Rotator cuff repair is notoriously challenging to recover from. Not only is it generally painful, but it also requires adherence to a very specific protocol. Progressing too slowly results in prolonged stiffness and pain, while progressing too quickly risks the rotator cuff repair failing to heal. I recommend the following 4 steps.
The first step begins at the time of surgery and ends 2 weeks after surgery. During this phase of rehabilitation I recommend minimizing any motion of your shoulder. Performing active finger, wrist, and elbow exercises is encouraged without limitation, but try to minimize any shoulder range of motion. Avoid any lifting, pushing, or pulling (even using only your hand) because it is really impossible to isolate your shoulder. You will be in an abduction sling, which allows the shoulder to rest, and takes tension off of the rotator cuff repair. To get dressed, and for hygiene, you will obviously have to temporarily remove the sling. Any motion of the shoulder during this stage must be passive only. The best way to accomplish this is via pendulum exercises.
Step 2 involves intentional passive range of motion exercises. During this stage you still need to avoid any active range of motion. This is often difficult for patients. Following along with me in the accompanying video will very helpful. Stretching needs to continue on a daily basis from this point until you have full, symmetric range of motion with your other shoulder.
Step 3 involves active range of motion. This is how we normally move around. Stretching should continue every day. No strengthening should occur yet.
As you enter the final stage of rotator cuff rehabilitation, you will now add strengthening exercises. Strengthening should be done 2-3 times per week only. It is not appropriate to perform resistance exercises on a daily basis. The exercise stimulates the muscle to grow, it then needs a few days to actually grow.
Most patients will continue to make progress with regard to range of motion, strength, endurance, and pain for an entire year following surgery. While the process is lengthy and unpleasant, careful adherence to this protocol will minimize the chance of ongoing stiffness and help prevent the rotator cuff from not healing. Many patients will need to continue stretching and strengthening for many months beyond what I have outlined above. This is normal, and anticipated. Continue stretching until you have achieved symmetry with your other shoulder. Continue strengthening until you are able to do all desired activities. most patients will report ongoing progress for an entire year following surgery.
The difference between active and passive range of motion is easy for surgeons and physical therapists to understand, but is often unclear to patients.
Distinguishing between these two motions is crucial to properly rehabilitate certain surgeries, especially for a rotator cuff repair. Although I do my best to demonstrate each motion, and patients usually voice understanding, it is common for them to then demonstrate that they do not indeed understand.
Active range of motion is what we normally do all day every day. Our body normally functions using a coordinated series of active motions. This motion is controlled by muscles. Muscles cross joints, which are where bones meet and move relative to each other. When a muscle contracts, a joint moves. This is active range of motion.
Passive range of motion much less common in our normal daily activities. It requires a person to relax and allow their joint to be moved by an outside force. This force could be gravity, or another person (like a physical therapist), or a machine (like a stretching brace, or pulley).
The rotator cuff is a commonly injured tendon. Repairing rotator cuff tears makes up a large part of my practice. I perform this surgery using an arthroscope, and it takes about an hour for me to repair the average rotator cuff tear. Patients usually go home the same day, wearing a special brace to protect the repair.
This is where the hard work begins for the patient.
Rehabilitating a repaired rotator cuff takes time, involves discomfort, and is not fun. It is also crucial to do it properly. Improperly rehabilitated rotator cuff repairs could result in problems. Inadequate stretching (passive range of motion) could cause stiffness. Too much active range of motion, too soon, could cause the repair to fail.
I recommend thinking about rotator cuff rehabilitation as a sequence of 3 main phases:
It is very difficult to completely relax while someone, or something else moves your shoulder. Try to imagine your shoulder is paralyzed. Allow your arm to hang relaxed by your side. Then bend forward at your waist allowing your arm to swing away from your body under the influence of gravity . Keep bending at your waist as far as you can. At this point your arm will be hanging straight down, almost like you are trying to touch your toes or the floor in front of you. Now slowly stand up allowing your arm to gradually return to your side. Try to keep the arm completely relaxed throughout the entire motion. When you are standing upright again and your arm is at your side you are done. Congratulations. You just properly performed a basic passive range of motion exercise.
In an upcoming post I will upload a video demonstrating this basic passive range of motion maneuver and a sequence of increasingly complex passive exercises. After this I will demonstrate active range of motion exercises.
Orthopedic Surgeon focused on the entire patient, not just a single joint.