Phase 1 Protective Phase (0-6 Weeks)
Goals
- Gradual increase in ROM
- Increase shoulder strength
- Decrease pain and inflammation
0-3 Weeks
- Fit brace or sling (physician determines)
- Begin pendulum exercises
- Perform active-assisted ROM exercises (L-bar exercise):
- Flexion to 125 degrees
- ER/IR (shoulder at 40 degrees abduction) to 30 degrees
- Perform passive ROM to tolerance
- Use rope and pulley-flexion
- Perform elbow-ROM and hand-gripping-exercises
- Begin sub-maximal isometrics:
- Flexors
- Abductors
- ER/IR
- Elbow flexors
- Use ice and pain modalities
3-6 Weeks
- Discontinue brace or sling @6wks
- Continue all exercises listed above
- Performed active-assisted ROM exercises:
- Flexion to 145 degrees
- ER/IR (performed at 65 degrees abduction) range to tolerance
Phase 2 Intermediate Phase (7-14 Weeks)
Goals
- Full, non-painful ROM (10 Weeks)
- Gradual increase in strength
- Decrease pain
7-10 Weeks
- Perform active-assisted ROM L-bar exercises:
- Flexion to 160 degrees
- ER/IR (performed at 90 degrees shoulder abduction) to tolerance
(greater than 45 degrees)
- Perform strengthening exercises:
- Use exercise tubing ER/IR, arm at side
- Initiate humeral head stabilizing exercise
- Initiate dumbbell-strengthening exercises, for the following:
- Deltoid
- Supraspinatus
- Elbow flexion/extension
- Scapular muscles
10-14 Weeks
- Continue all exercises listed above (full ROM by 10-12 Weeks)
- Begin isokinetic strengthening (scapular plane)
- Begin side-lying ER/IR exercises (dumbbell)
- Begin neuromuscular control exercises for scapula
Note: Patient must be able to elevate arm without shoulder and scapular hiking before initiating isotonics; if unable, maintain on humeral head stabilizing exercises
Phase 3 Advanced Strengthening Phase (15-26 Weeks)
Goals
- Maintain full, non-painful ROM
- Improve strength of shoulder
- Improve neuromuscular control
- Gradual return to functional activities
15-20 Weeks
- Continue active-assisted ROM exercise with L-bar:
- Flexion, ER, IR
- Perform self-capsular stretches
- Begin aggressive strengthening program:
- Shoulder flexion
- Shoulder abduction (to 90 degrees)
- Supraspinatus
- ER/IR
- Elbow flexors/extensors
- Scapular Muscles
- Begin interval sports program
21-26 Weeks
- Continue all exercises listed above
- Use isokinetic test (modified neutral position) for ER/IR at 180 and 300 degrees per second
- Begin interval sport program
Phase 4 Return to activity Phase (24-28 Weeks)
Goals
- Gradual return to recreational sport activities
24-28 Weeks
- Continue all strengthening exercises
- Continue all flexibility exercises
- Continue progression on interval programs.
Click here to download Printable Version of Rotator Cuff Repair Rehab Protocol.