PHYSICAL THERAPY PROTOCOL
Rotator Cuff Repair
Physical Therapy Protocol
Rehabilitation after rotator cuff repair must protect tendon healing while gradually restoring motion, strength, and function. This protocol provides a general framework and may be modified based on tear size, tissue quality, repair strength, stiffness risk, and associated procedures.
Protect Repair
Restore Motion
Begin Strengthening
Durable Tendon Healing
Important Note
This protocol is a general guideline. The surgeon’s specific postoperative instructions always take priority. Larger tears, revision repairs, poor tissue quality, subscapularis repair, biceps tenodesis, stiffness risk, or other associated procedures may require modification.
Rehabilitation Philosophy
Rotator cuff repair requires protection while the tendon heals back to bone. Pain often improves before the tendon is biologically healed, so rehabilitation must progress deliberately. The goal is not simply fast motion — the goal is a shoulder that heals reliably and functions well long term.
Phase I: Protection Phase
Timeframe: 0–6 weeks
Goals
- Protect the repair
- Control pain and swelling
- Maintain elbow, wrist, and hand motion
- Begin safe passive shoulder motion
- Avoid stress on the repaired tendon
Sling
- Sling worn full time unless otherwise instructed
- Remove for hygiene and exercises only
- Sleep in sling
- No active shoulder lifting
- No lifting, pushing, pulling, or supporting body weight
Exercises
- Pendulums
- Elbow range of motion
- Wrist and hand motion
- Grip strengthening
- Scapular retraction and depression
- Gentle passive shoulder motion as instructed
Phase II: Early Motion Phase
Timeframe: 6–12 weeks
Goals
- Discontinue sling when cleared
- Restore passive range of motion
- Begin active-assisted motion
- Progress to active motion
- Normalize scapular mechanics
Exercises
- Table slides
- Pulleys
- Cane-assisted motion
- Supine active-assisted elevation
- Gentle posterior capsule stretching
- Scapular stabilization
Avoid During This Phase
- Heavy lifting
- Sudden jerking motions
- Strengthening before clearance
- Overhead resistance
- Painful aggressive stretching
Phase III: Strengthening Phase
Timeframe: 12–18 weeks
Goals
- Restore full functional motion
- Begin gradual strengthening
- Improve endurance
- Restore dynamic shoulder stability
- Improve quality of movement
Exercises
- Theraband rotator cuff strengthening
- Light dumbbell strengthening
- Deltoid strengthening
- Scapular strengthening
- Closed-chain stabilization
- Proprioception exercises
Phase IV: Advanced Strengthening
Timeframe: 18–24+ weeks
Strength
Progress resistance gradually while maintaining excellent mechanics.
Function
Advance toward work-specific, sport-specific, and recreation-specific activities.
Endurance
Build tolerance for repetitive shoulder use without pain or compensation.
Return To Activity Guidelines
Desk Work
Often 1–2 weeks, depending on pain control and sling needs.
Driving
Usually after sling discontinuation and when safe control of the vehicle is possible.
Light Daily Use
Typically begins gradually after sling discontinuation.
Golf
Putting around 8 weeks, chipping around 10–12 weeks, full swing often 4–6 months.
Weight Training
Light strengthening begins around 3 months. Heavy lifting usually waits until approximately 6 months.
Throwing Sports
Usually 6–9 months depending on strength, healing, and sport demands.
Therapist Notes
- Protect the repair during the first 6 weeks.
- Prioritize tendon healing over rapid strengthening.
- Restore passive motion before aggressive strengthening.
- Monitor stiffness, but avoid excessive early stress on the repair.
- Emphasize scapular mechanics throughout rehabilitation.
- Progress based on tissue healing, not pain improvement alone.
- Contact the office if progress deviates significantly from expectations.
Red Flags
Contact The Office For
- Fever
- Increasing redness
- Drainage from incision
- Sudden increase in pain
- Sudden loss of shoulder function
Seek Urgent Care For
- Chest pain
- Shortness of breath
- Calf pain or significant leg swelling
- Severe uncontrolled pain
Related Resources
Questions About Rotator Cuff Repair Rehabilitation?
Rehabilitation must be individualized to the repair, tissue quality, healing biology, and patient goals. This protocol provides a structured framework for safe recovery.
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