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There are 2 main problems for why people end up with chronic rotator cuff issues:
1) Muscle imbalance - there are 4 muscles considered part of the rotator cuff and 2 of them act as external rotators. However most natural movements as well as lifting exercises (think chest press and pullups / rows) use the internal rotators. External rotator exercises are often ignored and these muscle get underdeveloped relatively.
2) Poor recovery for acute or overuse injuries - tendons in rotator cuff can get tendonitis or injured much like any other tendon in the body, and the medical community is very bad at communicating how to repair these.
Proper tendon rehab requires progressive overload of eccentric exercise of the injured muscle-tendon over the course of many months - and during the actual exercises the movement will feel moderately painful and potentially popping sounds (scar tissue breaking down). Most people won't do this or trust it is correct but it is. PTs aren't clear on this. Doctors would rather you get surgery for $$$.
I had a severe tear in my supraspinatus (rotator cuff) from a cycling crash that I literally could not lift my arm. 4 months later of smart, consistent rehab and I was at ~95% full recovered.
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