Rotator cuff surgery is a common procedure performed to repair torn tendons in the shoulder, aiming to restore strength and motion. The success of this repair relies heavily on the post-operative rehabilitation program, making physical therapy (PT) arguably the most important part of the recovery process. The timeline for starting therapy is carefully controlled by the surgeon to protect the newly repaired tissue. This timeline is not one-size-fits-all but follows a structured progression designed to balance protection of the repair with the need to prevent joint stiffness.
The Mandatory Immobilization Phase
The immediate period following rotator cuff surgery requires a period of strict rest to allow the repaired tendon to begin healing back to the bone. This initial phase typically lasts between one to six weeks, depending on the severity of the original tear and the strength of the surgical repair. During this time, the operated arm is kept in a specialized sling, often with a small pillow or cushion to position the arm slightly away from the body, which reduces tension on the repaired tendons.
The primary purpose of the sling is to protect the repair site from any active muscle contraction that could pull the tendon away from its reattachment point. While shoulder movement is strictly limited, patients are generally allowed to move their elbow, wrist, and hand to maintain circulation and prevent stiffness in those joints. Activities like lifting the arm, reaching, pushing, or pulling are strictly forbidden during this mandatory immobilization period.
Standard Protocols for Starting Physical Therapy
The exact timing for the start of formal physical therapy is a decision made by the surgeon and is primarily dictated by the size of the tear and the quality of the tissue repair. For smaller tears where the repair is under less tension, some surgeons may allow the initiation of therapy as early as one or two weeks post-surgery. Starting too early, however, risks structural failure of the repair, while starting too late can lead to debilitating joint stiffness, often called “frozen shoulder.”
A common window for initiating formal physical therapy for most repairs falls between two and six weeks after the operation. For medium-sized tears, therapy often begins around the four to six-week mark. For large or massive tears, where the repair was more complex, the start of therapy is often delayed until six weeks or later to ensure maximum protection of the healing construct. The surgeon’s specific protocol is the definitive schedule, as they know the exact details of the repair and the amount of load the new tissue can tolerate.
Defining the Initial Passive Range of Motion Phase
The initial stage of physical therapy focuses on Passive Range of Motion (PROM), which is distinctly different from strengthening exercises. PROM involves the physical therapist or a specialized device moving the patient’s arm and shoulder without the patient using any of their own rotator cuff muscles. The patient must remain completely relaxed, ensuring no active muscle contraction stresses the newly healed tendon.
The main objective of this gentle, assisted movement is to prevent the formation of scar tissue and adhesions that can cause long-term joint stiffness. This early mobility helps the joint maintain its basic range of motion without placing load or stress on the delicate tendon-to-bone interface. The PROM phase typically lasts for four to eight weeks, with the goal of regaining a specific, pain-free arc of movement before progressing. Once the surgeon confirms sufficient healing, the patient advances to active-assisted and then active motion exercises.
Factors That Adjust the Rehabilitation Schedule
While standard protocols provide a general timeline, the rehabilitation schedule is highly individualized and subject to change based on patient-specific and surgical variables. The method of repair, whether arthroscopic or open surgery, can influence the progression. Arthroscopic repairs sometimes allow for a slightly faster progression due to less soft tissue trauma, but the underlying tendon healing timeline remains the same.
Underlying patient health conditions play a significant role in the pace of recovery. Comorbidities such as diabetes or a history of smoking can slow down the body’s natural healing process.
Patient compliance is also a major factor, as failing to adhere to the restrictions on lifting and movement or neglecting the prescribed home exercises can lead to setbacks or re-tear of the repaired tissue. Any post-operative complications, such as an infection or excessive pain that is not easily managed, will necessitate a temporary delay or modification to the established therapy schedule.