Overview of Rotator Cuff Rehab with Dr. Catherine Logan

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.