Overview of Rotator Cuff Rehab with Dr. Catherine Logan
Rehabilitating a rotator cuff tear involves a structured and progressive approach to restore function, strength, and range of motion. Whether the treatment is non-surgical or post-surgical, the goal is to facilitate healing, improve shoulder mechanics, and prevent future injuries.
Here’s a detailed guide to rehabbing a rotator cuff tear:
Non-Surgical Rehabilitation
Phase 1: Acute Phase (First 1-2 Weeks)
- Goals: Reduce pain and inflammation, protect the shoulder, and maintain passive range of motion.
- Rest: Avoid activities that exacerbate pain.
- Ice: Apply ice packs for 15-20 minutes, 3-4 times a day.
- Medications: Use NSAIDs as prescribed to manage pain and inflammation.
- Passive Range of Motion (PROM) Exercises: Gentle exercises performed by a physical therapist or with assistance to maintain joint mobility.
- Pendulum Exercises: Lean forward and let the arm hang down, gently swinging it in small circles.
- Assisted Shoulder Flexion and Abduction: Using the non-affected arm or a pulley system to help move the affected arm.
Phase 2: Intermediate Phase (Weeks 3-6)
- Goals: Restore active range of motion (AROM), begin strengthening exercises, and improve shoulder stability.
- Active-Assisted Range of Motion (AAROM) Exercises: Exercises that transition from passive to active movements.
- Wall Crawls: Use fingers to crawl up a wall, helping lift the arm.
- Stick Exercises: Use a stick or broom handle to help guide the affected arm through its range of motion.
- Active Range of Motion (AROM) Exercises: Begin to move the shoulder independently.
- Arm Lifts: Slowly lift the arm forward and to the side without assistance.
- Strengthening Exercises: Start with isometric exercises and progress to light resistance.
- Isometric Internal and External Rotation: Pressing the hand against a wall or door frame without moving the arm.
- Scapular Stabilization: Shoulder blade squeezes and shrugs.
Phase 3: Advanced Strengthening Phase (Weeks 6-12)
- Goals: Improve strength, endurance, and functional movements.
- Resistance Exercises: Use resistance bands or light weights to strengthen the rotator cuff and surrounding muscles.
- External and Internal Rotations with Bands: Attach the band to a secure object and rotate the arm outward or inward against the resistance.
- Scaption: Raise the arm at a 45-degree angle (between front and side) with a light weight.
- Rows: Using resistance bands or cables to strengthen the upper back and shoulders.
- Functional Training: Incorporate exercises that mimic daily activities or sports-specific movements.
- Overhead Lifts: Gradually progress to lifting objects overhead as strength improves.
Phase 4: Return to Activity Phase (Months 3-6)
- Goals: Restore full strength, range of motion, and function for daily activities and sports.
- Advanced Strengthening: Continue to increase resistance and complexity of exercises.
- Push-Ups: Start with wall push-ups and progress to modified and standard push-ups.
- Lat Pulldowns: Strengthen the back and shoulder muscles.
- Plyometric Exercises: For athletes, incorporate plyometric movements to prepare for sport-specific demands.
- Medicine Ball Throws: Various throws to improve power and coordination.
- Sport-Specific Drills: Tailor exercises to mimic the specific movements and demands of the patient’s sport or activity.
Post-Surgical Rehabilitation
Phase 1: Protection Phase (Weeks 1-4)
- Immobilization: Wear a sling to protect the repair and allow healing.
- Passive Range of Motion (PROM) Exercises: Under the guidance of a physical therapist, passive movements are performed to prevent stiffness.
- Pendulum Exercises: Gentle, passive swinging of the arm.
- Assisted Shoulder Elevation: With assistance, move the arm through a limited range of motion.
Phase 2: Early Strengthening Phase (Weeks 4-8)
- Active-Assisted Range of Motion (AAROM) Exercises: Gradual transition from passive to active-assisted movements.
- Wall Crawls and Stick Exercises: Help move the arm with assistance.
- Isometric Strengthening: Start gentle strengthening exercises.
- Isometric Internal and External Rotation: Press against a stationary object without moving the arm.
Phase 3: Intermediate Strengthening Phase (Weeks 8-12)
- Active Range of Motion (AROM) Exercises: Increase range of motion and begin active movements.
- Arm Lifts: Lift the arm forward and to the side.
- Resistance Exercises: Begin using light resistance bands or weights.
- External and Internal Rotations with Bands: Strengthen the rotator cuff muscles.
- Scapular Stabilization: Shoulder blade squeezes and shrugs.
Phase 4: Advanced Strengthening Phase (Months 3-6)
- Progressive Resistance Training: Increase resistance and incorporate more complex movements.
- Weight Lifting: Gradually increase weights for shoulder exercises.
- Functional Movements: Exercises that mimic daily activities or sports.
- Plyometric and Sport-Specific Drills: For athletes, include plyometric exercises and drills specific to their sport.
Long-Term Maintenance
- Regular Exercise: Continue with a regular exercise program to maintain shoulder strength and flexibility.
- Stretching: Incorporate stretching exercises to maintain flexibility.
- Avoid Overuse: Avoid repetitive overhead activities that can strain the shoulder.
Summary
Rehabilitating a rotator cuff tear requires a progressive approach that includes pain management, range of motion exercises, strengthening, and functional training. Whether the treatment is non-surgical or post-surgical, it’s crucial to follow a structured rehabilitation program and work closely with a healthcare professional or physical therapist. Consistency and gradual progression are key to a successful recovery and return to full function.
Author
Dr. Catherine Logan, MD, MBA
Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.
