Physical Therapy Protocols

Rotator Cuff Repair Rehab Protocol

Early active-motion pathway — therapist reference

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Approach

This is an early active-motion pathway. Progression is guided by comfort and pain — do not progress beyond pain. Aggressiveness should be individualized to tear size and tissue quality per surgeon; larger or massive repairs may warrant a more protected, delayed-motion course.

Phase 1 · Weeks 0–4 (Early Motion)

Days 0–7:

  • Abduction sling: may remove once the block wears off and the patient is comfortable; adjust to pain.
  • Begin active ROM when comfortable — progress slowly, not beyond pain. Pendulums.
  • Scapular isometrics; cryotherapy regularly for pain/swelling. Office visit ~2 weeks.

Days 7–28:

  • Sling not required (per comfort/preference). Continue active ROM as comfortable; pendulums; scapular isometrics.

Phase 2 · Weeks 4–6 (Full Passive ROM)

  • No sling. Goal: full passive ROM by 4–6 weeks.
  • Pendulums; end-range stretch (ER, IR, elevation); progressive PROM; supine flexion/IR/ER (adduction and behind-back).
  • Pulley (AAROM); prone rowing to neutral (AROM); aquatherapy for light AROM; gentle scapular/glenohumeral mobilizations.
  • May use heat before ROM; continue cryotherapy as needed.

Phase 3 · Weeks 6–12 (Active Motion & Strengthening)

  • Weeks 6–8: continue PROM/AAROM; AROM flexion in the scapular plane, abduction, ER, IR; rotator cuff isometrics; periscapular exercises.
  • Weeks 9–11: add dynamic stabilization; begin resistive work — Theraband ER/IR, side-lying ER, lateral raises, full can in the scapular plane (no empty-can), prone rowing/horizontal abduction/extension, elbow flexion/extension.
  • Weeks 12–13: continue; initiate light functional activities as permitted.

Phase 4 · Weeks 14+ (Advanced Strengthening & Return)

  • Week 14: progress to fundamental shoulder strengthening.
  • Week 16: continue ROM and self-capsular stretching; progress strengthening; advance proprioception/neuromuscular training. Return to light sport-specific activity (e.g., golf chipping/putting) if doing well.
  • Week 20: maintenance strengthening and stretching; may resume all activities as tolerated.

References

  • Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large tears): a meta-analysis of RCTs. BMC Musculoskeletal Disorders, 2023.
  • Rehabilitation after Rotator Cuff Repair. PMC.
Questions about this protocol? Call the clinic where the surgery was performed — Dr. Allred is happy to talk through the plan.