Rehab for your Rotator Cuff
December 13, 2022
Shoulders are such an important part of our daily function. Without them, we wouldn’t be able to eat, drive, write, dress—complete any activity involving our arms! What helps the shoulder act as a key player in the majority of our daily activities is the rotator cuff. The rotator cuff is a term used to describe a group of four muscles within the shoulder that work together to move the joint in all different directions. Because the shoulder is a ball-and-socket joint, the movability is much greater than most other joints in the body, and thus requires more coordination between muscles. With the rotator cuff making up nearly half the muscles of the shoulder joint, you can about imagine the amount of wear-and-tear these muscles experience over the years. With this wearing-down of tissue comes injury, and even surgery. According to IData Research, over 400,000 rotator cuff repairs are completed each year in the United States. But how do you know if you need surgery? And what does the recovery process look like?
The decision for rotator cuff repair surgery always depends on a couple factors. The size of the tear is the first consideration. The only way to know the amount of damage in the shoulder joint is imaging from a doctor’s office or hospital. An MRI will be able to show a clear picture of the tendons and muscles, defining the degree of tear in the shoulder. A partial-thickness tear describes a tear within a rotator cuff tendon that does not cut all the way through the tendon. Some partial-thickness tears require surgical intervention, but some patients are able to continue functioning without surgery. Full-thickness tears describe those that do happen to cut all the way through the tendon. In this case, patients almost always require surgery in order for the arm to be functional again.
The second consideration is the severity of symptoms with the injury. Some patients, despite the grade of tear, can press on and continue about their daily activities without too much pain or dysfunction. With more conservative treatment methods, they may be able to return nearly to their prior level of function. Others presenting with damage to the rotator cuff tendons may lose quite a bit of motion and experience pain that is difficult to manage. Excess pain makes it hard to move a joint, and a greater loss of motion is a possibility. In this instance, it is likely surgery will be the best option. Despite progress that can be made in therapy as far as pain management and range of motion, it isn’t always enough to justify bypassing surgery.
If you and your doctor decide to proceed with surgery, you will be expected to complete physical therapy in order to fully heal. A typical protocol for a rotator cuff repair consists of about 14 weeks of gradual exercise progressions. Immediately after surgery, the doctor will place you in a sling that positions your shoulder in optimal position for proper healing. You can expect to wear the sling for the initial phase of the recovery process (approximately 6 weeks). This initial phase places a sole focus on passive range of motion. This means the therapist stretches your shoulder for you. You will be discouraged to complete any sort of movement with the shoulder on your own as that will strain the repair sight and put you at risk for re-tear.
Once the passive motion has improved and you are at least 7 weeks post-op, the active motion then comes into play. This means you are able to move the arm on your own, without therapist assistance. This is when we work on the quality of movement, decreasing any compensatory patterns that may develop as a result of weakness in the shoulder. Strengthening typically begins within this phase as well. Light resistance bands and dumbbells are used to initiate strength within all muscles in the arm that have been affected. Progressing the strength will depend on the rate of healing, the quality of movement, and the muscle response to the new routine.
In an average case, you can expect to be close to your prior level of function after 12-14 weeks of rehab. However, in order for tissues and joints to fully heal from a traumatic event, such as a surgery, time is needed. It is said that true, full healing will take up to one year. For this reason, it is pertinent to keep stretching and exercising even after you’ve finished your bout in physical therapy.
If you aren’t sure whether or not surgery is in your future, discuss your options with your doctor and local physical therapist. They will be able to accurately diagnose the grade of injury and determine the appropriate interventions for your specific injury. In any case, therapy is always a beneficial route to take. Your therapist will be able to create a plan of care based on how you present and help get you on the right track. Whether you are trying to avoid surgery, have decided you need surgery, or are just coming out of surgery, therapy can prepare you for that next step.