; Total: $7,660

Research students

Honours student

Karen Meehan (2017): Advice and patient education in physiotherapy management of patients with rotator cuff-related pain: a scoping review and focus group study
Melissa Gillespie (2016): Rotator cuff syndrome: patients’ understanding and experiences of their pain


Gillespie M, Mącznik A, Wassinger C, Sole G (2017). Rotator cuff-related pain: patients’ understanding and experiences. Musculoskeletal Science and Practice 30:64-71

Spall P, Ribeiro DC, Sole G (2016). Electromyographic activity of shoulder girdle muscles in patients with symptomatic and asymptomatic rotator cuff tears: a systematic review and meta-analysis. Physical Medicine and Rehabilitation, doi: 10.1016/j.pmrj.2016.02.015

Ribeiro DC, Falla C, Shemmell J, Sole G (2016). Shoulder muscle activity during the modified dynamic relocation test and side-lying shoulder external rotation: a cross-sectional study on asymptomatic individuals. Journal of Manual and Manipulative Therapy, doi: 10.1080/10669817.2016.1157945.

Ribeiro DC, Castro M, Sole G, Vicenzino B (2016). The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: a repeated measures study on asymptomatic shoulders. Manual Therapy 22:101-108

Fyhr C, Gustavsson L, Wassinger C, Sole G (2015). The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Manual Therapy, 20:28-37

Sole G, Osborne H, Wassinger C (2015). The effect of experimentally-induced subacromial pain on proprioception. Manual Therapy, 20:166-170

Sole G, Osborne H, Wassinger C (2014). Electromyographic response of shoulder muscles to acute experimental subacromial pain. Manual Therapy, 19:343-348

Wassinger CA, Sole G, Osborne H (2013). Clinical measurement of scapular upward rotation in response to acute subacromial pain. Journal of Orthopaedic and Physical Therapy, 43:199-203

Ho CC, Sole G, Munn J (2009). The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Manual Therapy 14:463-474

Brandt C, Sole G, Krause MW, Nel M (2007). An evidence-based review on the validity of the Kaltenborn rule as applied to the glenohumeral joint. Manual Therapy 12:3-11

Sole G (2003). A multi-structural approach to treatment of a patient with sub-acromial impingement: a case report. Journal of Manual and Manipulative Therapy 11(1) 49-55


Sole G, Mącnik A, Ribeiro DC, Jayakaran P, Wassinger C. “It’s about our whole”: responses of participants with rotator cuff-related pain to a neuroscience pain education session. Podium presentation at the NZ Manipulative Physiotherapists Association, Rotorua, 19/20 August 2017 (Abstract book p 18)

Gillespie M, Mącnik A, Wassinger C, Sole G. Rotator cuff-related pain: patients’ understanding and experiences. Podium presentation at the NZ Manipulative Physiotherapists Association, Rotorua, 19/20 August 2017 (Abstract book p 18) Won the “Best Presentation” award at the conference.

Roy JS, Michener L, Cools A, Sole G, Struyf F. Why rotator cuff tendinopathies become chronic. Member of this international Focussed Symposium that was accepted by the World Confederation of Physical Therapy (WCPT) conference, Cape Town, 2-4 July 2017.

Gillespie M, Mącznik, Wassinger C, Sole G (2016). Rotator cuff related pain: patients’ understanding and experience. Presentation at Otago Medical School Research Society Masters/Honours meeting, November 2016. Abstract published in the proceedings, NZ Medical Journal (2017), 130 (1448).

Research team

Project lead: Dr Gisela Sole

Co- researchers:
Dr Meredith Perry, Dr Prasath Jayakaran, Dr Daniel Cury Ribeiro (CHARR, School of Physiotherapy, University of Otago)
Dr Nicola Swain (Department of Psychological Medicine, University of Otago)

International collaborator: Dr Craig Wassinger (Department of Physical Therapy, University of East Tennessee, USA)