Overview

Rotator cuff repair is surgery to reattach a torn rotator cuff tendon to the bone. Because the repair must heal in place before it can be loaded, rehabilitation follows a strict order: protect → restore range → rebuild strength → return to activity.

This guide is general education for the repair path. Your surgeon's protocol — especially sling duration, active-movement restrictions and exercise doses — always takes priority.

Who This Guide Is For

This is for people who have had surgical repair of a rotator cuff tear. If you are managing a tear without surgery, use the rotator cuff tear rehabilitation guide instead.

Phase 1: Protection (Weeks 0–6)

Goals: protect the repair, control pain, begin passive movement.

Wear the sling as directed — often day and night for the first 4–6 weeks
Pendulum exercises: gentle circles with a relaxed arm, as cleared
Passive or assisted range only — the muscles should not actively lift the arm
Move the hand, wrist and elbow freely
Sleep in a supported position, usually with pillows, to avoid rolling onto the shoulder

The tendon is weakest in the first weeks. Do not lift, pull, push or reach with the operated arm during this phase.

Phase 2: Early Movement (Weeks 6–12)

Goals: restore comfortable range, begin gentle muscle activation.

Active assisted range: use the other arm, a wand or a table to help lift
Isometric shoulder holds: gentle pushes against resistance without movement, as cleared
Scapular retraction rows: shoulder-blade control
Wall slides for overhead range, staying within comfort
Stop using the sling gradually as directed

Phase 3: Rebuilding Strength (Months 3–6)

Goals: progressive strengthening of the rotator cuff and shoulder muscles.

External rotation with a band: light resistance, 2 sets of 10–15
Internal rotation with a band: 2 sets of 10–15
Progressive scapular and shoulder strengthening
Light lifting with very small loads; no heavy or overhead lifting without clearance

Phase 4: Return to Activity (Months 6–12)

Goals: full strength, confidence and return to sport and work.

Progress resistance one variable at a time
Return to overhead work and throwing sports only when strength and range criteria are met
Continue rotator cuff and scapular strengthening long after symptoms settle
Use return-to-sport testing rather than a calendar date

Precautions

Do not actively lift the arm overhead during the protection phase
Do not pull, push or lift anything heavy until cleared
Avoid sudden movements, reaching behind the back forcefully or supporting your body weight on the arm
Do not drive until cleared (often once the sling is off and reaction time is normal)

What Exercise Should Feel Like

Expect stiffness and some discomfort, especially early. Mild soreness that settles within a day is normal. Sharp pain, catching, or a sudden giving-way feeling is a signal to stop and check in with your team.

Common Mistakes

Removing the sling too early
Actively lifting the arm during the protection phase
Skipping the passive-range work because it seems "too easy"
Returning to lifting or throwing before strength criteria are met

When to See Someone Urgently

Contact your surgeon for a red, hot or leaking wound, fever, sudden severe pain, or a shoulder that looks or feels out of place. Contact your physiotherapist if range is not returning as expected or if pain is climbing.

Questions to Ask Your Clinician

How long do I wear the sling, day and night?
Which movements are restricted at each phase?
When can I drive, sleep without support and return to work?
What strength and range criteria should I meet before returning to sport?

References

AAOS OrthoInfo. "Rotator Cuff Tears." https://www.orthoinfo.org/en/diseases--conditions/rotator-cuff-tears/
JOSPT. "An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain." 2020. https://www.jospt.org/doi/10.2519/jospt.2020.8498

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly. Always follow your surgeon's specific post-operative protocol.

Rotator Cuff Repair Rehabilitation Guide