Rotator Cuff Repair Rehabilitation Guide

Understanding Your Rotator Cuff Repair

The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that work together to center and stabilize the shoulder joint. Think of them as the fine-tuning mechanism for your arm—they coordinate movement and keep the ball of your upper arm centered in the socket of your shoulder blade.

When these tendons tear, the shoulder becomes weak and painful. Lifting your arm, reaching behind your back, sleeping comfortably—all become difficult. Rotator cuff repair reattaches the torn tendon to bone using sutures and anchors. But surgery is just the beginning. The healing tendon is fragile, and how you rehabilitate determines your final outcome.

Tendon healing follows a predictable biological timeline. Inflammatory phase (days 1-7): bleeding and swelling bring healing cells. Proliferative phase (weeks 2-6): new collagen forms but is weak and disorganized. Remodeling phase (weeks 6-12+): collagen organizes and strengthens. This timeline dictates rehabilitation—too aggressive and the repair fails; too conservative and stiffness becomes permanent. The balance is delicate.

Recovery Timeline Overview

Rotator cuff rehabilitation follows a carefully sequenced progression that protects the healing tendon while preventing stiffness:

Week 0-6: Protection Phase

The tendon is healing to bone. This is the most critical period—your activity determines whether the repair succeeds or fails.

Daily Milestones

Essential Exercises (Weeks 0-6)

Pendulum Exercises (Codman's):

• Lean forward, let surgical arm hang relaxed
• Use body movement to gently swing arm
• Small circles, forward-back, side-to-side movements
• NO active shoulder muscle contraction
• 2-3 minutes, 3-4 times daily

Passive Forward Elevation:

• Lie on back, surgical arm at side
• Use non-surgical hand or stick to lift surgical arm overhead
• Keep surgical arm completely relaxed
• Progress toward 90-120° elevation by week 6
• Hold at end range 30 seconds, relax
• 2 sets of 10 reps, 2 times daily

Passive External Rotation:

• Lie on non-surgical side
• Surgical arm at side, elbow bent 90°
• Use stick or non-surgical hand to rotate forearm away
• Keep surgical arm relaxed
• Hold 30 seconds, relax
• 3 sets, 3 times daily

Scapular Squeezes:

• Stand or sit with good posture
• Squeeze shoulder blades together and down
• Hold 5 seconds, relax completely
• 10-15 reps, 3 times daily

Elbow and Hand Exercises:

• Elbow bends: touch shoulder with hand, 10 reps
• Wrist circles: 10 each direction
• Grip squeezes: hold 5 seconds, 10 reps
• 3 times daily

Week 6-12: Protected Motion Phase

The tendon has begun to incorporate. You can start active-assisted motion, gradually progressing to active motion.

Motion Progression

Key Exercises (Weeks 6-12)

Active-Assisted Forward Elevation:

• Lie on back (gravity eliminated)
• Use non-surgical hand to support surgical arm
• Gently lift both arms overhead
• Surgical arm does 50% of work, non-surgical provides 50%
• Progress as surgical arm takes more of the load
• 2 sets of 10-15 reps, 2 times daily

Active-Assisted External Rotation:

• Stand with surgical arm at side, elbow bent 90°
• Use stick held in both hands
• Non-surgical arm pushes stick, rotating surgical arm outward
• Surgical arm stays relaxed
• Progress to surgical arm actively pushing against stick resistance
• 2 sets of 10-15 reps, 2 times daily

Table Slides for forward elevation:

• Sit at table with small towel under surgical arm
• Lean forward, allowing arm to slide forward on table
• Use body weight to gently push arm into elevation
• Excellent for achieving full overhead reach
• 2 sets of 10 reps, 2 times daily

Wall Walks for elevation:

• Stand facing wall, fingers of surgical arm on wall at waist level
• Walk fingers up wall, allowing arm to elevate
• Go as high as comfortable
• Walk fingers back down
• 2 sets of 5-10 reps, 2 times daily

Active Scapular Exercises:

• Scapular retraction: squeeze blades together
• Scapular protraction: reach arms forward, round shoulders
• Scapular elevation: shrug shoulders toward ears
• Scapular depression: pull shoulders down away from ears
• 10-15 reps each, 2 times daily

Week 12-16: Strengthening Phase

Now that tendon has healed and motion is restored, focus shifts to strengthening. But remember: the repaired tendon is permanently weaker than the original.

Strengthening Exercises (Weeks 12-16)

Isometric External Rotation:

• Stand in doorway, surgical arm at side, elbow bent 90°
• Press back of wrist into doorframe
• Hold 5 seconds, relax
• 10 reps, 3 times daily

Isometric Internal Rotation:

• Stand in doorway, surgical arm at side, elbow bent 90°
• Press palm into doorframe
• Hold 5 seconds, relax
• 10 reps, 3 times daily

Scaption (45° elevation):

• Stand with light dumbbells (1-2 lb)
• Raise arms in scapular plane (30° forward of side)
• Raise to 90°, lower slowly
• 2 sets of 12-15 reps, 3 times weekly

External Rotation at 90° abduction:

• Lie on side, surgical arm up
• Abduct arm 90°, elbow bent 90°
• Rotate forearm upward (like stop sign)
• Use light dumbbell or resistance band
• 2 sets of 12-15 reps, 3 times weekly

Horizontal Abduction:

• Lie on stomach, surgical arm hanging off edge
• Lift arm out to side (horizontal abduction)
• Keep thumb pointed up (full can position)
• 2 sets of 12-15 reps, 3 times weekly

Month 4-6: Advanced Strengthening

Progressive resistance and functional movements prepare you for return to activity.

Progressive Resistance:

• Increase resistance band weight as able
• Progress dumbbell weight gradually
• Never exceed 8-10 lb for rotator cuff exercises
• 3 sets of 12-15 reps, 3 times weekly

Functional Exercises:

• Wall ball tosses (light ball, short distance)
• Resistance band diagonals (D2 pattern)
• Push-up progressions (wall → counter → floor)
• Planks and side planks

Overhead Progression (after month 5):

• Overhead reaches against wall
• Overhead press with light weights (3-5 lb max)
• Avoid heavy overhead lifting permanently

Month 6+: Return to Activity

Full return to activities, with some permanent modifications.

Return to Work Timeline

Desk job: 2-4 weeks (typing with one hand initially)

Light duty: 6-8 weeks (light lifting ＜5 lbs, no overhead)

Medium duty: 3-4 months (lifting 10-15 lbs, occasional overhead)

Heavy manual labor: 4-6 months (may have permanent restrictions)

Overhead athletes: 6-9 months (throwing program, sport-specific training)

Return to Sports Timeline

Non-overhead sports (running, cycling): 3-4 months

Overhead sports (tennis, volleyball, swimming): 6-9 months

Throwing sports (baseball, softball): 9-12 months

Throwing athletes require dedicated progression program:

• Month 6: Beginning throwing program (30 feet)
• Month 7-8: Progress distance and intensity
• Month 9: Mound work for pitchers, sport-specific drills
• Month 9-12: Return to competition

Warning Signs: When to Seek Help

Long-Term Protection and Maintenance

Your repaired rotator cuff needs lifelong care:

Permanent Activity Modifications:

• Avoid heavy lifting (＞10-15 lbs repeatedly)
• Avoid prolonged overhead work
• Avoid behind-the-back lifting
• Avoid extreme ranges of motion
• Use proper mechanics for all activities

Maintenance Exercises (lifelong):

• Rotator cuff strengthening 2-3 times weekly
• Scapular strengthening 2-3 times weekly
• Stretching to maintain motion
• Warm up before activities

Activity Pacing:

• Take breaks during repetitive activities
• Avoid fatigue that compromises form
• Listen to your shoulder—pain means stop

Body Mechanics:

• Keep work at waist level when possible
• Use step stool instead of reaching overhead
• Slide objects instead of lifting
• Use both hands for heavier objects

Factors Affecting Outcome

Common Questions

References