Rotator Cuff [Shoulder]

General Guidelines:

– Maintain surgical motion early, but don’t push it.

– Protect the repair (know what muscles were involved)

– Strengthen the repair only when it regains adequate strength to tolerate strengthening, usually 4 ½ months.

– Strengthen the surrounding musculature.

– Alternate between pool and land therapy.

– Minimize heavy, excessive cyclic loads for the first 6 months.

– No resistive exercise or therabands should be used to strengthen the repaired rotator cuff muscle until 4 ½ months

– No resistive cuff exercises EVER for Massive tears This is a gradual progression, not a stepped progression

Outpatient Rehab Phase I 0-3 weeks post op


o Wear for 6 weeks except when:

 Performing exercises

 Eating

 Using computer or reading

 Dressing

 Showering

 Most may shower immediately

o Wear at night

– PROM (Performed by Therapist)

o FLEX, ABD, IR and ER

– minimize reps (5), holding for 5-10 seconds.

– No Therpist Manual PROM in Massive tears until 8 weeks

– Pendulums and Codman’s ex’s

– Encourage Towel slides or equivalent

– Pool for PROM.

– General conditioning (stationary bike, treadmill, etc)

– Maintain hand strength

– Maintain normal motion at the elbow/wrist

– For Biceps Tenodesis:

o Use Assistive elbow flexion exercise for first 3 weeks, then may progress to AROM flexion exercises without any weight, 3-6 weeks

o No lifting anything using elbow flexion until 6 weeks

3-6 weeks post op.

– Supine AAROM (* this to begin at 6 wks if pt has massive tear)

o FLEX, ABD, ADD, IR with towel, ER (minimize reps 5-10).

– Pool for PROM and AAROM (water is the assistance)

o Use combined motions and teach fluidity of movement.

o 10 reps with combined movements in pool.

– Light scapular strengthening (i.e. scapular setting, gentle MR scap protraction and retraction).

– Gentle joint mobilization and soft tissue mobilization to restore normal scapular mobility.

– Nerve glides as necessary

Phase II 6-12 weeks

– Continue with PROM.


– More AAROM on land o Progress from SUPINE to SEATED, then to STANDING position.

– At 9 weeks begin AROM on land, against gravity (be more cautious with massive tear).

– Pool – continue


– Can begin pulley work.

– Progress to some light closed-chain proprioceptive ex’s (wall washing) at 9 weeks.

– Arm bike with no resistance.

– Begin jt mobes to restore normal accessory glide motion in shldr girdle if necessary.

Phase III 12-18 weeks post op


– Begin light strengthening

o Begin strengthening for lats, rhomboids, biceps/triceps, pecs, and deltoids.

– Pool – continue

o Use floats and paddles for resistive work in the pool.

– Increase scapular strengthening with theraband and light weights.

– Add more advanced proprioceptive ex specific for work, ADL’s and sport.