# Patient-Specific Factors of Recovery in Rotator Cuff Tendinopathy

> **NIH NIH R01** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2024 · $238,916

## Abstract

Patient-Specific Factors of Recovery in Rotator Cuff Tendinopathy
PROJECT SUMMARY
Rotator cuff tendinopathy is a frequent cause of shoulder pain. A known effective treatment is resistance
exercise, which is the current standard of care. However, the outcomes of resistance exercise are highly
variable, with 40-50% developing chronic or recurrent pain. Resistance exercise should be designed to
stimulate tendon healing and individually tailored to change the biomarker of tendinopathy – tendon structure.
The lack of knowledge as to how the tendon structure responds to resistance exercise, how this relates to
patient-reported pain and disability, and what other factors impact the tendon response is limiting the delivery
of patient-specific treatment approaches and outcomes of care. We hypothesize the tendon response and
patient outcomes are affected by deficits in muscle function, brain pain processing, and psychological factors
as they influence the ability and willingness to move the shoulder. To stimulate tendon structural remodeling,
resistance exercise imparts load to the tendon via muscle activation. Deficits in shoulder muscle activation can
reduce tendon loading and thus healing. Elevated pain-related psychological distress in the form of
kinesiophobia and pain catastrophizing and deficits in pain and sensorimotor processing are associated with
poorer outcomes and chronicity in individuals with rotator cuff tendinopathy. Our pilot work supports our
hypotheses that higher levels of muscle activation along with lower levels of psychological distress, central
pain and sensorimotor processing deficits are associated with a positive tendon structural response and patient
outcomes. In this study, we will quantify the effects of resistance exercise on the biomarker of tendon structure
and the impact of muscle deficits, psychological factors, and brain dysfunction in pain and sensorimotor
processing on shoulder pain and disability outcomes. Patients with rotator cuff tendinopathy (N=70) will be
observed during standard-of-care 8 weeks of a resistance exercise. At baseline, 4 weeks, 8 weeks we will use
ultrasound to assess tendon structure, electromyography and a load cell for muscle, psychological factors via
patient report, functional magnetic resonance brain imaging for pain and sensorimotor processing dysfunction,
pain-rating during shoulder functional tasks, and shoulder functional outcomes. We will follow-up at 6-months
on patient-reported shoulder outcomes. These data will deliver evidence to design and evaluate a future novel
stepped and matched care pathway clinical trial; patients whose tendon is responsive to exercise will continue
with resistance exercise, and those with limited response will be `stepped and matched' to alternative care of
psychologically-informed treatment for brain dysfunction and psychological deficits, and/or alternative
resistance approach to target muscle deficits. Resistance exercise is a known effective treatment, b...

## Key facts

- **NIH application ID:** 10978161
- **Project number:** 1R01AR083626-01A1
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** Lori Ann Michener
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $238,916
- **Award type:** 1
- **Project period:** 2024-07-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10978161

## Citation

> US National Institutes of Health, RePORTER application 10978161, Patient-Specific Factors of Recovery in Rotator Cuff Tendinopathy (1R01AR083626-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10978161. Licensed CC0.

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