Rotator Cuff Repair Post-Op Protocol and Exercise Progression

Rehabilitation after a rotator cuff repair requires a carefully phased protocol to balance tendon healing with safe return of strength and function.

Phase I: Protection and Passive Motion (Weeks 0–6)

• Goals: Protect repair, control pain and swelling, prevent stiffness.
• Precautions:
  • Sling use (4–6 weeks, depending on surgeon’s advice).
  • Avoid lifting, pushing, pulling, or sudden movements.
• Interventions:
  • Pendulum exercises.
  • Passive range of motion (PROM) only (flexion, abduction, external rotation within limits).
  • Elbow, wrist, and hand active motion to prevent stiffness.

Phase II: Active-Assisted and Active Motion (Weeks 6–12)

• Goals: Restore active motion without stressing the repair.
• Interventions:
  • Transition to active-assisted range of motion (AAROM) (pulleys, cane-assisted).
  • Progress to active ROM (AROM) when pain-free and with good scapular control.
  • Begin scapular stabilization exercises (protraction, retraction, depression).

Phase III: Strengthening (Weeks 12–20)

• Goals: Build muscular endurance and restore dynamic shoulder stability.
• Interventions:
  • Isometric rotator cuff and deltoid strengthening.
  • Resistance bands or light weights for external/internal rotation, rows, and scaption.
  • Closed-chain exercises (wall push-ups, quadruped weight shifts).

Phase IV: Advanced Strength and Return to Activity (Weeks 20–26+)

• Goals: Regain full strength, endurance, and functional ability.
• Interventions:
  • Plyometric and sport-specific drills (e.g., medicine ball throws).
  • High-level strengthening of rotator cuff and scapular stabilizers.
  • Gradual reintroduction of overhead and heavy activities.

Clinical Considerations

• Progression depends on surgical findings, tendon quality, and tissue healing rates.
• Overly aggressive strengthening too early can compromise the repair.
• Patient education on activity modifications is crucial to prevent re-injury.
• Return to heavy labor or sport may take 6–12 months.

Conclusion

A rotator cuff repair protocol progresses from protection to mobility, then strength, and functional restoration. Close monitoring, individualized progression, and patient compliance ensure optimal recovery.

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