Six weeks after rotator cuff surgery marks a significant transition point in the healing process. It moves from an initial, more restrictive protection phase to a stage where active rehabilitation begins. This article outlines typical expectations for physical therapy progression, managing daily activities, understanding pain levels, and recognizing warning signs during this recovery phase.
Rehabilitation Milestones
At approximately six weeks post-surgery, physical therapy typically advances from passive range of motion (PROM) exercises to active-assisted range of motion (AAROM) and, in some cases, gentle active range of motion (AROM). During PROM, a therapist or device moves the arm, while AAROM involves using the unaffected arm or a tool, such as a stick or pulley, to aid movement. The primary aim of this stage is to restore shoulder flexibility and improve joint mechanics. Exercises commonly introduced include pendulum swings, assisted flexion, and gentle external rotation.
Physical therapists may also introduce very light isometric exercises to begin reactivating shoulder muscles without significant load. Individuals should avoid pushing through any sharp pain. The progression of exercises is individualized, recognizing that healing rates can vary among patients.
Managing Daily Activities
Around six weeks, many individuals can begin to gradually reduce their sling use, though some may choose to discontinue it immediately. This allows for greater use of the operated arm for light, routine tasks like brushing teeth or getting dressed. When dressing, it is still advisable to insert the operated arm into clothing first. Sleeping arrangements may continue to require adjustments, such as using a pillow under the upper arm for support, and avoiding sleeping on the operated side for at least six weeks.
Showering is typically permitted, but care should be taken to avoid lifting the arm overhead or reaching behind the back. Driving is usually not advised until surgeon clearance, often around six to eight weeks, and only when no longer taking pain medication and capable of performing emergency maneuvers safely. Light household tasks are generally permissible, but lifting anything heavier than a few pounds should be avoided. Activities involving pushing, pulling, or reaching overhead remain restricted to protect the healing repair. Returning to work depends on job demands; sedentary roles may be possible around six to eight weeks, while manual labor requires a significantly longer recovery.
Pain and Recovery Signs
At six weeks post-surgery, some pain, soreness, or stiffness is expected as the shoulder starts to engage in more movement. Occasional sharp pains or twinges may occur with specific movements as tissues continue to heal and adapt. Pain management involves taking prescribed medications as directed; over-the-counter options can be used if approved by a healthcare provider.
Applying ice packs can help reduce localized swelling and discomfort. Gentle, controlled movement, as advised by a physical therapist, can also contribute to improved circulation and reduced stiffness. The surgical incision site should demonstrate good healing, with minimal redness or swelling, and the formation of a developing scar. It is important to recognize the difference between expected soreness from rehabilitation and any concerning pain that might indicate a problem.
Warning Signs and Next Steps
Certain symptoms after rotator cuff surgery warrant prompt medical attention. These include increased redness, warmth, or pus-like discharge from the incision site, which could signal an infection. A sudden, significant increase in pain that does not improve, or the development of new or worsening numbness, tingling, or weakness in the arm or hand, are also indicators to contact a medical professional. Excessive swelling that does not subside or the onset of a fever should also be reported to the medical team.
Looking forward, continued physical therapy is necessary for several more months to achieve full strength and range of motion. The overall recovery process is gradual, and complete recovery can take anywhere from nine to fourteen months, depending on factors such as the size of the original tear and individual healing capabilities. As healing progresses, resistance exercises will be gradually introduced to build strength in the shoulder muscles.