- Deana McNeeley, PT, DPT practices in our Fairfax Clinic.
So you need to have a rotator cuff repair?
You’re not alone. This is a fairly common procedure, and once you announce that you’re having it done, you’ll find neighbors, family members, and perfect strangers who have had it done and are happy to share their experiences with you. Following is some general information about what to expect from physical therapy after a rotator cuff repair. Please remember that all rotator cuff repairs are different.
The rotator cuff is made up of 4 muscles (the supraspinatus, infraspinatus, teres minor, and subscapularis). Your rehab will differ based on which muscle is being repaired. Sometimes people tear more than one. Sometimes people have a biceps tendon tear or labral tear at the same time. There are little tears (partial thickness tears) and big tears (full thickness tears). And many surgeons have different timelines for the rehabilitation of their patients based on their own preferences and surgical techniques. That is something that you should discuss with your physician before surgery to help guide your expectations.
This is a general guideline to help you in prepare for your surgery, and to give you an idea of what to expect from physical therapy.
Most patients start physical therapy after a rotator cuff repair within a few weeks.
In the beginning, your shoulder will be sore, so it’s best to keep up with your pain medication as prescribed by your surgeon.
Many patients have difficulty finding a comfortable sleeping position at first, and find that sleeping in a recliner, or propped up on lots of pillows, can be more comfortable. Most patients sleep in their sling for at least a while.
Depending on your physician’s protocol, you will also be limited in your driving at first, especially if you drive a standard transmission car. You may want to arrange alternate transportation to and from your physical therapy appointments (and work, school, etc).
Realize that for the first month or so, simple daily tasks like dressing, bathing, cooking, etc., will be limited to the use of one arm. It’s a good idea to either line up help or allow for extra time to complete these tasks.
Generally, patients are allowed only passive range of motion (PROM) of the shoulder for the first 2 to 6 weeks after surgery. That means you’ll be allowed to do stretches as instructed by your surgeon or physical therapist, but you won’t be allowed to actively move your arm away from your body, behind your back, etc.
You won’t be allowed to lift anything for the first 6 to 12 weeks.
Many people can return to a computer/desk job within a few weeks, with some modifications at their desk to allow for easier typing.
You WILL be allowed to perform active range of motion at your elbow, wrist, and hand, and lift light objects (like a coffee cup, fork, etc.) as long as you keep your upper arm by your side and move only through your elbow, wrist, and hand.
You will be instructed in isometric exercises where you contract the muscles by pushing against something, without moving the arm. This will begin around 3 weeks after surgery.
You will be instructed in active assistive range of motion (AAROM) exercises, which involve moving your arm with some assistance from your other arm. These often begin around 2 to 3 weeks after surgery.
While this seems like a lot of limitations, after the first 4 to 6 weeks, many patients are allowed to begin active range of motion (moving the arm away from the body), and then resistance after 6 to 12 weeks (exercises in the form of dumbbells, resistive bands, etc). After the 6-week mark, patients tend to feel like they are making more progress. They are able to do more things and start to regain their normal lifestyle
4 to 12 weeks
You will begin active range of motion (AROM) exercises around 5 to 6 weeks after surgery. This is when you lift the weight of your arm against gravity, but no additional weight.
Around 7 to 8 weeks most patients begin strengthening exercises using weights or resisted bands.
12 weeks and beyond
For those of you that are athletically inclined, most patients who have rotator cuff repairs are able to return to sports and recreational activities within 4 to 6 months after surgery. For patients with more involved repairs, or more athletic goals, this can take a little longer.
After your initial evaluation appointment, your follow-up appointments will consist of 25 to 30 minutes of hands-on time with your therapist as well as time performing supervised exercise (this time is minimal in the initial phase, but will increase to 30 minutes or more by the end of your therapy). In the beginning, your therapist will focus hands- on time stretching your shoulder and possibly other manual therapy techniques, such as joint or soft tissue mobilization. As time passes, and you begin to progress, your therapist will perform manual strengthening exercises with you and will provide functional training to get you back to your activities of daily living or work-related activities. Sport specific training will be initiated when appropriate. Exercises done in our clinic are always supervised by physical therapy aides, and your therapist will always be on site. Your sessions may include the application of therapeutic modalities including ice, ultrasound, electrical stimulation, etc. Most patients spend between an hour and an hour and a half at their physical therapy appointments. If possible, please wear or bring a sleeveless or short-sleeved shirt for all of your appointments. All of our facilities have a place for you to change if you need to.
Your physical therapist is an excellent resource for you to get information about what you can do and when you can do it. We send regular updates to your surgeon, and can always get extra information from him or her if necessary. We will make every attempt to make your rehabilitation as pain-free as we can, and get you back to your regular activities as quickly and safely as possible. Please remember that all of the information in this article is a generalization, and your physical therapist will tailor your rehabilitation to your specific injury, surgery, limitations, and goals. With some hard work and time, you’ll be back to playing golf (or tennis, or swimming, or playing the piano, gardening, or whatever your favorite activity is) before you know it!