Latissimus Dorsi Strengthening Exercises in Rotator Cuff Tendinopathy

The aim of this study is to investigate the effects of strengthening exercises targeting the latissimus dorsi muscle on acromiohumeral distance, shoulder function, and pain levels in individuals with rotator cuff tendinopathy. By increasing the activation of the latissimus dorsi, one of the shoulder adductor muscles, the exercises are expected to facilitate inferior gliding of the humeral head and improve subacromial distance. Individuals aged between 18 and 50 years with a diagnosis of rotator cuff tendinopathy will be included in the study. A total of 47 participants will be enrolled and randomly assigned to one of three groups: A group performing exercises targeting only the rotator cuff muscles, A group performing exercises targeting the latissimus dorsi muscle, A group performing a combination of both rotator cuff and latissimus dorsi exercises. The exercise interventions will be applied over a 12-week period. Before and after the intervention, the following outcomes will be assessed: Acromiohumeral distance (via ultrasound), Range of motion, Shoulder function and pain using the SPADI and WORC questionnaires, and Avoidance behavior using the Adap-Tr questionnaire.

Inclusion Criteria: * Age between 18 and 50 years * At least 3 months of ongoing shoulder pain * At least 3 positive tests out of 5 (Neer, Hawkins-Kennedy, Jobe, Painful Arc Sign, Pain on Resisted External Rotation) * Ultrasound diagnosis of rotator cuff tendinopathy * Shoulder pain during activity rated greater than 3 out of 10 on the Numeric Pain Scale * Central Sensitization Inventory score below 40 Exclusion Criteria: * Bilateral shoulder pain * History of surgery or dislocation in the symptomatic shoulder * Acromioclavicular degeneration * Presence of shoulder capsulitis (restriction in passive glenohumeral range of motion in 2 or more directions) * Full-thickness rotator cuff tear * Shoulder osteoarthritis, rheumatoid arthritis, systemic inflammatory or neurological disease * Any injection to the symptomatic shoulder within the past 6 weeks * BMI greater than 30 kg/m2 * Refusal to participate in the study