Rotator Cuff Injury Rehab

Tendinopathy • Partial-Thickness Tear • Full-Thickness Tear

🧠 What Is the Rotator Cuff?

The rotator cuff is not a single muscle—it’s a team of four muscles that work together to stabilize and move your shoulder:

• Supraspinatus

• Infraspinatus

• Teres Minor

• Subscapularis

Think of them as the shoulder’s core stabilizers, responsible for lifting, rotating, and controlling the arm.

But like any team, when one part breaks down—tendinopathy, partial tear, or full tear—the whole system suffers.

❓ What Causes a Rotator Cuff Injury?

Younger Adults (Under 40):

• Often due to trauma or overuse

• Common in athletes (e.g., baseball, swimming) and physical laborers

Older Adults (40+):

• Typically results from degenerative wear and tear

• Most often affects the supraspinatus

• Strength training (especially in Phase 3) is key for prevention

🚨 Common Symptoms of injury

• Pain on the top or side of the shoulder

• Radiating pain down the upper arm

• Worse with reaching overhead or away from the body

• Trouble sleeping, especially on the affected side

• Pain localized to the front (subscapularis/biceps) or back (infraspinatus/teres minor)

• Dull ache that becomes sharp with movement

⚠️ What Makes It Worse?

• Reaching overhead or away

• Sleeping on the injured side

• Carrying or lifting with an extended arm

• Poor posture (e.g., rounded shoulders)

🕐 Healing Timeline & Prognosis

• Tendinopathy: 4–12 weeks with rehab

• Small Tears: Up to 6 months

• Large/Full-Thickness Tears: Often require surgery

🛠️ Rehab Strategy: A 3-Phase Progression

🔹 Phase 1: Reduce Pain & Rebuild the Foundation of your rotator cuff

Goals:

• Release soft tissue restrictions:

  • Posterior rotator cuff

  • Upper traps

  • Levator scapulae

  • Pecs

  • Thoracic spine

What You’ll Do:

• Isometric shoulder exercises to gently load the tendon

• PROM (Passive Range of Motion) to maintain mobility without strain

⚠️ Avoid AROM early if it increases pain—start light and progress gradually.

🔹 Phase 2: Mobility & Early Strength

Goals:

• Improve thoracic spine mobility and scapular control

• Transition from PROM → AAROM → AROM

Key Movements:

• Thoracic flexion/extension

• Scapular protraction/retraction

• Angels (pec stretch + posture reset)

• Prone “T” raises for scapular retractors

🔹 Phase 3: Build Strength & Resilience

When:

• Once your shoulder can move freely with minimal pain

What to Train:

• Rows → Scapular retractors

• External rotation variations → Cuff stability

• Internal rotation → Subscapularis

• Shoulder raises → Supraspinatus + deltoid

• Pressing patterns → Chest, delts, serratus anterior

• Supinated curls → Biceps tendon (especially if front-of-shoulder pain is present)

🔍 If your pain is mainly front-of-shoulder, consider a biceps-specific protocol instead.

🧬 When to Consider Surgery

• Full-thickness tears rarely heal with rehab alone

• Delaying surgery can lead to joint degeneration

• Surgery is usually advised if:

  • The tear is large

  • Pain lasts > 6 months despite rehab

  • There's noticeable loss of function

✅ Good News: Surgical outcomes are often excellent—less pain, more function, and lower long-term risk.

💡 Final Thought: Movement Is Medicine

Rotator cuff injuries can be frustrating—but they’re highly treatable.

Whether you’re:

• Just beginning rehab

• Building strength

• Returning to sport or training

Each phase builds on the last.

Take your time.

Respect the process.

Move with purpose.