When you sustain an injury to your rotator cuff, not only are you experiencing a lot of pain, but your shoulder joint mechanics are thrown out of alignment, adversely affecting your upper extremity function. Rehabilitation for the torn rotator cuff, pending physician approval, is designed to reduce your pain, restore proper muscular forces affecting the shoulder joint and improve your function.
Passive Mobility
Rehabilitation for the torn cuff initially following is very conservative. You must start with mobility exercises for your elbow and hand as well as gripping a tennis ball at one to two weeks after surgery. You should also lay on your stomach and let your arm dangle off the edge of the mat or bed and use your body to swing your arm in circles like a pendulum during this period of time. Once your physician has discontinued your sling use, you may also perform mild passive range of motion for the shoulder using pulleys or your opposite arm, with your injured arm placed 30 or 40 degrees out to the side, increasing this angle to 45 to 90 degrees as tolerated with your elbow supported by the end of the week.
Active Assistive Mobility and Submaximal Rotator Cuff Strengthening
By the second week following sling removal, you can progress the exercise program by beginning to move your injured arm with assistance. You can continue with the pulley exercises described above, keeping your arm supported at the elbow at all times. This time, however, attempt to use your injured arm partially, continuing to rely upon the uninjured arm to do most of the active work.
You can also start strengthening the muscles of your rotator cuff. This should ideally be initiated one month post-surgery for a small tear and 6 weeks post-surgery for a medium-sized tear. Keep your arm slightly away from your side with elbow bent to 90 degrees, place a towel roll underneath your armpit and gently resist the inward and, especially outward movement of your arm. Hold these movements for 5 seconds each.
Cuff Strengthening
You can begin strengthening your rotator cuff more aggressively about six weeks following your surgery. At that point, you may begin strengthening your rotator cuff with a sports cord. Cords vary in strength from minimal to heavy resistance. Begin with a light cord, attaching it to a doorknob or tying it around a stable object at waist level. Continue to keep your arm slightly away from your side with elbow bent to 90 degrees with a towel roll underneath your armpit. Grab the free end of your cord and turn your arm outward, pulling the cord in front of your body ten to fifteen times.
Scapular Strengthening
About three to four weeks following your surgery, it is important to perform exercises to strengthen your upper back. Lay on your stomach with your injured arm at your side but hanging off the table and raise your elbow towards the ceiling. Perform 10 times. Progress this exercise by bringing your arm away from your side gradually before raising your elbow. You can add resistance to this exercise about 6 weeks following your surgery. Also, squeeze your shoulder blades together, ten to fifteen times.
Exercise Precautions
There are different degrees of tears. Be conservative and exercise with caution following surgery, letting pain be your guide, especially if you have experienced a major rotator cuff tear. Avoid keeping your arm in painful positions and do not perform any weighted overhead activities.
References
- Rotator Cuff Lesions and Rehabilitation", Kevin Wilk, 2000
- Rehabilitation Protocol Following Arthroscopic Rotator Cuff Repair
- Rotator Cuff Repair- revised 8/2008
