– 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:
Using computer or reading
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.
– NO RESISTANCE EXERCISES TO THE ROTATOR CUFF
– 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
o AAROM and AROM
– 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
– Continue AROM with COMBINED MOTIONS
– 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.