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What is the REAL Recovery Process After Rotator Cuff Surgery?


A common question that I often get as an occupational therapist and certified hand therapist is, what’s the real recovery process after a rotator cuff repair? My name is Hoang. I’m an occupational therapist, certified hand therapist, and I work with shoulder injuries and shoulder rotator cuff repairs all the time. So I’m gonna give you my take on the recovery process after rotator cuff repair. So, you know, there’s a few variations.

What is the recovery process from a rotator cuff repair? 

Rotator cuff encompasses four muscles that are part of your shoulder complex that hold the ball into the socket. So, the four muscles essentially compress that ball into the socket so your shoulder can move really well and can move really well without pain. So, a lot of times we have one particular muscle that is torn the most. It’s called your supraspinatus tendon. And that tendon, so if you have a muscle, at the end of each muscle is a tendon, and that supraspinatus muscle has a tendon and that tendon tends to ride right underneath this acromion, like, this little bone and the ball is there. And so a lot of times, over time that ball and the scapula, the acromion, it doesn’t align and sit very well.

So what happens is over time it can hit and you can have a wear and tear type of rotator cuff tear. Or you might have had an injury of some sort, like, if you fell and you put your arms out or you were doing some heavy lifting, you’re pulling or pushing in the end ranges, like, women do this all the time. We carry our purse and we reach out back like this to put our purse on the weight of it over time. If you have kids, I did this all the time. I would reach back for my kids. And so after a certain period of time, you can, one, create a wear and tear or, two, you can have an incident that then tore your rotator cuff. Now, it’s usually just one muscle, but sometimes you might tear the other one. A lot of times it might be your subscapularis, which is a muscle that’s in the front. That’s a really big, thick muscle too, but there’s variations of tears depending on your injury. But here is the recovery process.

What does the Rotator recovery recovery process look like?

I’m gonna explain to you really simply what I talked through with my own patients. Every surgeon might have their own protocol or the way they prefer to do things. I’ll know about them. You’re gonna have to go talk to your surgeon. That’s what I tell my patients, “Talk to your surgeon and ask them what’s their protocol.” If you are working with a therapist that you know and like, ask them what their preferred protocol is. I’ll share with you my preferred protocol. And this is the one that when I have a chance, I talk to the surgeons and I say, “Hey, you know, can we do this protocol because I get great results with this.” I get great results. And of course, it depends on the quality of the repair, the quality of the tendon. So when you talk with a surgeon, if they see the quality of your tendon looks really good, they might start you along this protocol. If the quality of your tendon is not that great or sometimes they might talk about and say they have to anchor your tendon down either with one screw, sometimes they have to anchor it down with two screws.

So, some surgeons if you anchor it down with two screws, it means, like, oh, it’s a little bit more severe, and that you have to slow it down, But that doesn’t, you know… Essentially to me, it’s the same. Like if you have your muscle and your tendon and it pulled back, and then now you anchor it down, once you’re anchored down, you’re solid, you’re good, And now we just have to take care of it so the muscle isn’t pulling and pulling and pulling on that repair. You have to give it a certain amount of downtime. So, the very first week, it can be quite painful, you’re gonna be in a sling. It’s really important if you have an opportunity to work with a therapist beforehand so they can show you how to safely get dressed, how to safely put your sling on and off, get in and out of bed. How to lay down in position, because all of those things are, really, at the end of the day, very important to reduce the amount of pain you have.

When I work with my patients, and I work with them before they have the surgery, that is exactly what I go through. I show them how to safely take their shirts on and off without moving their arm, without stressing the repair. And sleeping is really huge. Sometimes people are like, “Oh, sleep in a recliner.” But sleeping in a recliner can often make your back and shoulders really tight, which then contributes to how much shoulder pain you have, because it’s this position, You’re in a slumped position, and 100% if your back hurts, you’re gonna slow your shoulder process down. And your muscles are connected., being able to sleep flat is the most ideal. So, talk to someone about what that looks like in the first week to two weeks.

And then my preferred method is, let’s get started with passive range of motion early. So, the reason why passive range of motion early is really important is because we have to make sure that we have tissue around that joint, and it gets tight when you don’t move. So passive range of motion allows a very gentle stretch of that capsule, but yet does not pull on the repair, So, that’s really key, passive range of motion. So, passive range of motion means that your therapist is doing the movement and you as the patient, you are not helping, That is pure passive range of motion. If you can relax and trust someone else to do pure passive range of motion, you actually don’t have pain. How do I know this? I’ve seen it and I’ve done it. So, if you can do passive range of motion in the first, you know, by day five, day seven, you start with a passive range of motion regimen. The therapist can also teach you on how you can participate in some of the passive range of motion where it’s called Codman’s or pendulum types of exercises, where you literally just stand and then you just hang your arm like this.

There’s a very passive way to do it. And in my experience as a therapist of, like, over 20-plus years, every single time I work with someone and teach them how to do it, and they’ve done it with someone like the doctor’s office teaches them how to do it, they do it wrong. If it hurts you, you’re doing it wrong because that is one of the most passive things to do and it should not hurt, So, there’s ways to do a very passive range of motion movements that don’t hurt. So, the goal is to gain passive movement without pain. So, we can go for about four weeks, right, three to four weeks, and then you start doing an active range of motion. So, active range of motion means, like, your shoulder is very loosey-goosey, your scapula is moving really well, And you have minimal pain, and then we’re gonna start to move actively against gravity. So, there’s different ways to do it. If you’re laying down, and you lift your arm up like this, then that’s active movement, but with gravity eliminated.

So, all of our muscles don’t line up all the same, some go across our bodies. So, the way you’re positioned makes a big difference. Laying face up, laying on the side, laying on your belly, there’s many positions where…sitting up or standing, these make a difference in terms of how you would progress. And there’s a lot of steps to it. And it’s just based on your progress and how your therapist should be able to take you through those steps. But over a period of weeks, you should start to slowly gain active range of motion. I think one of my best candidates, he was in his 70s, and he had a rotator cuff tear. He came in at, like, day five and we did a passive range of motion, making sure everything was moving really well. By the time he was able to move, he was allowed to move, he was moving. He didn’t have any stiffness. You want a little stiffness to work through, but you don’t want a lot of stiffness to work through. A lot of stiffness to work through means that you might be at risk for a frozen shoulder, right? So, he was great.

Once we started doing active range of motion, then we were able to do active range of motion against gravity and do more complex types of exercises to make sure his shoulder was moving in all directions with no problems. And then by week eight, so by two months, we were allowed to start doing gentle strengthening. Was it eight weeks? So, it’s four weeks, and then eight weeks you start to do gentle strengthening. By 3 months, right, by 12 weeks, you can start doing even more, You can start doing even more strengthening and progress to what’s called proprioceptive or plyometrics exercise where there’s, like, this kind of, like, stop and go types of movements, which your joints really need to relearn how to move and how to move well, so you don’t hurt yourself, But you still at the three-month mark, still have to be cautious and still have to strengthen in a way that can prevent re-occurrence or re-tears. I’ve had a woman in her 80s and I’ve had a guy in his 40s go back to very sports-specific activities or go too heavy, too hard, too fast and have retorn.

So, work with your therapist and make sure, you know, if you’re doing really, really well sometimes with tendons, we have to slow it down a little bit because probably you can hurt yourself. This woman in her 80s she was a tennis player and she did really well. So, she went back to playing tennis but she went back to playing real tennis, like, over the head, hit the ball. And essentially, she retore her rotator cuff. I had a young guy go back to heavy lifting. And you know, he did amazing in therapy. And you know, did the warning, “Hey, don’t go too heavy too fast. You gotta work on this.” But he only needed about two months of therapy, two and a half months of therapy. And he was like, “I’m good. I’m gonna go do my strength thing on my own.” But see, he was missing that plyometric, that proprioceptive types of exercises to really make sure his muscles and his joints knew how to work when you’re doing this stuff and go and you’re doing heavier weights. And he unfortunately, he retore as well.

How long does it take to recover from rotator cuff surgery?

After the surgery, a minimum of three months recovery process. Majority of the time people need a little bit longer. So, sometimes you need a little bit longer, like six months, some people get really stiff, and so they need almost up to a year for 100% recovery, 100% recovery. You feel like, “I’m good. I got nothing wrong.” So, it’s totally possible for you to have 100% recovery if you only have a rotator cuff tear. If you continue to have pain, usually it’s because something is not moving well in the joint and you wanna discover what it is and you want to be able to work in the right direction. So, if you have pain going up and going up all the time, maybe the exercise that you need to do is not to keep going up, but you and your therapist can discover in which part is your capsule really tight.

So, your capsule is like a circle, Here, I’m gonna draw. Your capsule is kind of like a circle, And at the top it’s the acromion, is the bone.. But a lot of times, the capsule on the bottom and the capsule in the back can get really, really tight. And so then the ball sits a little bit too far forward. So, like, even a smidge of how your bone is sitting is due to the fact that your muscles are not well-balanced, It’s not to say you’re weak, a lot of people are strong, but it’s strength in comparison to other muscles. So, in that shoulder, because I’ve worked with really strong people. I’ve worked with people who are just normal like me, like, barely, you know, have strength, barely have muscles. But it is in comparison to yourself, not in comparison to anyone else. So, I think strong people have really, really strong muscles in certain places, but then the weaker muscles tend to want to be weaker, they’re naturally weaker. So, we just, in comparison to those strong muscles, have to get those little muscles a little bit stronger.

So, you have 20% of people who can recover in 3 months, very small. I would say 10% to 15% people recover. And then your other, you know, 20% is, like, “Oh, my God, I got stuck. I need another surgery. I have a frozen shoulder.” Very small percentage of people that can happen, Majority of the bulk of the people, bulk of the people are going to need, you know, a minimum of six months, like, the three to six months. Three months is like really fast, to be honest, but, like, a good solid six months. You don’t have to be in therapy that long. I’m just saying for you to feel really good. But the first three months are gonna be essential to move you through the phases of therapy. And then based on how stiff you are, or how weak you might be feeling, or what kind of activities you want to get back to might indicate that you might need a little bit more time. But, yeah.

So, I hope this helps you to have a real good understanding of the recovery process after a rotator cuff tear, after a rotator cuff repair. And I would highly recommend, you know, finding that trusted therapist in your town, in your area. My name is Hoang. If you are in Miami, Florida, my clinic is located in Doral. It’s called Hands On Therapy Services. We work with people with shoulder injuries, rotator cuff repairs all the time. So, you know, give us a call, come talk to our therapists.

Whether you’re considering surgery, have recently undergone the procedure, or feel you’ve reached a plateau in your current therapy, our team of experts can provide personalized guidance and support.

A successful recovery after a rotator cuff repair is entirely possible. By following a tailored plan and working with experienced professionals, you can regain full mobility and strength in your shoulder. 

CLICK HERE! to watch the YT video

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About Hoang Tran – an expert in physical & occupational therapy  

Hoang Tran is a Miami certified hand therapist , the owner of Hands-on Therapy Services and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!). 

The aim of her occupational therapy practice is to bring patients back to full functionality, without pills, injections or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care. 

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