Physical Therapy for Rotator Cuff Tears

Physical therapy plays a critical role in recovery from a rotator cuff tear, helping individuals regain strength, mobility, range of motion, and coordination in the shoulder. Rotator cuff tears involve a partial or complete tearing of a rotator cuff tendon or muscle due to an acute trauma to, chronic overuse of, or age-related degeneration of the shoulder joint. Exercise rehabilitation is the cornerstone of physical therapy treatment for rotator cuff injuries. The physical therapist’s goal is to restore full, pain-free range of motion, flexibility, muscle balance, and scapulothoracic and glenohumeral muscular control and stability for full function and mobility in the injured shoulder and rotator cuff complex.

What is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that are responsible for keeping the shoulder joint stable and connecting the upper arm bone (humerus) to the shoulder blade (scapula). The rotator cuff also contributes to the stability and movement of the glenohumeral joint and is essential to the functioning of the upper limb.  The rotator cuff tendons merge together to form a cap or hood around the head of the humerus.

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Rotator Cuff Tears

Rotator cuff tears involve a partial or complete tearing of a rotator cuff tendon or muscle due to an acute trauma to or chronic overuse of the shoulder joint. A complete tear extends from the top to the bottom of the rotator cuff muscle or tendon, whereas a partial tear affects some portion of the rotator cuff tendon or muscle but does not extend all the way through. Partial tears of the rotator cuff muscles are more common than full tears.

Rotator cuff tears can be acute, chronic, or degenerative. An acute rotator cuff tear can occur in athletes and heavy laborers, resulting from a traumatic injury to the shoulder from lifting, falling, or throwing. Chronic rotator cuff tears are slower to develop, resulting from repeated actions in which the arms work above shoulder level, such as overhead throwing in baseball or certain work activities. These repetitive actions lead to mechanical overuse of and progressive degeneration of the rotator cuff tendon until the tendon tears.

Rotator cuff tears can occur alongside shoulder impingement or injury to the biceps tendon or shoulder labrum. Rotator cuff tears can also be degenerative, resulting from age-related muscular and tendon changes. In fact, the incidence of rotator cuff tears increases with age, with full-thickness tears present in approximately 25% of individuals in their 60s and more than 50% in their eighties, though not all experience symptoms of a tear.

Symptoms of a rotator cuff tear can include:

• Pain over the top of the shoulder or down the outside of the arm

• Weakness in the shoulder

• Loss of shoulder motion and mobility

• Feeling of weakness or heaviness in the arm

• Inability to lift the arm to reach up or behind

• Inability to perform common daily activities due to pain or limited motion

• A popping or clicking sound when the arm is moved

Physical Therapy for Rotator Cuff Tears

Physical therapy plays a critical role in recovery from a rotator cuff tear, helping individuals regain strength, mobility, range of motion, and coordination in the shoulder. If surgery is needed, such as when an acute full thickness tear has occurred, a physical therapist can provide pre-surgical rehabilitation to prepare for surgery and post-surgical rehabilitation to help restore function to the shoulder after the operation. Surgery is opted for in acute tears or chronic full-thickness tears in younger individuals, athletes, and workers, given the high likelihood of full healing after early surgical intervention.

However, for a partial thickness tear in older patients, physical therapy can help heal the intact portion of the torn rotator cuff tendon to help avoid surgery and address deficits in strength and function through a targeted strengthening program of the shoulder complex. Research has shown that patients who do physical therapy for a rotator cuff injury demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. If surgery is necessary, however, physical therapy is essential to regain full function of the shoulder.

Exercise rehabilitation is the cornerstone of physical therapy treatment for rotator cuff injuries. The goal of the physical therapist is to restore full, pain-free range of motion, flexibility, muscle balance, and scapulothoracic and glenohumeral muscular control and stability for full function and mobility in the injured shoulder and rotator cuff complex.

Physical therapy treatment for rotator cuff tears can include:

• Pain and swelling management using ice, moist heat, gentle massage, or TENs unit

• Patient education on activity modifications to reduce stress on the rotator cuff as well as posture retraining

• Manual therapy soft tissue and joint mobilizations and targeted stretching of tight muscles to recover range of motion in the shoulder

• Range of motion exercises to restore mobility in the shoulder complex

• Targeted strengthening exercises of the shoulder, upper trunk, and back to relieve stress on the rotator cuff and correct muscle weaknesses and imbalances. The therapist specifically targets the scapular muscles to enhance scapular stability and ensure proper neuromuscular control of the shoulder girdle.

• Functional work and sport-specific training, simulating work and sport-related activities to ensure proper body mechanics and to modify movements to reduce stress on the rotator cuff muscles and tendons

Following shoulder surgery, the repaired rotator cuff is very vulnerable to re-injury. Therefore, working with a physical therapist is crucial to restore function to the shoulder through a safe, progressive rehabilitation program. After surgery, there are four phases of rehabilitation:

1. Phase 1: Maximal Protection Phase: During the first few weeks post-surgery, the arm will be in a sling. The physical therapist teaches the patient gentle range of motion and isometric strengthening exercises and uses manual therapy, cold compression, and electrical stimulation to relieve pain.

2. Phase 2: Moderate Protection Phase: During this phase, the physical therapist works to restore mobility in the shoulder and progress range of motion and strengthening exercises of the shoulder. The therapist may also add in core muscle strengthening and targeted strengthening of the shoulder blade muscles to provide additional support and stability to the shoulder.

3. Phase 3: Return to Activity Phase: At this phase, the aim is to restore strength and joint awareness in the injured shoulder equal to that of the healthy shoulder. The patient should be able to have full use of the arm for daily activities. Strengthening exercises are advanced, but no sport-specific or strenuous activities are included yet.

4. Phase 4: Return to Sport Phase: At this point, the patient is ready to engage in return to work and sport-specific activities in the controlled environment of the physical therapy clinic, such as throwing, catching, or lifting heavy objects. The therapist assesses the patient’s ability to perform these tasks before giving the go ahead to return to work or sport.

Research studies have noted that physical therapy is highly effective in treating rotator cuff tears. A Finnish research study of 173 people aged 55 and older with non-traumatic rotator cuff tears found that physical therapy was just as effective as surgery. Participants were divided into a physical therapy only intervention group and a group that underwent surgery followed by physical therapy. The researchers found that a significant number of participants were treated successfully with conservative physical therapy. At 12 months post-intervention, there was no difference between the physical therapy only group and the surgery plus physical therapy group.

In a 2014 study, 452 patients with atraumatic full thickness rotator cuff tears underwent a physical therapy program for treatment of their rotator cuff and were evaluated at 6 and 12 weeks. Patients reported outcomes improved significantly at 6 and 12 weeks after physical therapy. Patients in the cohort elected to undergo surgery less than 25% of the time. Researchers noted that non-operative physical therapy treatment was effective in treating atraumatic full thickness rotator cuff tears in 75% of patients who were followed up with two years after the intervention.

If you have experienced a rotator cuff tear or are recuperating after rotator cuff surgery, come work with our physical therapists to regain function and strength in your shoulder and return to your sport and work safely!