Rotator Cuff Repair Physical Therapy Protocol

Rehabilitation after arthroscopic rotator cuff repair must balance tendon healing with restoration of shoulder motion, strength, and long-term function.

This protocol is a general guide. Therapy may be adjusted based on tear size, tissue quality, repair strength, stiffness risk, and individual recovery.

Phase 1: Protection Phase — 0 to 6 Weeks

• Sling use as instructed
• Hand, wrist, and elbow motion encouraged
• Pendulum exercises
• Passive shoulder motion as directed
• No active lifting with the operative arm
• No strengthening
• Avoid sudden reaching, pushing, pulling, or lifting

The goal is to protect the tendon repair while minimizing unnecessary stiffness.

Phase 2: Motion Restoration — 6 to 12 Weeks

• Progress passive range of motion
• Begin assisted shoulder motion
• Progress toward active motion when appropriate
• Begin scapular stabilization
• Avoid heavy lifting or sudden loading

Large tears, revision repairs, and poor tissue quality may require slower progression.

Phase 3: Strengthening — 12 to 20 Weeks

• Begin progressive rotator cuff strengthening
• Scapular strengthening
• Resistance band exercises
• Endurance training
• Functional strengthening

Strengthening should progress gradually to avoid overload of healing tissue.

Phase 4: Return to Activity — 5 to 9 Months

• Progressive return to golf, tennis, and recreational activity
• Gradual return to weight training
• Sport-specific rehabilitation when needed
• Work-specific strengthening when appropriate

Recovery after rotator cuff repair continues for many months as the tendon heals and shoulder strength improves.