What You Need to Know About PT for Rotator Cuff Surgery

Healthy rotator cuffs enable you to lift and rotate your arms and reach in various directions, necessary movements for performing even the most basic daily tasks. A partial or complete tear in one or more of your rotator cuff muscles can significantly impair strength and movement in the affected shoulder joint.

Experts estimate that 500,000-600,000 rotator cuff surgeries are performed annually in the United States and expect the numbers to increase. Although rotator cuff tears occur most often in older adults, overuse tears caused by sports activity or overhead work also occur in younger people. Most rotator cuff tears in young adults are caused by a traumatic injury, like a fall.

What is the Rotator Cuff?

The rotator cuff is a ball-and-socket joint made up of four muscles and strong bands of tendons that stabilize the shoulder joint, keeping the upper arm bone in its socket and allowing the shoulder to rotate through its range of motion.

Rotator cuff muscles include:

• Supraspinatus – keeps humerus in place, stabilizes upper arm, and helps lift your arm
• Infraspinatus – allows you to rotate your arm in the socket and extend your shoulder
• Teres minor – helps rotate your arm away from your body
• Subscapularis – holds your upper arm bone to your shoulder blade and helps you rotate your arm out from your body, hold it straight out and lower it

Although tears can happen in any muscle tendon, they occur most often in the supraspinatus tendon. A complete tear is a full thickness tear that separates the tendon from the bone. A partial tear is when one or more rotator cuff tendons are frayed or partly torn, so the tendon is damaged but has not been entirely torn from the bone.

What Causes Rotator Cuff Tears?

A fall or other traumatic injury to the shoulder, degeneration due to aging, or overuse caused by repetitive motions are often the cause of a rotator cuff injury. Most rotator cuff tears occur in people aged 40 and older, resulting from the normal wear and tear that goes along with aging.

The most common causes of rotator cuff injuries include:

• Repetitive stress injuries to the shoulder may occur if you continuously perform the same shoulder movements. The motions used in tennis, baseball pitching, weightlifting, volleyball, or other activities that require continual overhead movements can damage muscles and tendons.
• A lessening of your blood supply may naturally occur as you age. Insufficient blood supply to the shoulder joint increases the risk of a tear.
• Bone spurs are hard bumps of extra bone that develop on the edge of a bone. It is not uncommon for bone spurs to develop under the highest point of the shoulder, especially as you age, which may rub on the rotator cuff tendon when you lift your arm. The rubbing motion may fray and weaken the tendon making it more vulnerable to a tear.

Do I Need Surgery for My Rotator Cuff Injury?

A partially torn rotator cuff does not usually require surgery. Your doctor may prescribe ice packs, medication, and physical therapy. A physical therapist will teach you exercises to reduce stiffness and improve range of motion and use other modalities to reduce pain and inflammation.

If you have a medium to severe partial or complete tear, your doctor may recommend surgery to restore function, improve flexibility and range of motion, and relieve pain.

While the standard of care is for physical therapy following rotator cuff surgery, some experts also recommend physical therapy before surgery. Called prehabilitation or prehab, physical therapy before the procedure can help you prepare physically and mentally for your surgery and may result in a shorter hospital stay and faster recovery.

A study recently published in the Journal of Physical Therapy Science found a physical therapy rehab program before rotator cuff surgery may improve pain, posture, joint mobility, muscle strength, and function to the point where surgery can be deferred or avoided. Other studies found similar results.

What Can I Expect From Physical Therapy for Rotator Cuff Surgery?

After a thorough evaluation, your physical therapist will design a program to fit your specific needs. Typically, physical therapy after rotator cuff surgery includes the following goals:

• Reduce swelling, stiffness, and pain
• Improve flexibility and range of motion
• Increase strength in muscles that support the shoulder
• Improve circulation
• Strengthen core muscles to improve gait, balance, and stability
• Reduce scar tissue

Your physical therapist will also work with you on proper lifting and carrying techniques, posture, and other ways to reduce your risk of re-injury and a home exercise program to supplement your clinic work.

Physical therapy after shoulder surgery often progresses through several stages:

Passive motion

Your physical therapist moves your shoulder without your assistance. They also apply cold therapy or other modalities to reduce pain and swelling. This phase may last about six weeks, during which you should avoid reaching, pulling, or raising your affected arm and lifting or carrying heavy objects.

Active motion without resistance

During this phase, you move your arms independently but do not use added resistance like weights or resistance bands. This phase may last another six weeks.

Active motion with resistance

At this point, your physical therapist will add stretching, weights, and resistance bands to your exercise routine so you can begin strengthening your shoulder, neck, and upper back muscles.

Full recovery can take as long as eight or nine months, depending on the extent of your injury and how successful the surgical repair was. However, if you commit to your physical therapy program, both in-clinic and at home, you may enjoy a successful recovery much more quickly.

The compassionate, skilled team at Athletic Physical Therapy understands how frustrating it is to have a shoulder incapacitated. Trying to perform daily tasks may be literally beyond your reach.

Our proprietary physical therapy program, the Active Rehabilitation Continuum (ARC), speeds healing and fully rehabilitates shoulder injuries quickly and safely, getting you back to the active life you deserve.