How to Achieve the Best Outcome after Rotator Cuff Surgery

It is estimated that nearly 1 of every 4 rotator cuff repairs will re-tear within 6 months of surgery.  Overly aggressive rehabilitation or inappropriate use of the involved arm can increase this risk.  Based on my 15-plus years of experience as a physical therapist, this is the time when patients are tempted to progress themselves too quickly.  Don’t take the chance.  If you want to achieve the best outcome from rotator cuff surgery, perform your rehabilitation under the guidance of your physical therapist.

Rotator cuff tendon healing is considered sufficient to begin gentle strengthening exercises between the 12th and 16th week after surgery.   After restoring range of motion, it is important that resistance is gradually introduced and progressed.  The purpose of this article is to highlight several key exercises which are utilized during the later phases of rehabilitation after rotator cuff surgery.  Your physical therapist will help you develop the best-individualized plan based on your surgery and long-term goals.

Strengthening Exercise after Rotator Cuff Surgery

Strengthening exercises for the rotator cuff is initiated below–chest level with exercises such as internal and external rotation.  During active-assisted arm elevation exercises, it is important that you maintain appropriate exercise form in order to minimize the risk of developing compensations.  A common compensation is to “shrug” the entire shoulder when attempting to raise the arm overhead.  When you can perform a press-up exercise overhead without compensation, you are ready to progress to performing the full-can scaption with a light dumbbell.  The level of resistance is generally kept low (1 to 2 pounds) but may be increased based on your functional demands.

External Rotation in Side-Lying

This exercise is ideal for strengthening two of the rotator cuff muscles, the infraspinatus and teres minor.  Begin lying on the side with the involved arm on top.  The elbow remains bent at 90 degrees throughout the exercise.  Rotate the arm upwards through a full range of motion while keeping the elbow tucked to the side of the body.  Hold the top position for 2 to 3 seconds before slowly lowering back to the starting position.  Typically 2 to 3 sets of 10 to 20 repetitions are performed.

Band Internal Rotation @ 0 Degrees

This exercise is ideal for strengthening the subscapularis muscle of the rotator cuff.  Begin standing with the involved arm closest to where the resistance band is anchored.  The elbow remains bent at 90 degrees throughout the exercise.  Rotate the arm inwards through a full range of motion while keeping the elbow tucked to the side of the body.  Hold the top position for 2 to 3 seconds before slowly returning back to the starting position.  Typically 2 to 3 sets of 10 to 20 repetitions are performed.

Wand-Assisted Flexion in Standing

This exercise is helpful for transitioning back to full overhead reaching activities.  Stand holding a wand or cane in both hands.  The uninvolved arm will assist in elevating the involved arm overhead.  The elbow remains straight with a thumb-up position throughout the exercise.  The thumb-up position increases rotator activation and minimizes the risk for shoulder impingement when the arm is raised.  It is important to slowly control the lowering of the arm using as much of the musculature on the involved side as possible.  Hold the top position for 2 to 3 seconds.  Typically 2 to 3 sets of 10 repetitions are performed.

 Serratus Punch

 This exercise activates the rotator cuff and shoulder blade muscles while incorporating a more functional reaching movement.  Begin with a resistance band anchored behind you.  The hand starts close to the body with the elbow bent.  A punching movement is performed with a slight upwards inclination.  Hold the top position for 2 to 3 seconds before slowly returning back to the starting position.  Typically 2 to 3 sets of 10 to 20 repetitions are performed.

Press-Up in Standing

This exercise is a progression of wand-assisted flexion in standing.  Initially, the exercise is performed without any weight.  As the strength of the rotator cuff improves, 1 to 2 pounds is added to the movement.  In a standing position, start with the hand close to the body with the elbow bent.  A pressing movement is performed overhead.  The elbow straightens as the arm passes overhead.  The top position is held for 2 to 3 seconds before slowly lowering the arm back down to the starting position. Typically 2 to 3 sets of 10 repetitions are performed.   It is important to avoid “shrugging” the shoulder or arching of the low back.

Full-Can Scaption

Once the press-up exercise can be performed properly without compensation, the full-can exercise is added to improve rotator cuff strength.  This exercise specifically targets the supraspinatus muscle which is the most commonly torn tendon of the rotator cuff.  The exercise starts from a standing position with the elbow straight and thumbs pointing up.  The arms are elevated from an angle midway between the front and side of the body.  The top position is held for 2 to 3 seconds before slowly lowering the arm back down to the starting position. Typically 2 to 3 sets of 10 repetitions are performed.   It is important to avoid “shrugging” the shoulder or arching of the low back.

Final Thoughts on Rotator Cuff Surgery Rehabilitation

Rehabilitation after rotator cuff surgery is a slow progression lasting anywhere from 3 to 6 months.  Your physical therapist will be your guide through the process.  You will be safely progressed in the most effective manner based on your own healing capabilities and long-term goalsYour physical therapist will know when to ramp things up and when to slow things down.  In the end, you will feel like a new person.   Contact your physical therapist if you have questions or are ready to get started with your rehabilitation.


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