Physical Therapy After Rotator Cuff Surgery: What to Expect

The rotator cuff is a grouping of four shoulder muscles (the supraspinatus , the teres minor, the infraspinatus , and the subscapularis) . This muscular group surrounds the head of the humerus (the ball-shaped top of the arm bone) and helps to elevate and rotate your shoulder.

These muscles are also responsible for adding stability to the joint and ensuring that the humeral head stays centered in the socket (glenoid) portion of the joint.

Occasionally, one (or more) of your rotator cuff muscles can either partially or completely tear. This can happen as a result of wear and tear over time or after a traumatic injury.

Regardless, this issue can significantly impact the strength, stability, and movement of your arm. Because of this, a rotator cuff repair surgery may need to be performed.

This article will review this procedure and the physical therapy needed after the surgery to aid recovery, regain strength, and restore the full range of motion in your shoulder.

What Is Rotator Cuff Repair Surgery?

Not every rotator cuff tear needs to be repaired. In fact, asymptomatic rotator cuff tears are common. Multiple studies have found that the prevalence of asymptomatic rotator cuff injuries may be as high as 46%.

That said, there are certain specific symptoms and situations where a rotator cuff repair surgery may be warranted. These include:

• Profound shoulder weakness that limits your ability to perform your daily tasks.
• Pain and other shoulder symptoms that are present for longer than six months
• Shoulder weakness after an acute injury or fall
• MRI or other imaging showing a large rotator cuff tear (over 3 centimeters in size)

Once you and your orthopedic surgeon decide to proceed with this operation, the surgeon will typically repair the tendon by securing anchors to your humerus and then fastening the torn tendon to the anchors using sutures. Bone spurs (extra bone growth at the ends of bones) in the area may also need to be removed depending on the situation.

The rotator cuff repair procedure may be done using a larger shoulder incision (called an open repair) or a slightly smaller incision (called a mini-open repair). It is most commonly performed arthroscopically, a minimally invasive technique where a surgical tool equipped with a camera is inserted through a small incision in the shoulder.

4 Stages of Post-Operative Physical Therapy

Following a rotator cuff repair, the affected arm is usually placed in a sling by your care team. You will be told not to actively move your arm for multiple weeks.

Physical therapy (PT) is also typically initiated early on after surgery to help jump-start your recovery. While in PT, your rehab is commonly divided into several distinct phases:

Passive Range of Motion

Early on after surgery, the main goal of therapy is to slowly advance your shoulder’s range of motion while protecting the surgical repair. Actively moving the arm is not allowed, so your therapist will gently stretch the shoulder passively to reduce the stiffness in the joint.

Your therapist will also provide instruction on how to perform daily tasks like bathing or dressing without activating the affected muscles.

Soft tissue massage and icing may also be utilized to alleviate the post-operative soreness and swelling that normally occurs. There is still some disagreement about the optimal duration of this rehab phase.

That said, this stage of therapy typically lasts for two to eight weeks, depending on the size of the tear and your surgeon’s preferences.

Active-Assisted and Active Range of Motion

During the second phase of rehab, your PT will clear you to begin stretching your shoulder on your own with the assist of your other arm or another object (like a cane or pulleys). You will also be cleared to discontinue the use of your sling and to start actively moving the arm as much as you can tolerate.

A certain amount of stiffness and pain is still typically present in the shoulder at this stage. Because of this, passive stretching by the therapist and icing may still need to be performed. Usually, this phase of rehab lasts for three to four weeks.

Initial Strengthening

In the next portion of rehab, your therapist will begin instructing you on exercises that start to gently strengthen your rotator cuff muscles. By this point, the surgical repair is more secure and can tolerate light resistance.

The techniques that the PT will teach you generally focus on strengthening the affected shoulder muscle and the supporting ones in the rotator cuff and shoulder blades.

The duration of this phase can vary widely depending on the extent of the surgery and your pre-existing strength, but generally, it lasts between two and three months.

Late Strengthening

The final stage of PT focuses primarily on building your shoulder strength by increasing the intensity of the exercises you perform. Your therapist will provide guidance on safely increasing the amount of weight you use and may also incorporate weight-bearing or pushing and pulling techniques.

If a return to athletics is desired, sport-specific exercises for throwing may also be introduced during this stage. The timeline for this portion of PT is variable, but it can take several months before you are fully discharged from therapy.

Summary

Rotator cuff repair surgery involves fixing torn or damaged tendons in the shoulder. This surgery typically requires four stages of physical therapy as you recover. In the first two to eight weeks after surgery, you'll limit movement, wear a sling, and work with a PT on passive stretching. In the second stage, you'll work on active stretching. Finally, you'll work on initial strengthening and eventually weight-bearing strengthening until you get back to normal levels of movement.

A Word From Verywell

Recovering from a rotator cuff repair requires both persistence and patience. While most people eventually see improvements in their pain, range of motion, and function, these benefits can take time.

To maximize the likelihood of successful rehabilitation, be sure to find a physical therapist who is skilled in treating patients who undergo rotator cuff repairs. Working hand in hand with a knowledgeable PT gives you the best chance at a successful outcome.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Academy of Orthopaedic Surgeons. Rotator cuff tears.
2. Lawrence RL, Moutzouros V, Bey MJ. Asymptomatic rotator cuff tears. JBJS Rev. 2019;7(6):e9. doi:10.2106/JBJS.RVW.18.00149
3. American Academy of Orthopaedic Surgeons. Rotator cuff tears: surgical treatment options.
4. Thomson S, Jukes C, Lewis J. Rehabilitation following surgical repair of the rotator cuff: a systematic review.Physiotherapy. 2016;102(1):20-28. doi:10.1016/j.physio.2015.08.003
5. Edwards PK, Ebert JR, Littlewood C, Ackland T, Wang A. A systematic review of electromyography studies in normal shoulders to inform postoperative rehabilitation following rotator cuff repair.J Orthop Sports Phys Ther. 2017;47(12):931-944. doi:10.2519/jospt.2017.7271

By Tim Petrie, DPT, OCS
Petrie is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.

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