What to Expect from Rotator Cuff Physical Therapy

After tearing your rotator cuff, physical therapy is a common recovery option people seek. A physical therapist is a movement and injury specialist that can help you get the best possible results; whether you opt for conservative treatment or need rehab after surgery. Keep reading to learn what you can expect from physical therapy when recovering from a rotator cuff tear. 

Conservative Treatments & Rehab

If your shoulder function is mostly preserved after your rotator cuff injury, conservative treatment may be the best option for you. If possible, it’s always best to avoid surgery to preserve the overall integrity of the shoulder joint. The best treatment for you depends on how your injury is affecting your quality of life. Conservation rehab with a physical therapist for this common injury includes these 5 general phases:

Pain Management

The first step is to get shoulder pain and swelling under control to build tolerance for other treatment options, and allow rest time for the injured rotator cuff tendons, soft tissues and sore muscles. It’s important to avoid overuse.

You’ll likely explore these treatment methods with your physical therapist.

Stretching, Strengthening & Range of Motion Exercises

When your pain relief is better managed, it’s time to focus on restoring shoulder flexibility. You will start with passive exercises that require no muscle use (with the help of your PT) and progress to active assisted and eventually unassisted motion. You will use your pain and any symptoms of shoulder impingement as a gauge for when to progress to the next level of difficulty.

As your range of motion slowly returns, your therapist will begin introducing strengthening exercises within the new range you’ve gained. With time, you will build rotator cuff muscle strength within your full range of motion. Core and shoulder blade stabilization will also play a role in returning to normal life.

Here are some exercises you can expect.

Tools

There are a variety of tools you can expect for your physical therapist to utilize when rehabbing your shoulder. Stretching straps are commonly used to achieve deeper more effective stretches; while resistance bands (often used in sports medicine) will help to activate smaller shoulder muscles and scapula that are more difficult to strengthen.

Your PT may also use kinesiology tape to help the muscles move appropriate during activity and provide support.

Learn About Rotator Cuff Taping Here

Return to Normal Daily Activities

The most important step with your rehab is making sure that the progress you’ve made actually translates into your everyday activities and helps avoid future overuse issues. You will practice daily movements that involve shoulder movements with your therapist, and continue on your own once discharged to troubleshoot any issues.

Rehab Phases After Surgery

Surgery is often diagnosed using magnetic resonance imaging. If you do end up needing surgery, there are many different rehab protocols available following a rotator cuff repair. Each surgeon has their own preferences for the recovery process and will work with your PT to optimize recovery. Each phase has general timelines and appropriate home exercises determined by the progress you make.

Immediate Recovery Phase (1-4 weeks)

At this stage, the fresh surgery needs time to heal and stay in the brace full time. This limits what can be accomplished. The focus is on pain management, gentle isometric muscle activation of the shoulder blades, and the start of passive shoulder range of motion. Common pain modalities may include TENs, ice, and gentle massage.

Protection Phase (5-9 weeks)

This phase means tissues are starting to heal and stabilize. Your PT will gradually increase your passive range of motion until you are ready to start actively assisting with movement of your shoulder around 6 weeks. By the end of this phase you will start gentle isometric strengthening exercises and most likely be free of your brace. Use of a shoulder pulley or cane are both techniques you’ll be introduced to at this stage.

Intermediate Phase (10-14 weeks)

By now, you should have your full shoulder range of motion restored (depending on what level of stiffness your shoulder had prior to injury) and will be building your overall shoulder strength in a pain free range. Your shoulder will feel uncoordinated and need specific exercises for rebuilding stability. Your therapist will introduce you to resistance bands, dumbbells, and more as you progress.

Your focus will be on restoring strength with external rotation, internal rotation, abduction, and flexion.

See our full strengthening article for specific moves.

Advanced Rehab (14+ weeks)

The last stage is meant to build up your shoulder strength, endurance, coordination and power. Your therapist will choose exercises that fit your lifestyle goals and help you get back to your normal daily activities. Once you are discharged, it’s important to continue with your home exercise program indefinitely to maintain shoulder strength and range of motion while preventing issues like frozen shoulder and impingement syndrome.

How Long is Physical Therapy?

The length and frequency of PT is always dependent on your unique circumstance and based off of these key factors:

• severity of injury
• learning style
• past experiences/injuries
• current impairments

You and your physical therapist will decide together what works best. For non-surgical treatment, you can expect to 1-3 times per week for 6-18 weeks. For surgery you can expect 1-4 visits per week for 4- 6 months.

Tips for Your First Session

Your first physical therapy session will be in depth. Your PT will be asking about your lifestyle, past injuries, and current symptoms. If you had surgery, your physical assessment will be limited. Otherwise, expect a full exam of your injured arm to determine the best possible treatment plan. Here’s what you should bring for your first visit:

• A list of medications you are currently taking
• A surgical protocol from your surgeon if you have one (your PT will probably already have it but it’s good to have an extra copy just in case)
• A list of questions to ask. It’s easy to get overwhelmed and forget your questions
• Pay attention to your symptoms in the days prior to your visit so that you can report the details
• Bring an open mind, your PT will provide a lot of education related to your injury that will help you feel empowered to heal and recover sustainably!

Following a Safe Rehab Program

Having a professional healthcare provider guide your torn rotator cuff recovery is a great way to boost your potential. There is great risk in doing too little or too much after a shoulder injury, a physical therapist can help you find that perfect balance. If you had surgery, your surgeon will most likely recommend physical therapy. If you are recovering conservatively, talk to your orthopaedic doctor or directly to your PT.

Sources:

https://www.physio-pedia.com/Rotator_Cuff_Tears

https://www.sportsandortho.com/UserFiles/Full%20Male%20Conservative%20Rotator%20Cuff%20Protocol%20w-pics%206-20-14% 20reduced .pdf

https://bostonshoulderinstitute.c om/wp-c ontent/uploads/2014/07/ Shoulder-Arthroscopic-RCT-Repair-Protocol -all-sizes2.pdf

Rotator Cuff Tear Products