Rotator Cuff Repair and Rotator Cuff Tear Physical Therapy | Charlottesville VA

 

Rotator cuff tear physical therapy is essential following the surgery. Therapy will allow your shoulder to heal correctly by minimizing losses in range of motion and gradually restoring muscle strength, endurance, and motor control. Shoulders are inherently complex and mobile joints which require specific therapy following a rotator cuff repair. We have outlined how our office can get your shoulder back to 100% to help you become a stronger version of yourself.

Some rotator cuff injuries we treat:

  • physical therapy for strained rotator cuff
  • physical therapy for rotator cuff impingement
  • physical therapy for rotator cuff tendinitis
  • physical therapy for supraspinatus tear
  • physical therapy for partial rotator cuff tear
  • physical therapy for shoulder tendonitis
  • physical therapy for rotator cuff injury

Basic considerations following a rotator cuff repair

Sling

Following surgery, you will likely be asked to wear a sling for the first 4-6 weeks. Not only will this position your arm for healing, but it will help to protect it from unwanted movement and from people accidently bumping into you in crowds. After the first few weeks, you can often remove the sling while resting at home to get the shoulder into a slightly different position.

 

Sleeping

People generally find it more comfortable to sleep upright in a recliner for the first week or 2 as this prevents the likelihood of rolling onto the shoulder or moving the shoulder into a painful range accidentally when sleeping. It can also help to put a pillow under the surgical arm between the ribs and arm to make the shoulder feel more comfortable and decrease pain. 

Painkillers

Painkillers are prescribed for a reason: The shoulder will likely be in pain for the first 1-2 weeks following surgery. The sooner you can wean yourself from using them the better. These drugs can be highly addictive and also lead to other side effects such as constipation and sedation. Therapy can also be inherently uncomfortable, but the pain response to specific movements or exercise can be a good indicator of how far your shoulder can be pushed with therapy. Pain is usually the gauge your provider will use to know how quickly you can progress. If painkillers are used before your therapy sessions, it can take the edge off of the session, but may lead to your provider pushing you too far too quickly and inadvertently causing more pain. Please use your discretion when using these drugs. 

 

Rotator Cuff Repair Physical Therapy Protocol

All progression is based on the individual’s tolerance to movements and exercise. Everyone progresses at a different rate. Post surgical protocols serve as a guideline and will be adjusted based on each individual’s needs. If you have any concerns about your progression or any questions about the protocol, do not hesitate to ask your therapist or contact your surgeon at any time. Below is a basic guideline of what to expect during the rehab process. 

Rotator Cuff Repair Physical Therapy: Weeks 1-6

Mobility

This is the phase where your provider can really help you shoulder. Due to inherent tendon attachment weakness following the surgery. No active contraction of the muscle is allowed. This means you will rely on your provider to move your shoulder through the range to increase motion and to reduce pain, stiffness, and swelling. Range of motion is usually limited during this phase to protect the repair and ensure that things heal properly, but in some instances may progress into full range of motion depending on the patient’s pain. 

Strengthening

During this phase you will begin active motion and exercises for your lower arm including your wrist and elbow. This will ensure that you maintain strength, mobility, and function throughout your lower arm as you are protecting your shoulder. You will also begin activating muscles around the shoulder blades as these muscles will be important for regaining normal motion later in your rehabilitation. Gentle stability drills will be initiated during this phase if tolerated. These are performed to cause a low level of activation in the rotator cuff muscles to begin improving stability and activation for normal movement. Active strengthening exercises of other muscle groups are likely to be added as well if tolerated. 

 

Rotator Cuff Repair Physical Therapy: Weeks 6-12

Mobility

Passive range will be continued by your provider if indicated. You will become a more active member of improving your range of motion by using something so that your unaffected arm can help to move the surgical arm through the range. Motion should be full or progressed to full within the phase of  recovery. Active exercises will be initiated, although care must be taken as the tendon is still continuing to heal and has not fully recovered by this point. Active motion can be performed in a pain-free range, usually limited to 90deg initially, but then progressed as tolerated and as normal movement control improves.

Strengthening

Rotator cuff strengthening will be initiated or progressed based on tolerance to the initial performance of these exercises. Goals are to improve strength and mobility through active exercise. Functional movements are progressed during this phase including starting at lower ranges and progressing to overhead movements as tolerated. Resistance will also be added as tolerated. 

Goals for this are to improve strength and restore normal pain-free movement. 

 

Rotator Cuff Repair Physical Therapy: 3-6 months

During this phase, motion should be full and maintained. There should be minimal to no pain with all exercises performed during this phase. More intensive self stretching will be performed in order to ensure full ROM throughout the shoulder joint and the surrounding muscles. 

Weight is increased with all movements and strengthening is progressed into more complex movement patterns to simulate functional activities. Strengthening will be performed using the full range of motion throughout the shoulder joint. Weight bearing exercises, like push-ups, will be initiated and progressed to promote improved stability and strength throughout the shoulder joint. 

 

Sports Rehabilitation For Rotator Cuff Repair Physical Therapy: Months 6+

Exercises and activities will be progressed to return the patient to sport and high level activities. Your provider can help to break down complicated tasks, like throwing, to practice each component independently to ensure proper form and function throughout the shoulder complex. This is essential to ensure proper reintegration into sport to reduce the risk for re-injury.

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