Rotator cuff injuries are a common cause of shoulder pain and limited arm function, affecting the muscles and tendons that stabilize the shoulder joint. The timing for beginning physical therapy (PT) is the most important consideration in ensuring a successful recovery, whether the injury is managed conservatively or requires surgery. Starting too soon can risk further damage to the delicate tendon tissue, while starting too late can lead to joint stiffness and muscle atrophy. The appropriate timeline is not one-size-fits-all, but instead depends entirely on the initial diagnosis and the chosen treatment path.
Initial Assessment: Defining the Injury Path
Determining the severity of the rotator cuff injury dictates the rehabilitation timeline. Following the initial trauma, the immediate focus is on managing pain and reducing inflammation, often through rest, ice, and over-the-counter pain relievers. A healthcare professional will perform a physical exam, which includes moving the arm into different positions and testing muscle strength, to assess the damage.
Imaging tests are necessary to confirm the diagnosis and determine the extent of the tear. An ultrasound or Magnetic Resonance Imaging (MRI) scan provides a detailed view of the soft tissues, distinguishing between a partial-thickness tear and a full-thickness tear. A partial tear may be suitable for conservative management, while a large, full-thickness tear often requires surgical repair. This diagnostic information allows the physician to decide on the appropriate treatment course and set the initial timeline for physical therapy.
Physical Therapy for Non-Surgical Injuries
For many partial-thickness tears, or for patients opting against surgery, physical therapy is the primary treatment and can begin relatively quickly. Physical therapy often starts within the first week after the acute pain and inflammation have subsided.
The initial phase focuses on protecting the shoulder while maintaining motion. This involves passive and active-assisted range of motion exercises, such as pendulum exercises, where the arm hangs freely and moves in small circles to promote circulation without engaging the injured muscle. Once pain is controlled and basic range of motion is achieved, the intermediate phase begins around weeks four through eight. This phase introduces active range of motion, where the patient moves the arm independently, and light strengthening exercises to rebuild muscle endurance. The non-surgical timeline is generally faster, with a progressive strengthening phase starting around week eight, aiming for a return to full function within three to four months.
Post-Surgical Rehabilitation Phases
Rehabilitation following rotator cuff repair surgery is a longer, more structured process. The timing of PT is strictly controlled by the surgeon to protect the reattached tendon, and the protocol is customized based on the tear size and tissue quality. Physical therapy almost always begins in the immediate post-operative period, but the activities are highly restricted.
Immediate Post-Surgery Phase
This phase typically lasts from zero to six weeks and is focused on maximum protection and pain management. During this time, the arm is immobilized in a sling, and the patient is restricted from any active movement of the shoulder. PT sessions only involve passive range of motion (PROM) exercises, where the therapist gently moves the arm to prevent joint stiffness without the patient engaging the rotator cuff muscles.
Early Motion Phase
This phase generally begins around six weeks post-surgery. The patient is cleared to stop wearing the sling and starts active-assisted range of motion exercises, using the opposite hand or tools like a cane to help move the operated arm. This phase restores mobility, preparing the shoulder for the subsequent demands of strengthening.
Strengthening Phase
This phase begins around twelve weeks post-surgery. The focus shifts to building muscle strength and endurance in the rotator cuff and surrounding shoulder blade muscles. Resistance exercises, often using bands or light weights, are introduced and progressively increased over the following months. Full recovery and a return to strenuous activities may take six months to a year, depending on the tear size and individual progression.
Recognizing Factors That Modify the Timeline
A patient’s personal health status significantly modifies the timeline for starting and progressing through physical therapy. Factors like age and pre-existing health conditions can slow the healing process and necessitate a more cautious schedule. For instance, smoking and diabetes are known to negatively impact tendon healing, potentially delaying the introduction of active motion or strengthening exercises.
Adherence to the prescribed home exercise program is a major determinant of recovery speed. Following the exercises diligently helps prevent a setback. It is important to recognize “red flags” that require immediate attention from a physician. These include:
- A sudden onset of sharp, severe pain.
- Noticeable swelling.
- Signs of infection like fever.
These symptoms indicate a potential complication, such as a re-tear of the tendon, and mean that physical therapy must be paused until the doctor provides new clearance.