Rotator Cuff Repair Rehab Protocol

Early active-motion pathway — therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 6 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

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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 sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.