A rotator cuff tear, whether partial or complete, affects the group of four muscles and their tendons—the supraspinatus, infraspinatus, teres minor, and subscapularis—that stabilize the shoulder joint and facilitate arm movement. This injury often leads to pain, weakness, and restricted range of motion, making daily tasks difficult. The goal of rehabilitation is to restore function and strength to the shoulder complex, frequently allowing for recovery without surgery. Consulting a healthcare professional, such as a physician or physical therapist, for a personalized diagnosis and treatment plan is the first step before attempting any exercises.
Immediate Movement Guidelines
Following a rotator cuff injury, the primary goal is to protect the damaged tissues from further strain. Any movement that causes a sharp increase in pain should be immediately stopped, as pain serves as a protective signal.
Patients should avoid lifting, pushing, or pulling with the injured arm, especially against resistance or involving heavy objects. Overhead activities, such as reaching into a high cabinet or throwing, place significant strain on the rotator cuff and must be limited. Even simple repetitive motions, like reaching behind the back, can aggravate the injury.
Maintaining good posture is a helpful guideline, as a slumped position can crowd the shoulder joint and impede healing. When sitting, keep the head aligned over the shoulders, which helps position the shoulder blade properly. Carrying a heavy bag or purse on the affected side should be discontinued temporarily to reduce downward pull on the joint.
Early Stage Therapeutic Exercises
Once acute pain has subsided, the initial phase of exercise focuses on maintaining passive range of motion without actively contracting the injured muscle. These movements prevent joint stiffness and promote circulation, aiding in healing.
The classic exercise for this stage is the Pendulum Swing, also known as the Codman exercise. To perform this, the individual bends over at the waist, allowing the injured arm to hang straight down toward the floor, using a table or chair for support with the non-injured hand. The arm should be relaxed, and movement is initiated by rocking the body’s weight back and forth or side to side. The diameter of the swing should be kept small, ideally no larger than 8 to 12 inches, to ensure the rotator cuff muscles remain inactive. These movements help decompress the joint space and are performed for a few minutes at a time, several times a day.
Another form of early movement is Passive Range of Motion (PROM) using the non-injured arm or a cane/wand. For instance, the person lies on their back and holds a broom handle with both hands, using the unaffected arm to push the injured arm through a pain-free range of motion. This technique allows for controlled movement, such as raising the arm overhead or across the body, without requiring the injured muscles to generate force.
Mid-Stage Progression and Strengthening
Progression occurs when passive mobility is restored and the shoulder can tolerate light muscle activation without increased pain. This phase gradually introduces controlled strengthening exercises to rebuild muscle capacity and stability. This progression should only happen under the guidance of a physical therapist or physician, as starting too soon can re-injure the tendon.
Isometric exercises are the first form of strengthening introduced, as they involve muscle contraction without joint movement, placing minimal strain on the tendons. These involve pressing the arm against an immovable object, like a wall or doorframe, in different directions. For example, to strengthen the internal rotators, the elbow is bent to 90 degrees and tucked at the side, with the fist pressing inward against a wall.
Similarly, for external rotation, the back of the hand presses outward against the wall, holding the contraction for a short duration, such as five seconds. The resistance applied should start gently, often at 25 to 50 percent of maximal effort, and should never cause pain.
Following successful isometrics, light resistance exercises are introduced, often using a low-resistance elastic band or light weights. These exercises focus on the key movements of the rotator cuff, such as internal and external rotation, with the elbow tucked to the side. Scapular stability exercises are also integrated, focusing on controlling the shoulder blade’s position, as a stable base is necessary for the arm to move efficiently and safely. Exercises like scapular setting—drawing the shoulder blades down and back—or wall push-ups help engage the muscles that support the shoulder girdle, providing a foundation for stronger arm movement.
The Role of Professional Physical Therapy
While these guidelines offer a framework for initial movement, professional physical therapy is essential for complete recovery from a rotator cuff tear. A physical therapist conducts a thorough assessment, determining the tear location, size, and the individual’s functional limitations, which informs a customized treatment plan. This level of personalization is impossible to achieve through self-guided exercise alone.
The therapist monitors progress and adjusts the resistance and complexity of exercises as the tendon heals, ensuring the progression is safe and effective. They provide manual therapy techniques and joint mobilization to improve flexibility, which cannot be accomplished solely with home exercises. A physical therapist also teaches proper form, preventing compensatory movement patterns that can lead to chronic pain or further injury.
Whether the treatment path is non-surgical (successful for many partial tears) or involves post-operative rehabilitation, the therapist guides the patient through the phases of recovery. They ensure the repaired tissue is protected during the initial healing period and then systematically restore strength to the weakened muscles. Adherence to a structured, professionally supervised rehabilitation program is correlated with a successful outcome, often taking many months to regain full function.