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Injury Recovery

Rotator Cuff Injury

By September 11, 2025No Comments

Clinical Importance of Biokinetics through the Means of Physical Therapy

Rotator cuff injuries—ranging from tendonitis, partial tears, to full-thickness tears—can significantly impair shoulder function. Whether treated conservatively or with surgical repair, physical therapy is essential to:

1. Restore Functional Shoulder Mechanics:

  • The rotator cuff stabilises the glenohumeral joint during movement. Injury disrupts scapulohumeral rhythm, causing weakness, impingement, and dysfunction.

2. Prevent Joint Stiffness and Frozen Shoulder:

  • Immobilisation (especially post-op) increases the risk of adhesive capsulitis. Early controlled motion helps maintain mobility.

3. Build Strength and Prevent Recurrence:

  • Progressive rotator cuff and scapular strengthening reduces overload on tendons and prevents future breakdown.

Important Exercises and Their Purpose

Rotator cuff rehab follows a stage-based approach, balancing healing tissue protection with progressive loading. The protocol differs slightly between non-operative rehab and post-surgical repair due to healing timelines. Below are the clinically relevant rehabilitation phases:

Phase 1: Protection & Pain Management

Focus: Reduce pain and inflammation, protect the tendon, and prevent stiffness.

Post-surgical patients must follow the surgeon’s ROM limits, often limiting ER and flexion to 90° in the first 4–6 weeks.

Phase 2: Controlled Motion & Isometric Activation

Focus: Restore PROM → AAROM → AROM, initiate safe rotator cuff activation.

Phase 3: Strengthening & Dynamic Control

Focus: Progress strength, endurance, and functional range.

Phase 4: Return to Function & Sport-Specific Drills

Focus: Restore overhead function, dynamic control, and confidence.

Safe Range of Motion (ROM)

Week 0-4

Passive flexion ~90°, ER ~30° (post-op)

Week 4-8

AAROM/AROM to 120–140° flexion, ER to 60°

Week 8-12

Full AROM in all planes with minimal substitution

>12 weeks

Full functional ROM and strength return

Note: Avoid early active abduction or ER at 90° abduction in post-surgical cases to protect the supraspinatus and infraspinatus.

Clinical Considerations

  • Pain is not a guide for rotator cuff rehabilitation; early tissue strain may not cause pain but can damage the repair.
  • Scapular dyskinesis must be corrected alongside cuff work.
  • In post-op cases, delayed strength work is key to avoiding retears.
  • Use clinical tests (e.g., ER lag sign, drop arm) to track functional return.

Summary

Rehabilitation for rotator cuff injuries must:

  • Balance tendon healing with progressive loading
  • Restore scapulohumeral rhythm
  • Reinforce rotator cuff and scapular strength
  • Support long-term function and injury prevention

A successful outcome requires controlled progression, close monitoring, and functional reintegration through staged rehabilitation.

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