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Physical therapy alone is associated with coordinated short-term clinical improvement and neurotrophic correlates in patients with chronic rotator cuff tendinopathy and sleep disturbance.

Q: What is the main finding of the FORTIS trial?

The main finding is that physical therapy alone was associated with significant improvements in pain, insomnia, shoulder function, and cognitive performance, and these improvements correlated with changes in serum BDNF, supporting PT as the cornerstone of nonoperative management for rotator cuff tendinopathy.

Q: Did injection-based treatments add any benefit over physical therapy alone?

Injection-based adjuncts (steroid, nerve block, PRP) produced selective, time-limited effects (e.g., early pain reduction with steroid, improved sleep quality and executive function with nerve block), but no significant between-group differences were observed in clinical outcomes or BDNF levels.

Q: What was the role of BDNF in this study?

Serum BDNF was measured as a neurotrophic marker. Only physical therapy alone showed significant correlations between BDNF changes and reductions in pain and insomnia severity, suggesting a potential neurotrophic mechanism underlying PT's benefits.

Q: Who were the participants in this trial?

Participants were 29 patients with MRI-confirmed supraspinatus tendinopathy and sleep disturbance (PSQI ≥ 5), randomized to one of four groups: PT alone, PT + steroid injection, PT + suprascapular nerve block, or PT + platelet-rich plasma injection.

In a pilot randomized trial of 29 patients with MRI-confirmed supraspinatus tendinopathy and sleep disturbance, physical therapy (PT) alone led to significant improvements in pain, insomnia severity, shoulder function, and processing speed (all P ≤ .04). PT alone also showed significant correlations between changes in serum BDNF and reductions in pain and insomnia severity (P < .01), whereas injection-based adjuncts produced only selective, time-limited effects.

Last updated: Aug 30, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100

Human RCT★★☆☆☆

Meta-analysis☆☆☆☆☆

Mechanism★★★★★

Safety★★★★☆

Confidencelow

Study Evidence

Study 1. Functional and Neurotrophic Outcomes After Physical Therapy and Injection-Based Treatments for Rotator Cuff Tendinopathy: The FORTIS Pilot Randomized Trial.

observational

Pawłuś N, Turkiewicz S, Lesman J, Gabryelska A, Domżalski M, Kanak M · Orthopaedic journal of sports medicine (2026)

Participants: N/A

Duration: 12 weeks

Intervention: Standardized 12-week physical therapy program alone versus PT combined with subacromial steroid injection, suprascapular nerve block, or platelet-rich plasma injection.

Outcome: Pain, insomnia severity (PSQI), shoulder function, cognitive performance (processing speed, executive function), and serum BDNF levels.

Effect Size: N/A (no effect sizes reported in abstract)

Population: Patients with chronic rotator cuff tendinopathy (MRI-confirmed supraspinatus tendinopathy) and sleep disturbance (PSQI ≥ 5); 29 patients (29 shoulders).

Result:

PubMed: 42661896 DOI: 10.1177/23259671261468532

Mechanism Graph

Physical therapy reduces pain and improves shoulder function

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Reduced pain and improved function lead to better sleep quality

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Improved sleep and reduced pain are associated with increased serum BDNF

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BDNF changes correlate with clinical improvements, suggesting neurotrophic involvement

Limitations

⚠Small sample size (n=29) and pilot design limit generalizability
⚠No significant between-group differences in serum BDNF levels, suggesting neurotrophic effects may not be specific to PT alone
⚠Short-term follow-up (3 months) does not assess long-term outcomes

Frequently Asked Questions

What is the main finding of the FORTIS trial?▼

The main finding is that physical therapy alone was associated with significant improvements in pain, insomnia, shoulder function, and cognitive performance, and these improvements correlated with changes in serum BDNF, supporting PT as the cornerstone of nonoperative management for rotator cuff tendinopathy.

Did injection-based treatments add any benefit over physical therapy alone?▼

Injection-based adjuncts (steroid, nerve block, PRP) produced selective, time-limited effects (e.g., early pain reduction with steroid, improved sleep quality and executive function with nerve block), but no significant between-group differences were observed in clinical outcomes or BDNF levels.

What was the role of BDNF in this study?▼

Serum BDNF was measured as a neurotrophic marker. Only physical therapy alone showed significant correlations between BDNF changes and reductions in pain and insomnia severity, suggesting a potential neurotrophic mechanism underlying PT's benefits.

Who were the participants in this trial?▼

Participants were 29 patients with MRI-confirmed supraspinatus tendinopathy and sleep disturbance (PSQI ≥ 5), randomized to one of four groups: PT alone, PT + steroid injection, PT + suprascapular nerve block, or PT + platelet-rich plasma injection.

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References

1.Pawłuś N, Turkiewicz S, Lesman J, Gabryelska A, Domżalski M, Kanak M. "Functional and Neurotrophic Outcomes After Physical Therapy and Injection-Based Treatments for Rotator Cuff Tendinopathy: The FORTIS Pilot Randomized Trial.." Orthopaedic journal of sports medicine, 2026. PMID: 42661896 DOI: 10.1177/23259671261468532

Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.