Inner West Allied Health and Specialist Centre
24/7 physiotherapy keeps you moving well

Rotator Cuff Tear/Surgery Rehabilitation Exercise Program

Please call 95183400 to make an appointment for rotator cuff rehab

Do I need surgery for my rotator cuff tear??



 
A: crescent shaped tear     B: U shaped tear                C: L shaped tear

Your prognosis for recovery from a rotator cuff tear is determined by:

Shape of the tear: U shaped or crescent shaped tears will not heal without surgery as muscle activation will pull on the torn fibres.


traumatic vs degenerative: a severe tear of a healthy tendon from a traumatic event will respond well to surgical reattachment. A degenerating tendon tends to fray and slowly tear and by the time it ruptures the quality of the tissue is poor. 

Degenerative rotator cuff tears also tend to coexist with poor muscle bulk (muscle atrophy) and fatty infiltration of the one or more rotator cuff muscles. These tears respond poorly to surgery. The image below is an MRI sagittal plane of the rotator cuff. this image indicates a tear to the supraspinatus (SS). Note that the infraspinatus (IS) has become atrophied and infiltrated with fatty tissue. 


    

The drawings above represent the classification given to rotator cuff fatty infiltration seen on the corresponding MRI.


When you attend our practice the physiotherapist can clinically determine the extent of your injury and the prognosis for full recovery.


A rehab strengthening and stabilization program will be formulated for degenerative tears and a three phase rehab program will be used for post operative patients.


The goals for your  post operative rehab are:


 

1: Optimize healing (avoid re-tears!)

 

2: Mobilize the joint as early as possible

 

3: Load the repaired  tendons safely

 

4: Strengthen the rotator cuff muscles progressively


Phase 1: up to 6 weeks post op: passive range of motion exercises in 3 planes 


Phase 2: from 6-12 weeks post op: active range of motion exercises in 3 planes 


Phase 3: from 12 weeks post op: strengthening of rotator cuff and periscapular muscles. Particular care is taken in this phase not to impinge the tendon on the acromion so no strenthening over the horizontal plane takes place at this time. particular care is taken at this phase to avoid retear of tendon


Phase 4: 6 months post op: sport specific strength and coordination training


What next? from 6 months onwards if you have performed your exercises safely and progressively you are finished! Hooray! You can now  enjoy your lifestyle and quality of life and enjoy the benfits of a very strong shoulder!




Rehabilitation exercises for rotator cuff tears, tendonitis and impingement syndrome


 After an injury or surgery an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Performing a formulated conditioning program will also help you return to sports and other recreational activities.

This is a general conditioning program that provides a wide range of exercises. To ensure that the program is safe and effective for you, it should be performed under your physiotherapist's supervision.


Strength: Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Keeping these muscles strong can relieve shoulder pain and prevent further injury.


Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.


The following exercises are a resource for patients of the clinic to refer to following consultation with your physio post injury or surgery. You will be instructed specifically which exercises you should be performing and the load/frequency will be monitored and modified accordingly. Please do not continue an exercise if it is aggravating your injury and please inform your physio if you have any concerns or feedback regarding the exercises.


This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should contact their physiotherapist.








Exercise 1: Sleeper Stretch

Main muscles worked:  Infraspinatus,teres minor
You should feel this stretch in your outer upper back, behind your shoulder

Equipment needed:  None

Repetitions:  4 reps, 3x a day 
Days Per Week:  Daily

Step-by-step directions

  • Lie on your side on a firm,flat surface with the affected shoulder under you and your arm bent, asshown. Use your unaffected arm to push your other arm down. Stop pressingdown when you feel a stretch in the back of your affected shoulder.
  • Hold this position for 30seconds, then relax your arm for 30 seconds.
Tip:  Do not bend yourwrist or press down on your wrist.







Exercise 2: Crossover Arm Stretch

Main muscles worked:  Posteriordeltoid
You should feel this stretch at the back of your shoulder

Equipment needed:  None

Repetitions:  4 each side
Days Per Week:  5 to 6

Step-by-step directions

  • Relax your shoulders andgently pull one arm across your chest as far as possible, holding at yourupper arm.
  • Hold the stretch for 30seconds and then relax for 30 seconds.
  • Repeat with the other arm.
Tip:  Do not pull or putpressure on your elbow. 










Exercise 3: Standing Row

Main muscles worked:  Middle andlower trapezius
You should feel this exercise at the back of your shoulder and into yourupper back

Equipment needed:  Usetheraband of moderate resistance. As the exercise becomes easier to perform,progress to 3 sets of 12 repetitions. This exercise can also be performed on aweight machine.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Make a 1-1.5m loop with theelastic band and tie the ends together. Attach the loop to a doorknob orother stable object.
  • Stand holding the band withyour elbow bent and at your side, as shown in the start position.
  • Keep your arm close to yourside and slowly pull your                                                                                                  elbows back                                                                                                                                                                                Slowly return to the startposition and repeat.
                                                                                                       Tip:  Squeeze your shoulderblades together as you                                                                                                                 pull.





Exercise 4: External Rotation with Arm Abducted 90 degrees

Main muscles worked:  Infraspinatusand teres minor
You should feel this exercise at the back of your shoulder and into yourupper back

Equipment needed:  Usetheraband with moderate resistance (you can get different resistance bands from your physio)  . As the exercise becomes easier to perform,progress to 3 sets of 12 repetitions. This exercise can also be performed on aweight machine.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Make a 1-1.5m long loop withthe theraband and tie the ends together. Attach the loop to a doorknob orother stable object.
  • Stand holding the band withyour elbow bent 90° and raised to shoulder-height, as shown in the startposition.
  • Keeping your shoulder andelbow level, slowly raise                                                                                                 your hand until it is in line with your head                                                                                                    Slowly return to the startposition and repeat.
                                                                                                Tip:  Make sure your elbowstays in line with your shoulder.





Exercise 5: Internal Rotation

Main muscles worked:  Pectoralis,subscapularis
You should feel this exercise at your chest and shoulder

Equipment needed:  Usetheraband of moderate resistance. As the exercise becomes easier to perform,progress to 3 sets of 12 repetitions. This exercise can also be performed on aweight machine.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Make a 1-1.5m long loop withthe therabandband and tie the ends together. Attach the loop to a doorknobor other stable object.
  • Stand holding the band withyour elbow bent and at your side, as shown in the start position.
  • Keep your elbow close toyour side and bring your arm across your body.
  • Slowly return to the startposition and repeat.

                                                                                                        Tip:  Keep your elbow pressed into yourside.




Exercise 6: External Rotation

Main muscles worked:  Infraspinatus,teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper back

Equipment needed:  Usetheraband of moderate  resistance. As the exercise becomes easier toperform, progress to 3 sets of 12 repetitions. This exercise can also beperformed on a weight machine.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Make a 1-1.5m long loop withthe theraband and and tie the ends together.
  • Attach the loop to adoorknob or other stable object.
  • Stand holding the band withyour elbow bent and at your side, as shown in the start position.
  • Keeping your elbow close toyour side, slowly rotate your arm outward.
  • Slowly return to the startposition and repeat.

                                                                                                Tip:  Squeeze your shoulder bladestogether when you pull                                                                                                     your elbow back.


 

 


Exercise 7: Biceps Curls

Main muscles worked:  Biceps
You should feel this exercise at the front of your upper arm

Equipment needed:  Begin with aweight that allows 3 sets of 8 repetitions and progress to 3 sets of 12repetitions. As the exercise becomes easier, add weight in 1kg increments untilyou reach your maximum. Each time you increase the weight, start again at 3sets of 8 repetitions.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Stand tall with your weightevenly distributed over both feet.
  • Keep your elbow close toyour side and slowly bring the weight up as shown                                                                                                     Hold for 2 seconds                                                                                                     Slowly return to thestarting position and repeat.

                                                                                                    Tip:  Do not do the exercise tooquickly or swing your arm.





Exercise 8: Tricep Curls

Main muscles worked:  Triceps
You should feel this exercise at the back of your upper arm

Equipment needed:  Begin with aweight that allows 3 sets of 8 repetitions and progress to 3 sets of 12repetitions. As the exercise becomes easier, add weight in 1kg increments toyour maximum. Each time you increase the weight, start again at 3 sets of 8repetitions.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Stand tall with your weightevenly distributed over both feet.
  • Raise your arm and bend yourelbow with the weight behind your head.
  • Support your arm by placingyour opposite hand on your upper arm                                                                                                    Slowly straighten your elbowand bring the                                                                                                   weight overhead Hold for 2 seconds                                                                                                    Slowly lower your arm backdown behind                                                                                                     your head and repeat.
                                                                                                        Tip:  Keep your abdominalmuscles tight and do not                                                                                                         arch your back




Exercise 9: Trapezius Strengthening

Main muscles worked:  Middle and posterior deltoid,supraspinatus, middle trapezius
You should feel this exercise at the back of your shoulder and into yourupper back

Equipment needed:  Begin with a light enough weight to allow 3to 4 sets of 20 repetitions without pain. As the exercise becomes easier toperform, add 1kg of weight, but do fewer repetitions. Progress to 3 sets of15 repetitions at each weight increment.

Repetitions:  3sets of 20 
Days Per Week:  3 to 5

Step-by-step directions

  • Place your knee on a benchor chair and lean forward so that your hand reaches the bench and helpssupport your weight. Your other hand is at your side, palm facing yourbody.
  • Slowly raise your arm,rotating your hand to the thumbs-up position and stopping when your handis shoulder height, with your arm parallel to the floor.
  • Slowly lower your arm tothe original position to a count of 5.

Tip:  Usea weight that makes the last few repetitions difficult, but pain-free.




Exercise 10: Scapular setting

Main muscles worked:  Middle trapezius, serratus
You should feel this exercise in your upper back, at your shoulder blade

Equipment needed:  None to start then add a 1kg dumbell

Repetitions:  10 
Days Per Week:  3

Step-by-step directions

  • Lie on your stomach withyour arms by your sides.
  • Place a pillow under yourforehead for comfort, if required.
  • Gently draw your shoulderblades together and down your back as far as possible.
  • Ease about halfway offfrom this position and hold for 10 seconds.
  • Relax and repeat 10 times.

Tip:  Donot tense up in your neck.





Exercise 11: Scapular Retraction and Protraction

Main muscles worked:  Middletrapezius, serratus
You should feel this exercise in your upper back at your shoulder blade

Equipment needed:  Begin with aweight that allows 2 sets of 8 to 10 repetitions and progress to 3 sets of 15repetitions. As the exercise becomes easier, add weight in 1kg increments untilyou reach your maximum. Each time you increase the weight, start again at 2sets of 8 to 10 repetitions.

Repetitions:  2 sets of 10 
Days Per Week:  3

Step-by-step directions

  • Lie on your stomach on atable or bed with your injured arm hanging over the side.
  • Keep your elbow straight andlift the weight slowly by squeezing your shoulder blade toward theopposite side as far as possible                                                                                                   Return slowly to thestarting position and repeat.
                                                                                                        Tip:  Do not shrug yourshoulder toward your ear. 




Exercise 13: Internal and External Rotation

Main muscles worked:  Internalrotation: anterior deltoid, pectoralis, subscapularis, latissimus.
External rotation: posterior deltoid, infraspinatus, teres minor
You should feel this exercise in the front and back of your shoulder, yourchest, and upper back

Equipment needed:  Begin with alight enough weight to allow 3 to 4 sets of 20 repetitions without pain. As theexercise becomes easier to perform, add 1kg of weight, but do fewerrepetitions. Progress to 3 sets of 15 repetitions at each weight incrementuntil you reach your maximum weight.

                                                                                                        Repetitions:  3 to 4 sets of 20 
                                                                                                        Days Per Week:  3 to 5

                                                                                                        Step-by-step direction                                                                                                          Lie on your back on a flatsurface                                                                                                          Extend your arm straight outfrom the shoulder and                                                                                                         bend the elbow 90° so that your fingers are pointedup                                                                                                          Keeping your elbow bent andon the floor, slowly move                                                                                                         your arm in the arc shown. Bring your elbow downto a                                                                                                         45° angle if you experience pain at 90°.

                                                                                                        Tip:  Use a weight thatmakes the last few repetitions                                                                                                         difficult, but pain-free.





Exercise 12: Prone Horizontal Extension

Main muscles worked:  Middle andlower trapezius, Infraspinatus, teres minor, posterior deltoid
You should feel this exercise at the back of your shoulder and into yourupper back

Equipment needed:  Begin with aweight that allows 3 sets of 8 repetitions and progress to 3 sets of 12repetitions. As the exercise becomes easier, add weight in 1kg increments toreach your maximum. Each time you increase the weight, start again at 3 sets of8 repetitions.

Repetitions:  3 sets of 8 
Days Per Week:  3

Step-by-step directions

  • Lie on your stomach on atable or bed with your injured                                                                                                   arm hanging over the side                                                                                                    Keep your arm straight andslowly raise it up to eye                                                                                                   level.                                                                                                   Slowly lower it back to thestarting position and repeat.
                                                                                                        Tip:  Control the movementas you lower the weight. 






Exercise 14: External Rotation in Side Lying

Main muscles worked:  Infraspinatus, teres minor, posteriordeltoid
You should feel this stretch in the back of your shoulder and upper back

Equipment needed:  Begin with weights that allow 2 sets of 8to 10 repetitions and progress to 3 sets of 5 repetitions. As the exercisebecomes easier, add weight in 1kg increments until you reach your maximumweight. Each time you increase the weight, start again at 2 sets of 8 to 10repetitions.

Repetitions:  2sets of 10 
Days Per Week:  3

Step-by-step directions

  • Lie on your side on afirm, flat surface with your unaffected arm under you, cradling yourhead.
  • Hold your injured armagainst your side as shown, with your elbow bent at a 90° angle.
  • Keep your elbow againstyour side and slowly rotate your arm at the shoulder, raising the weightto a vertical position.
  • Slowly lower the weight tothe starting position to a count of 5.

Tip:  Donot let your body roll back as you raise the weight.





Exercise 15: Internal Rotation in Side Lying

Main muscles worked:  Subscapularis,teres major
You should feel this stretch in the front of your shoulder

Equipment needed:  Begin withweights that allow 2 sets of 8 to 10 repetitions and progress to 3 sets of 5repetitions. As the exercise becomes easier, add weight in 1kg increments toyour maximum weight. Each time you increase the weight, start again at 2 setsof 8 to 10 repetitions.

Repetitions:  2 sets of 10 
Days Per Week:  3

Step-by-step directions

  • Lie on a firm, flat surfaceon the side of your affected arm.
  • Place a pillow or foldedcloth under your head to keep your spine straight.
  • Hold your injured armagainst your side as shown, with your elbow bent at a 90° angle.
  • Keep your elbow bent andagainst your body and slowly rotate your arm at the shoulder, raising                                                                                                    the weight to a vertical position                                                                                                    Slowly lower the weight tothe starting position.
                                                                                                    Tip:  Do not let your bodyroll back as you raise the weight.