Rotator cuff injuries are one of the more common injuries seen at Continuum Wellness Physical Therapy. The severity can range from mild inflammation and irritation from overuse to a full blown tear that requires surgery. Nearly 2 million people each year have rotator cuff pain and ⅓ of them require surgery. One study found that 20.7% of people in their group had complete rotator cuff tears and the prevalence increased with age. Risk factors included: increased age, previous trauma, dominant arm and being male. Once surgery is required, most people are unaware of what to expect after they have the procedure and during their rehabilitation process.
First we need to explain what the rotator cuff is. It is a group of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that attach the shoulder blade to the ball and socket of the shoulder. Their primary responsibility is to stabilize the ball and socket joint. They also assist the shoulder in rotating in and out, hence rotator cuff. Symptoms of a rotator cuff tear include: pain over the top of the shoulder or down the arm, weakness and difficulty raising your arm over your head, loss of range of motion.
Once you have surgery for a torn rotator cuff, it is very important to follow instructions from your surgeon and physical therapist. The surgery site is very vulnerable and any movement or use of the arm not specified by your PT can damage the surgery. You will be required to wear a sling, usually 6-8 weeks, depending on the nature of surgery and severity of your tear as well as the direction of your surgeon. At this time your physical therapist will be performing gentle stretches to your shoulder, help reduce pain and maximize healing.
Once you are out of the sling you are allowed to slowly start moving your arm on your own and your exercises will start to include active and passive range of motion and gentle strengthening until you are discharged.
Here is a typical physical therapy protocol for a rotator cuff repair
Phase I (maximal protection)
This phase lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. During this phase, your arm will be in a sling. You will likely need assistance or need strategies to accomplish everyday tasks such as bathing and dressing. Your physical therapist will teach you gentle range-of-motion and isometric strengthening exercises, will provide hands-on techniques such as gentle massage, will offer advice on reducing your pain, and may use cold compression and electrical stimulation to relieve pain.
Phase II (moderate protection)
This next phase has the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will become more challenging. Exercises will be added to strengthen the “core” muscles of your trunk and shoulder blade (scapula) and “rotator cuff” muscles that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but will still avoid any heavy lifting with your arm. Your physical therapist may use special hands-on mobilization techniques during this phase to help restore your shoulder’s range of motion.
Phase III (return to activity)
This phase has the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will advance the difficulty of your exercises by adding more weight or by having you use more challenging movement patterns. A modified weight-lifting/gym-based program may also be started during this phase.
Phase IV (return to occupation/sport)
This phase will help you return to sports, work, and other higher-level activities. During this phase, your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves, or instruction in raking, shoveling, or housework.
In general, physical therapy for a rotator cuff repair can last up to 6 months. Most people in our clinic report feeling 100% (returning to sport and daily activities with minimal symptoms) after about a year. Once you are discharged from PT, you will be given a home exercise program so you can continue strengthening your shoulder so your likelihood of re-injury is reduced.
The rehab process for a rotator cuff tear is a very long and frustrating process. Most people don’t expect the process to be as painful and demanding as it really is. Another thing most patients don’t realize is how immobile and dependant on friends and family they are for 6-8 weeks after surgery. Be sure to have a good support system of friends and family that will help you with chores, driving, hygiene and other daily activities.
If you think you have symptoms of a rotator cuff injury or even a tear, stop by any Continuum Wellness Physical Therapy for a free screening. We will do a complete screen, free of charge, of your shoulder and help determine what type of injury you may be dealing with. We can give you an exercise program, advise you on self treatment, recommend PT if necessary and help you find the right specialist for a more complete diagnosis.
 (2013). Rotator Cuff – A Nation in Motion. Retrieved January 27, 2016, from http://www.anationinmotion.org/value/rotator-cuff/.
 (2011). Physical Therapist’s Guide to Rotator Cuff Tear. Retrieved January 27, 2016, from http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=95bd746b-b25f-46f5-8373-fb56c9f6b46a.