Rotator Cuff Repairs

Phase 1: Immediate Post-Operative Phase (Weeks 0–6)

Goals:

• Protect the surgical repair (often in a sling).
• Minimize pain/swelling.
• Initiate passive motion to prevent stiffness.

Exercises & Interventions:

• Pendulum exercises (gentle swinging motions).
• Passive range of motion (PROM): Therapist-assisted shoulder flexion/abduction (avoid external rotation initially).
• Scapular squeezes to activate stabilizing muscles.
• Elbow/wrist/hand exercises to maintain circulation.
• Modalities: Ice, compression, and elevation for swelling.

Precautions:

• No active shoulder movement or heavy lifting.
• Avoid reaching behind the back or excessive stretching.

Phase 2: Early Rehabilitation (Weeks 6–12)

Goals:

• Restore active-assisted range of motion (AAROM).
• Begin gentle strengthening.

Exercises:

• AAROM with tools: Use a wand or pulley for flexion/abduction.
• Isometric exercises: Sub-maximal contractions for rotator cuff muscles (e.g., pressing hand into a wall).
• Active motion: Gradually introduce pain-free shoulder movements (e.g., scapular retraction/protraction).
• Light resistance: Therabands for internal/external rotation (start at 0° abduction).

Precautions:

• Avoid combined abduction/external rotation (e.g., throwing).
• Progress only if pain-free.

Phase 3: Intermediate Strengthening (Weeks 12–16)

Goals:

• Improve strength and dynamic stability.
• Restore full active range of motion (AROM).

Exercises:

• Strengthening: Resistance bands for rows, shoulder presses, and rotator cuff exercises.
• Scapular stabilization: Prone Y/T/W raises, wall push-ups.
• Proprioception: Ball rolls on a wall, closed-chain exercises.
• Stretching: Posterior capsule stretches (sleeper stretch) if stiff.

Phase 4: Advanced Strengthening & Functional Training (Months 4–6)

Goals:

• Restore power and endurance.
• Prepare for sport/activity-specific demands.

Exercises:

• Dynamic strengthening: Overhead presses, resisted diagonal patterns.
• Plyometrics: Medicine ball throws, wall dribbles.
• Sport-specific drills: Gradual reintroduction to throwing, swimming, or lifting.
• Eccentric training: Slow lowering of weights to build tendon resilience.

Criteria for Return to Sport:

• Full pain-free AROM.
• Strength ≥80% of the uninjured side (tested manually or via dynamometer).