Treatment of Rotator cuff 1. Physiotherapy management for type 1 rotator cuff repair. 2. Physiotherapy management for type 2 rotator cuff repair. 3. Physiotherapy management for type 3 rotator cuff repair. 1. PT management for type 1 rotator cuff repair It includes 5 phases protocol:- a) Phase 1 – (Days 1-10). b) Phase 2 – (Days 11 – week 5). c) Phase 3 – ( Weeks 6 – week 11). d) Phase 4 – (Weeks 12 – week 19). e) Phase 5 – (Weeks 20 – week 26). It includes 5 phases protocol:- Phase 1 – (Days 1-10). Phase 2 – (Days 11 – week 5). Phase 3 – ( Weeks 6 – week 11). Phase 4 – (Weeks 12 – week 19). Phase 5 – (Weeks 20 – week 26).

1. Dr. Prashant Kaushik
BPT, MPT (Sports)
Assistant Professor
KINPMS

2.  Physiotherapy management for type 1 rotator
cuff repair.
 Physiotherapy management for type 2 rotator
cuff repair.
 Physiotherapy management for type 3 rotator
cuff repair.

3.  It includes 5 phases protocol:-
1. Phase 1 – (Days 1-10).
2. Phase 2 – (Days 11 – week 5).
3. Phase 3 – ( Weeks 6 – week 11).
4. Phase 4 – (Weeks 12 – week 19).
5. Phase 5 – (Weeks 20 – week 26).

4.  Candidates for Type 1 Protocol:-
a) Young patients.
b) Excellent tissue quality.
c) Small tear (< 1cm).

5.  Goals:-
i) Maintain integrity of repair.
ii) Gradually increase passive ROM.
iii) Diminish pain and inflammation.
iv) Prevent Muscular inhibition.

6.  Days 1-6:-
(i) Sling.
(ii) Pendulum exercise.
(iii) Active assisted ROM exercise (L-Bar) – External and
internal rotation in scapular plane.
(iv) Passive ROM – Flexion to tolerance, external and internal
rotation in scapular plane.
(v) Elbow/ hand gripping and ROM exercises.
(vi) Sub maximal pain free isometrics – flexion, abduction,
external rotation, internal rotation, and elbow flexors.
(vii) Cryotherapy for pain and inflammation ( ice 15 – 20 min
every hour) .
(viii) Sleeping (in sling).

7.  Days 7-10:-
i) Discontinue sling at days 7-10.
ii) Pendulum exercises ( e.g. flexion, circles).
iii) Progress passive ROM to tolerance – flexion to least 115, external
rotation in scapular plane to 45 – 55 and internal rotation in
scapular plane to 45 -55 degrees.
iv) Active assisted ROM exercises – External rotation, internal
rotation in scapular plane, flexion to tolerance (therapist provides
assistance by supporting arm).
v) Continue elbow/ hand ROM and gripping exercise.
vi) Continue isometrics.
vii) Continue use of ice for pain control.
viii) Sleeping (continue sleeping in sling until physician instructs).

8.  Precautions:-
a) No lifting of objects.
b) No excessive shoulder motion behind back.
c) No excessive stretching or sudden movements.
d) No supporting of body weight by hands.
e) Keep incision clean and dry.

9.  Goals:-
a) Allow healing of soft tissue.
b) Do not overstress healing tissue.
c) Gradually restore passive ROM (weeks 2-3).
d) Reestablish dynamic shoulder stability.
e) Decrease pain and inflammation.

10.  Days 11 – 14:-
a) Passive ROM to tolerance – flexion 0 to 160, external rotation at 90
abduction at least 75 to 80, internal rotation at 90 abduction at
least 55 – 60.
b) Active assisted ROM to tolerance – flexion, external rotation and
internal rotation in scapular plane, external and internal rotation
at 90 degrees abduction.
c) Dynamic stabilization drills ( rhythmic stabilization drills) –
external and internal rotation in scapular plane, flexion and
extension at 100 degree flexion.
d) Continuing isotonic external and internal rotation with tubing.
e) Initiate prone rowing, elbow flexion.
f) Initiate active exercise (flexion – abduction) .
g) Continue use of cryotherapy.

11.  Week 3 – 4:-
a) Patient should exhibit full passive ROM, nearing full active ROM.
b) Continue all exercise listed above.
c) Initiate scapular muscular strengthening program.
d) Initiate side – lying external rotation strengthening (light
dumbbell).
e) Initiate isotonic elbow flexion.
f) Continue use of ice as needed.
g) May use pool for light ROM exercise.

12.  Week 5:-
a) Patient should exhibit full active ROM.
b) Continue active assisted ROM and stretching exercises.
c) Progress isotonic strengthening exercise program – ER
tubing, side lying internal rotation, prone rowing, prone
horizontal abduction, shoulder flexion, shoulder abduction
and biceps curls.

13.  Precautions:-
i) No lifting of heavy objects.
ii) No supporting of body weight by hands and arms.
iii) No sudden jerking motions.

14.  Goals:-
a) Gradual restoration of shoulder strength and power.
b) Gradual return to functional activities.

15.  Weeks 6 – 7:-
a) Continue stretching and passive ROM (as needed to
maintain full ROM).
b) Continue dynamic stabilization drills.
c) Progress isotonic strengthening program.
d) If physician permits, the patient may initiate light functional
activities.

16.  Weeks 8 – 11:-
a) Continue all exercises listed above.
b) Progress to fundamental shoulder exercises.
c) Initiate interval golf program (slow rate of progression).

17.  Goals:-
a) Maintain full non painful active ROM.
b) Enhance functional use of upper extremity.
c) Improve muscular strength and power.
d) Gradual return to functional activities.

18.  Weeks 12:-
a) Continue ROM exercises and stretching to maintain full
ROM.
b) Self capsular stretches.
c) Progress shoulder strengthening exercises to fundamental
shoulder exercises.
d) Initiate swimming or tennis program ( if appropriate).

19.  Week 15:-
a) Continue all exercise listed above.
b) Progress golf program to playing golf (if appropriate).

20.  Goals:-
a) Gradual return to strenuous work activities.
b) Gradual return to recreational sport activities.

21.  Week 20 – 26:-
a) Continue fundamental shoulder exercise program (at least
four time/wk).
b) Continue stretching if motion is tight.
c) Continue progression to sport participation.

22.  It includes :-
a) Phase 1 – Immediate post surgical phase – Days 1 – Days 10.
b) Phase 2 – Protection phase – Days 11 – Weeks 6.
c) Phase 3 – Intermediate Phase – Weeks 7 – Weeks 14.
d) Phase 4 – Advanced strengthening Phase – Weeks 15 –
Weeks 22.
e) Phase 5 – Return to activity Phase – Weeks 23 – Weeks 30.

23.  Candidates for type 2 Rehabilitation:-
a) Medium to large tear.
b) Active patients.
c) Good tissue quality.

24.  Goals:-
a) Maintain integrity of the repair.
b) Gradually increase passive ROM.
c) Diminish pain and inflammation.
d) Prevent muscular inhibition.

25.  Days 1 – 6:-
a) Sling or abduction brace (physician’s decision).
b) Pendulum stretches.
c) Active assisted ROM exercises (L – Bar) – External and
internal rotation in scapular plane.
d) Elbow/hand gripping and ROM exercises.
e) Sub maximal pain free isometrics.
f) Cryotherapy for pain and inflammation (ice 15 – 20 min
every hour).
g) Sleeping in sling or brace.

26.  Days 7 – 10:-
a) Discontinue brace at days 10 – 14.
b) Pendulum exercises (e.g. flexion, circles).
c) Progress passive ROM to tolerance.
d) Active assisted ROM Exercise (L – Bar).
e) Continue elbow/hand ROM and Griping exercises.
f) Continue isometrics.
g) Continue use of ice for pain control (at least six to seven
times daily).
h) Sleeping (in brace until physician instructs).

27.  Precautions:-
a) No lifting heavy weight.
b) No excessive shoulder extension.
c) No excessive stretching or sudden movements.
d) No supporting of body weight by hands.
e) Keep incision clean and dry.

28.  Goals:-
a) Allow healing of soft tissue.
b) Do not overstress healing tissue.
c) Gradually restore full passive ROM (week 4 – 5).
d) Reestablish dynamic shoulder stability.
e) Decrease pain and inflammation.

29.  Days 11 – 14:-
a) Discontinue use of sling and brace.
b) Passive ROM to tolerance.
c) Active assisted ROM to tolerance.
d) Dynamic stabilization drills (i.e., rhythmic stabilization drills).
e) Continue all isometric contractions.
f) Continue use of cryotherapy as needed.
g) Continue all precautions.

30.  Weeks 3 – 4:-
a) Patients should exhibit full passive ROM.
b) Continue all exercises listed above.
c) Initiate gentle external and internal rotation strengthening using exercise
tubing at 0 degrees of abduction.
d) Initiate manual resistance external rotation supine in scapular plane.
e) Initiate prone rowing to neutral arm position.
f) Initiate isotonic elbow flexion.
g) Continue use of ice as needed.
h) May use heat before ROM exercises.
i) May use pool for light ROM exercises.

31.  Weeks 5 – 6:-
a) May use heat prior to exercises.
b) Continue active assisted ROM and stretching exercises.
c) Initiate active ROM exercises.
d) Progress isotonic strengthening exercise program.

32.  Precautions:-
a) No heavy lifting of objects.
b) No excessive behind – the – back movements.
c) No supporting of body weight by hands and arm.
d) No sudden jerking motions.

33.  Goals:-
a) Full Active ROM (weeks 8 – 10).
b) Full passive ROM.
c) Dynamic shoulder stability.
d) Gradual restoration of shoulder strength and power.
e) Gradual return functional activities.

34.  Week 7:-
a) Continue stretching and passive ROM (as needed to
maintain full ROM).
b) Continue dynamic stabilization drills.
c) Progress strengthening program.

35.  Weeks 8 :-
a) Continue all exercise listed above.
b) If physician permits, may initiate light functional activities.
 Weeks 14:-
a) Continue all exercise listed above.
b) Progress to fundamental shoulder exercises.

36.  Goals:-
a) Maintain full non – painful ROM.
b) Enhance functional use of upper extremity.
c) Improve muscular strength and power.
d) Gradual return to functional activities.

37.  Week 15 :-
a) Continue ROM and stretching to maintain full ROM.
b) Self capsular stretches.
c) Progress shoulder strengthening exercises to fundamental
exercises.
d) Initiate interval golf program.

38.  Week 20:-
a) Continue all exercises listed above.
b) Progress golf program to playing golf (if appropriate).
c) Initiate interval tennis program (if appropriate).
d) May initiate swimming.

39.  Goals:-
a) Gradual return to strenuous work activities.
b) Gradual return to recreational sport activities.

40.  Week 23:-
a) Continue fundamental shoulder exercises program (at least
four time/wk).
b) Continue stretching, if motion is tight.
c) Continue progression to sport participation.

41.  It includes:-
a) Phase 1 – Immediate Postsurgical Phase – (Days 1 – 10).
b) Phase 2 – Protection Phase – (Days 11 – Week 6).
c) Phase 3 – Intermediate Phase – (Week 7 – Week 14).
d) Phase 4 – Advanced Strengthening Phase – (Week 15 –
Week 22).
e) Phase 5 – Return to Activity Phase – (Week 23 – Week 30).

42.  Candidates for Type 3 Rehabilitation:-
a) Large to Massive Tear.
b) Poor tissue quality.
c) Tenuous repair.

43.  Goals:-
i) Maintain integrity of the patient.
ii) Gradually increase passive ROM.
iii) Diminish Pain and inflammation.
iv) Prevent muscular inhibition.

44.  Days 1 – 6:-
i) Sling or slight abduction brace ( physician’s Decision).
ii) Pendulum exercises.
iii) Active assisted ROM exercise (L-Bar).
iv) Passive ROM.
v) Elbow/ Hand gripping and ROM exercises.
vi) Sub maximal gentle isometrics.
vii) Cryotherapy for pain and inflammation ( ice 15 – 20
min/hours).
viii) Sleeping (in sling or brace).

45.  Days 7 – 10:-
i) Continue use of brace or sling.
ii) Pendulum exercises (e.g. flexion, circles).
iii) Progress passive ROM and griping exercises.
iv) Continue elbow / hand ROM and gripping exercises.
v) Continue sub maximal isometrics.
vi) Continue use of ice for pain control (at least six to seven
times daily.
vii) Sleeping (in brace until physician instructs).

46.  Precautions:-
i) Maintain arm in brace, remove only for exercises.
ii) No lifting of objects.
iii) No excessive shoulder extension.
iv) No excessive or aggressive stretching or sudden
movements.
v) No supporting of body weight by hands.
vi) Keep incision clean and dry.

47.  Goals:-
i) Allow healing of soft tissue.
ii) Do not overstress healing tissue.
iii) Gradually restore full passive ROM (week 4 – 5).
iv) Reestablish dynamic shoulder stability.
v) Decrease pain and inflammation.

48.  Days 11 – 14:-
i) Continue use of brace.
ii) Passive ROM to tolerance.
iii) Active assisted ROM to tolerance.
iv) Continue all isometric contractions.
v) Continue use of cryotherapy as needed.
vi) Continue all precautions.

49.  Weeks 3 – 4:-
i) Initiate active assisted ROM flexion supine (therapist supports arm during motions).
ii) Continue all exercises listed above.
iii) Initiate external and internal rotation strengthening using exercise tubing at 0 degree of
abduction.
iv) Progress passive ROM till approximately full ROM at weeks 4 – 5.
v) Initiate prone rowing to neutral arm position.
vi) Continue use of ice as needed.
vii) May use heat prior to ROM exercises.
viii) May use pool for light ROM exercises.
ix) Continue use of brace during sleeping until end of week 4.
x) Discontinue use of brace at end of week 4.

50.  Weeks 5 – 6:-
i) May use heat prior to exercise.
ii) Continue active assisted ROM and stretching exercises.
iii) Initiate ROM exercises.
iv) Progress to isotonic strengthening exercise program.

51.  Precautions:-
i) No lifting.
ii) No excessive behind the back movements.
iii) No supporting of body weight by hands and arms.
iv) No sudden jerking motions.

52.  Goals:-
i) Full active ROM (Weeks 10 -12).
ii) Maintain full passive ROM.
iii) Dynamic shoulder stability.
iv) Gradual restoration of shoulder strength and power.
v) Gradual return to functional activities.

53.  Weeks 7:-
i) Continue stretching and passive ROM (as needed to
maintain full ROM).
ii) Continue dynamic stabilization drills.
iii) Progress strengthening program.

54.  Week 10:-
i) Continue all exercises listed above.
ii) If physician permits, may initiate light functional activities.
 Week 14:-
i) Continue all exercise listed above.
ii) Progress to fundamental shoulder exercises.

55.  Goals:-
i) Maintain full no painful ROM.
ii) Enhance functional uses of upper extremity.
iii) Improve muscular strength and power.
iv) Gradual return to functional activities.

56.  Week 15:-
i) Continue ROM and stretching to maintain full ROM.
ii) Self capsular stretches.
iii) Progress shoulder strengthening exercises to fundamental
shoulder exercises.
 Week 20:-
i) Continue all exercises listed above.
ii) Continue to perform ROM stretching, if motion is not complete.

57.  Goals:-
i) Gradual return to strenuous work activities.
ii) Gradual return to recreational sport activities.
 Week 23:-
i) Continue fundamental shoulder exercise program (at least
four time/wk).
ii) Continue stretching, if motion is tight.

58.  Week 26:-
i) May initiate interval sport program (e.g., golf).