Rotator cuff surgery involves repairing the group of tendons and muscles that surround the shoulder joint. The single most important element determining the success of this repair is the subsequent rehabilitation process. Starting physical therapy (PT) is a major milestone in recovery, but the precise timing is highly variable and carefully controlled. The timeline for beginning therapy is not a fixed date but rather a calculated decision influenced by several medical factors and protocols.
The Critical Immobilization Period
The time immediately following rotator cuff surgery is dedicated to protecting the surgical site and allowing initial tissue healing to begin. This period generally lasts between one and four weeks, sometimes extending up to six weeks, before formal physical therapy begins. The primary goal is to ensure the repaired tendon remains securely attached to the bone as the initial scar tissue forms.
Patients are required to wear a sling, often one that holds the arm slightly away from the body in a position that minimizes tension on the repair. The sling is typically worn full-time, including while sleeping, and is only removed for hygiene. During this phase, the patient must strictly avoid using the shoulder muscles to move the arm, which prevents any strain that could cause a re-tear of the delicate new repair.
Factors Influencing the Physical Therapy Start Date
The transition from complete protection to active rehabilitation depends primarily on three medical variables. The most significant factor is the complexity and size of the tear that was repaired; a small, single-tendon tear heals faster and can tolerate earlier motion than a massive or revision repair involving multiple tendons. For minor repairs, physical therapy may begin as early as one to two weeks post-surgery.
Conversely, complex repairs, especially those involving a large tear, may require a delayed start to PT, sometimes waiting four to six weeks to allow for more secure tendon-to-bone healing. The specific surgical technique used, whether open or arthroscopic, can also influence the surgeon’s protocol. Finally, the exact start date can vary based on individual practice preferences, as each surgeon maintains a specific philosophy and protocol.
Phases of Early Rehabilitation
Once the patient is cleared to begin therapy, the focus is maximizing healing while gradually restoring motion. The first phase, Passive Range of Motion (PROM), is the earliest and most delicate part of the process, typically lasting until about six weeks post-surgery. During this time, the physical therapist or a mechanical device moves the patient’s arm, but the patient’s own rotator cuff muscles remain completely relaxed and inactive.
The PROM phase prevents stiffness in the shoulder joint without placing stress on the healing tendon, thereby protecting the repair. Following this, the program progresses to the Active Range of Motion (AROM) phase, which usually begins around six to eight weeks post-surgery. In this phase, the patient is permitted to use their own muscles to move the arm through a controlled range of motion.
The transition from passive to active motion is a significant step, but it is strictly monitored to prevent moving too quickly. The risk of re-tearing the tendon is still high, and the progression to AROM is only introduced after the therapist and surgeon confirm sufficient initial healing. Strengthening exercises are not introduced until much later, often around 12 weeks, as the focus remains on restoring mobility and control during these first few months.
The Full Recovery Timeline
While early rehabilitation focuses on motion, the overall recovery is a long-term process extending far beyond the first few months of physical therapy. Patients typically reach functional milestones, such as being cleared to drive and discontinue the sling, around six to eight weeks post-surgery, assuming they have adequate pain control and mobility. Strength gains, however, continue for many months after range of motion has been restored.
Returning to full, unrestricted activity, including heavy lifting, physically demanding work, or sports, requires more time. This final return to full function is typically achieved between six and twelve months after the operation. The time needed for the repaired tendon to regain its full strength and resilience is why patients must continue a dedicated strengthening program long after formal physical therapy sessions conclude.