Rotator Cuff Exercises: When to Start

Exercise Timeline by Treatment Type

Conservative (Non-Surgical) Treatment

For partial tears, tendinitis, or impingement:

• Week 1-2: Pendulum exercises, passive ROM, pain management
• Week 2-4: Active-assisted ROM, gentle stretching, scapular stabilization
• Week 4-8: Progressive strengthening with resistance bands
• Week 8-12: Overhead activities, functional movements

Post-Surgical Repair (Small-Medium Tear)

Standard protocol for rotator cuff repair:

• Weeks 0-6: Passive ROM only (PT or other person moves arm), sling immobilization
• Weeks 6-8: Active-assisted ROM, begin using arm to assist movement
• Weeks 8-12: Active ROM without resistance, start gentle strengthening
• Weeks 12-16: Progressive resistance exercises, functional training
• Months 4-6: Return to full activities if cleared

Large or Massive Tear Repair

• Extended protection: 8-12 weeks passive ROM only
• Delayed strengthening: No resistance until 16+ weeks
• Recovery timeline: 6-12 months for full healing

Rehabilitation Phases

Phase 1: Passive Motion (Post-Op Weeks 0-6)

Goals: Protect repair, prevent stiffness

• Pendulum exercises: Gentle circular motions, arm relaxed
• Supine passive flexion: Therapist or opposite arm lifts surgical arm
• Passive external rotation: Using stick or strap
• Critical rule: DO NOT actively contract rotator cuff muscles
• Frequency: 4-5 times daily, 10-15 reps each

Phase 2: Active-Assisted (Weeks 6-8)

Goals: Begin muscle activation, continue ROM gains

• Pulley exercises: Assisted elevation
• Active-assisted forward flexion: Using opposite arm for help
• Cane/wand exercises: For rotation movements
• Scapular exercises: Rows, retraction without arm elevation

Phase 3: Active Motion (Weeks 8-12)

Goals: Independent arm movement, light strengthening

• Active ROM: Lift arm without assistance to tolerance
• Isometric exercises: Gentle resistance without movement
• Light resistance bands: External/internal rotation with elbow at side
• Wall slides: Gradually increasing height

Phase 4: Strengthening (Weeks 12-16+)

Goals: Build strength, return to function

• Progressive resistance: Increase band tension or light weights
• Functional exercises: Reaching, lifting, carrying
• Sport-specific training: If applicable, overhead activities
• Goal strength: 80-90% of uninjured shoulder

Stop Exercises and Contact Surgeon If:

• Sharp, sudden pain during exercise (may indicate re-tear)
• Significant increase in pain lasting beyond exercise session
• New inability to move arm that was previously possible
• Fever or wound drainage (infection signs)
• Excessive swelling or warmth in shoulder

Keys to Successful Recovery

• Follow protocol strictly: Premature strengthening causes 20-30% re-tear rate
• Consistency over intensity: Multiple short sessions better than one long session
• Pain as guide: Mild discomfort OK, sharp pain is stop signal
• Sleep positioning: Avoid sleeping on surgical shoulder for 6+ weeks
• Sling compliance: Wear as directed, typically 4-6 weeks
• PT attendance: Regular sessions crucial for monitoring progress
• Patience: Full recovery takes 4-6 months minimum

Clinical Pearl: The most common cause of failed rotator cuff repair is patients starting active exercises too early.