What is a rotator cuff repair protocol?

What should a rotator cuff repair protocol tell you?

A useful rotator cuff repair protocol should explain your current restrictions, your permitted exercises, and the conditions for moving to the next phase. Hospital protocols combine time since surgery with clinical checks because reaching a particular week does not automatically mean your shoulder is ready for more. OHSU rehabilitation guideline

When you read your plan, look for answers to these practical questions:

• When should I wear my sling, including at night?
• Can I move my shoulder myself, or should someone else support the movement?
• How far am I allowed to move it?
• Which exercises should I do, and how often?
• What are my lifting, pushing, and pulling restrictions?
• Who decides when those restrictions change?

Your answers will depend on what was repaired during your operation. Royal National Orthopaedic Hospital patient guide

“Start shoulder exercises” leaves too much room for interpretation. Ask your physical therapist to write down the exercise name, permitted range, repetitions, and any assistance you need. You should be able to open the instructions at home and understand what you were asked to do.

Why do rotator cuff repair protocols differ?

Rotator cuff repair protocols differ because the operation and the repaired tissue determine how much protection your shoulder needs. A larger tear, poorer tendon quality, or an additional procedure can require a different progression. Massachusetts General Brigham protocol for large to massive tears

The phrase “rotator cuff repair” doesn’t tell you everything that happened during surgery. Your surgeon may also have repaired the subscapularis, one of the rotator cuff tendons, or performed a biceps procedure. Those details can add restrictions that a generic shoulder program won’t account for. Massachusetts General Brigham protocol

This is why comparing your recovery with a friend’s can be misleading. You may both have had shoulder surgery and still have different instructions for using your arm.

Request the protocol that applies to your operation. If your physical therapist hasn’t received the surgical instructions, have the surgical office send them before the therapist progresses your shoulder exercises.

What happens during the protection phase?

The protection phase limits stress on the repair while you manage symptoms and follow the surgical team’s instructions for sling use, wound care, and permitted movement. Early guidance commonly includes movement of nearby joints, such as the hand and wrist, while restricting use of the operated shoulder. MedlinePlus shoulder surgery discharge guidance

A sling doesn’t answer every question about how you can use your arm. You also need instructions for getting dressed, washing, sleeping, and taking the sling off for prescribed exercises. Follow the method your team has taught you. Royal National Orthopaedic Hospital patient guide

Ordinary tasks can involve shoulder loading. Pushing yourself out of a chair, carrying a bag, or supporting your body weight through the operated arm may conflict with early restrictions. Hospital protocols commonly prohibit lifting and supporting body weight through that arm during the initial protection period. Massachusetts General Brigham protocol

Before you leave an appointment, describe the tasks you actually need to do at home. “Can I use this arm to get out of bed?” is a more useful question than “Should I take it easy?”

What is the difference between passive, assisted, and active movement?

During passive movement, a therapist or another prescribed method supports and moves your arm while the shoulder muscles stay relaxed. During assisted movement, your other arm or an approved aid helps you perform the motion. During active movement, you lift or move the arm under its own muscle power. Your team should demonstrate the version that is appropriate for your current phase. Royal National Orthopaedic Hospital patient guide

These are separate steps in many repair protocols, with different starting points and restrictions. Permission for one type of movement doesn’t automatically include the others. OHSU rehabilitation guideline

For example, permission for supported shoulder movement does not necessarily mean you can reach up to a cupboard. The second task uses the arm actively. Have your therapist connect the terminology in your protocol to everyday movements you recognize.

How long does a rotator cuff repair protocol take?

A rotator cuff repair protocol usually covers months of rehabilitation, but there is no single timetable that fits every repair. The stages can overlap, and your treating team may delay progression based on the operation and your examination. OHSU rehabilitation guideline

For a concrete example, Massachusetts General Brigham’s protocol for large to massive tears places the transition through assisted and active shoulder motion within a phase spanning approximately weeks 10 to 18. That is one institutional protocol for a particular category of repair. It is not a schedule to apply to every shoulder. Massachusetts General Brigham protocol

The calendar is useful for planning appointments and discussing work. Your shoulder still needs to meet the relevant progression criteria. Those may include controlled pain, adequate permitted motion, and the ability to move with appropriate control. OHSU rehabilitation guideline

If you’re behind a timeline you found online, bring that concern to your therapist. Don’t add exercises to catch up without checking whether that timeline applies to your repair.

Is it better to start moving the shoulder early?

Earlier movement is appropriate for some repairs, but it is not a universal recommendation. The AAOS 2025 guideline reports similar clinical outcomes and outcomes reported by patients with early or delayed mobilization in the studied setting of small to medium full thickness tears repaired arthroscopically. That finding should not be extended to every large or complex repair. AAOS rotator cuff injuries guideline

“Early movement” also needs a definition. Supported movement within a prescribed range is different from actively lifting your arm or starting resistance exercises. Research on one approach doesn’t give permission for all of them.

The practical question is: what movement is allowed for your repair now? Your surgeon or physical therapist can explain the reason for your current restrictions. If your plan calls for protection, use that explanation to understand the wait instead of treating the wait as lost progress.

When can you start strengthening or return to normal activities?

Strengthening and return to activity begin when your treating team determines that the repair has had sufficient protection and your shoulder has the motion and control needed for the next task. Time since surgery is one part of that decision. Massachusetts General Brigham protocol

Being able to move your arm comfortably does not, by itself, establish readiness for resistance. Institutional protocols separate movement work from later strengthening and use specific criteria before increasing demand. OHSU rehabilitation guideline

“Normal activities” is also too broad to guide a decision. Typing at a desk and lifting a suitcase into an overhead compartment place different demands on your shoulder. Return to work, lifting, and sport needs to account for the task involved. Royal National Orthopaedic Hospital patient guide

Tell your therapist exactly what you want to return to. Include the weight you need to lift, how high you need to reach, and how often you repeat the movement. Find out what you need to demonstrate before that task is cleared.

What should you do if exercises hurt or recovery feels off?

Contact your physical therapist or surgical team if exercises are painful, symptoms worsen unexpectedly, or you’re unsure whether a movement is permitted. Don’t independently increase the range or resistance to work through the problem. Royal National Orthopaedic Hospital patient guide

Make the message specific. Name the exercise, say when the symptom starts, and explain whether it settles afterward. Include any recent fall or other injury. That gives your team more useful information than “my shoulder hurts.”

Contact the surgical team promptly for:

• Pain that isn’t controlled by the prescribed plan.
• Increasing wound redness, swelling, or yellow drainage.
• Fever above 101°F, or 38.3°C, or the threshold in your discharge instructions.
• New or worsening arm swelling, numbness, or tingling.

These are warning signs listed in MedlinePlus postoperative guidance. Don’t wait for a routine exercise check in to report them. MedlinePlus shoulder surgery discharge guidance

Seek emergency care for uncontrolled bleeding, including bleeding that soaks the dressing and does not stop with firm pressure. A hand or fingers that become cold, pale, or blue also need emergency evaluation. Don’t wait for a callback from your surgical team or a response through an app. MedlinePlus bleeding first aid; MedlinePlus arterial embolism guidance

Where can GoodMetal fit into recovery?

GoodMetal’s programs are built by licensed physical therapists with 10+ years of experience each. They designed the structure every plan follows: which exercises are included, how weekly sessions are organized, and how the phases progress. That structure explains how sessions progress and when the program tells you to hold back.

GoodMetal can help explain and organize exercise guidance, but its general programs do not replace the postoperative protocol or assessment from your surgical team.

GoodMetal also includes a large guided exercise video library, proactive plan adjustments, and care coordination. Videos can show how an exercise is performed. They cannot establish whether your repaired tendon is ready for that exercise. Postoperative progression still requires the restrictions and clinical assessment relevant to your operation. OHSU rehabilitation guideline

Before using a general program after surgery, ask your treating team whether it is appropriate and which parts are permitted. GoodMetal’s program templates are not individualized medical care.

What should you ask at your next appointment?

Ask your surgeon or physical therapist to confirm your current phase, demonstrate what you’re allowed to do, and explain what needs to happen before you progress.

You can use this wording:

“Which rotator cuff repair protocol applies to my operation? Please show me the exercises and everyday movements I’m allowed to do now, tell me what I should avoid, and explain who will clear the next step.”

Bring the written protocol and a short list of tasks you’re struggling with. Before you leave, make sure you know who to contact if the instructions are unclear. You shouldn’t have to choose between conflicting shoulder exercise videos to work out what your own surgical team intended.

Sources

[1] OHSU Rehab Services Best Practice Guidelines: Rotator Cuff, published Feb. 2024; [2] A Patient's guide to Rotator Cuff Repair :: Royal National Orthopaedic Hospital; [3] Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair –; [4] Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline; [5] Comparison of Early versus Traditional Rehabilitation Protocol after Rotator Cuff Repair: An Umbrella-Review - PMC; [6] Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials - PubMed; [7] Which is better? Early versus delayed rehabilitation after arthroscopic rotator cuff repair.; [8] Shoulder surgery - discharge : MedlinePlus Medical Encyclopedia; [9] Rotator cuff repair - South Tees Hospitals NHS Foundation Trust.