Exercises After Rotator Cuff Surgery: What to Do in Each Phase

Exercises after rotator cuff surgery come in three phases.

First the arm is moved FOR you.
Then you move it yourself.
Then you add resistance.

Roughly, that’s weeks 0 to 6, weeks 6 to 12, and from about 3 months.

Little and often wins.

Short sessions of 5 to 10 minutes, several times a day, beat one long session you have to grit your teeth through. An ache or stretch while you exercise is normal. Intense pain that lasts more than about 30 minutes afterwards means you did too much.

Your surgeon’s protocol comes first, and large tears often wait longer at every step. For the overall timeline, see rotator cuff surgery recovery week by week.

Phase 1: the arm is moved for you (weeks 0 to 6)

The repaired tendon can’t take the pull of its own muscle yet. The aim is to keep the joint moving without asking the cuff to work. Some surgeons start this in the first week or two. Others wait longer after a big repair.

Shoulder blade setting: sitting tall, gently draw the shoulder blade back and down. Hold for 5 to 10 seconds, then relax. No slumping
Neck movements: turn your head side to side, then tilt each ear toward its shoulder. This eases the tension that builds up while you’re in the sling
Pendulums: lean forward, supporting yourself on a table with your good arm, and let the operated arm hang. Rock your body gently so the arm swings in small circles. Your body does the moving and the shoulder muscles stay relaxed
Assisted lifting, lying down: lie on your back, hold a stick with both arms and let the good arm lift the operated one forward. Start small and work toward the height your surgeon allows
Assisted outward turning: lying down with the operated arm tucked against your side, use the stick to gently turn it outward, like opening a door. Don’t push hard in the first two weeks. If the front tendon (the subscapularis) was repaired, follow your surgeon’s limit closely

What not to do early

Don’t lift the arm with its own muscles. This is the whole point of phase 1
Don’t push up out of a bed or chair with the operated arm
Don’t reach behind your back until your physio says so
Don’t force a stretch into sharp pain. Firm and uncomfortable is fine. Sharp and lingering isn’t
Don’t carry anything, even something light held close to your body

Let the other arm, the stick or gravity do the work. The repaired arm comes along for the ride.

Phase 2: you move it yourself (weeks 6 to 12)

Keep up the stick exercises, then move them from lying to sitting and standing, with less help from the good arm each week
Table or wall slides: with a towel under the arm, slide it forward along a table, or up a wall, as far as is comfortable
Lifting on your own: start lying on your back, which is easier on the shoulder, then progress to sitting and standing. If your shoulder hitches up toward your ear, you’ve gone too high. Lower it and build up slowly
Gentle static holds: press into a wall at about a third of your effort without letting the arm move, turning outward and then inward. Hold 10 seconds, 10 times, building up gradually
Reaching behind your back usually comes back gently in this phase, once your physio clears it

The arm will feel weak and clumsy at first. That’s six weeks of not using it, not a failed repair. Some stiffness at this stage is common, and stiff shoulders tend to re-tear less often.

See stiff shoulder after surgery.

Phase 3: strengthening (from about 3 months)

Very light strengthening often starts between 8 and 12 weeks, as the AAOS guide to rotator cuff surgery describes. The real loading builds from about 3 months.

Light band work: turning the arm outward and inward against an elastic band, with the arm by your side first, then with the arm raised
Rows and shoulder blade work, which give the cuff a stable base to work from
Lifting with a light weight, forward and out to the side, staying below shoulder height at first
Overhead and heavy lifting come last. Strength keeps improving for 12 to 18 months, so there’s no prize for rushing

How pain should behave

During exercise: aching, mild discomfort or a stretching feeling is normal
Afterwards: it should settle within about 30 minutes. If intense pain lasts longer, do less next time and tell your physio
The next morning: you should feel no worse than the day before. If you do, cut back the amount, not the frequency
At night: sleep is often rough for six to eight weeks. See how to sleep after rotator cuff surgery

Does starting early make a difference?

Less than people think.

In trials, people who started moving the arm sooner got a little more movement back in the first few months. By a year, pain, function and re-tear rates looked about the same. So there’s nothing to gain by getting ahead of your surgeon’s plan, and nothing lost by following it.

Call your surgeon today if

You felt a pop and suddenly can’t lift the arm, though someone else can still lift it for you
The wound is red, hot, swollen or leaking, or you feel unwell or feverish
Severe pain lasts more than about 30 minutes after your exercises, again and again
You have new numbness or weakness in the arm

Go to the emergency department if

You have chest pain, sudden breathlessness or cough up blood

Mention it at your next appointment if

Stiffness is getting worse week by week instead of better
Pain is stopping you from doing your exercises at all
You’re unsure which exercises you’re allowed to do yet

Moved for you, then moved by you, then moved against weight. Skipping a stage doesn’t save time.