Phases in Physical Therapy after Rotator Cuff Impingement Repair

Impingement is one of the most common syndromes among adults and athletes. Rotator cuff impingement is especially problematic, as it will impair your ability to do some activities; especially those involve your shoulders, such as dressing, combing, sewing, and even eating and drinking. To overcome the situation, rotator cuff impingement repair surgery may be required. Physical therapy after rotator cuff impingement repair is needed later, in order to rehab your shoulders and restore its functions. It has some phases. The phases are generally categorized based on the number of weeks after rotator cuff impingement repair. Each phase has specific goals and targets to meet. The end purpose of those phases is to fully restore patients’ ability in using their arms and shoulders. Patients can progress from one phase to another after being able to achieve targets of each phase. The phases of physical therapy after rotator cuff impingement repair are elaborated below. 

Physical therapy after rotator cuff impingement repair can be divided into some phases. Phase I of physical therapy is normally performed during first several weeks after surgery (around 0-3 weeks post-surgery). This phase is crucial, as there is a great risk of re-injury. You will also still feel some pains in your shoulders. Thus, you will need some assistance in accomplishing your daily tasks. The focus of Phase I is to reduce pain and swelling, relieve pain, activate stabilizing muscles, as well as to regain full passive assistive range of motion (PROM) and active assistive range of motion (AAROM). In this phase, patients must avoid activities that impose great risks of injury (e.g. running, jumping, and heavy lifting), use sling to support their shoulders, and get enough rests to reduce inflammation. Some suggested therapeutic exercises include hand gripping, gentle shoulders movements, and some postural exercises. Cardiovascular fitness like walking and riding stationary bike are also recommended. Gentle massage and cold compression to reduce and relieve pain may also be provided by your physical therapist.

Phase II of physical therapy after rotator cuff impingement repair has different focus. As patients have regained their full PROM and AAROM in Phase I, they can progress to this phase. Phase II is usually performed 4-5 weeks after repair. The purpose of this phase is to restore the ability of the shoulders to move. The use of sling can be reduced. The focus of Phase II exercises are core muscles and rotator cuff muscles. Assistance to perform daily activities might be reduced but patients must avoid heavy lifting with arms. Recommended therapeutic exercises include gentle shoulder movements, core strengthening motions, and postural exercises. Restoration of shoulders’ range of motion can be achieved by performing some hands-on mobilization techniques. Suggested cardiovascular activities are similar to Phase I: walking, riding stationary bike, and using Stairmaster. Patients still have to avoid running and jumping during Phase II. After being able to accomplish some key tasks such as internally/externally rotating shoulders at 45 degree abduction, patients can progress to Phase III.

Phase III of physical therapy after rotator cuff impingement repair aims to restore the strength of your shoulders and correct postural dysfunctions. This phase is usually started at 7-8 weeks after surgery. Patients can start to return to their normal activities involving their arms and shoulders. However, they still must refrain from doing physically strenuous activities, yard works, and some sports. Gentle mobilizations of shoulders, some core strengthening activities, and postural exercises are among the most recommended therapeutic exercises in Phase III. Cardiovascular fitness such as walking, riding stationary bike, using Stairmaster, and running are also suggested. Swimming and jumping must still be avoided at this point. The difficulty of the exercises can be advanced by asking patients to do more challenging movement patterns. Next, modified weight-lifting tasks can be introduced after patients are able to fulfill some criteria, such as being able to internally/externally rotate shoulders at 90 degree abduction.

The next phase of physical therapy after rotator cuff impingement repair is Phase IV. It is normally begun at 10-12 weeks after surgery. The focus of this phase includes continuing correction of postural dysfunctions, as well as to develop strength for performing works or sports. At this point, the patients can start to return to their occupations, regular activities, and sports.  It is also expected that higher-level tasks can be accomplished during Phase IV. Among all suggested therapeutic exercises are shoulder mobilizations, rotator cuff strengthening, throwing, and swimming programs. Activity-specific workouts and exercises are needed. Depending on patients need, the activity-specific workouts may include accomplishing housework, raking, or even catching drills (especially for some athletes). Physical therapy after rotator cuff impingement repair is finished in Phase IV.  After meeting some goals such as restored shoulders range of motions and normal rotator cuff strength, patients will usually receive clearance from their surgeon and therapists and return to their normal activities.

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