Why You Need Physical Therapy for Rotator Cuff Tears

Discover how your shoulder can move better and hurt less with PT
By Ben Wobker, PT, MSPT, CSCS, SFMAc
Why You Need Physical Therapy for Rotator Cuff Tears

If you’ve never had a rotator cuff tear, chances are good you know someone who has. It’s a common—yet painful—shoulder injury problem affecting millions of patients every year. With proper treatment, however, you can ease pain, keep the injury from getting worse, and heal. More often than not, that treatment includes physical therapy.

The rotator cuff, a group of four tendons that cover the head of the humerus, keeps the arm in the shoulder socket and allows the arm to be lifted and rotated. However, when one or more of the rotator cuff tendons is torn, it sometimes no longer fully attach to the head of the humerus, often resulting in pain and limited mobility.

A Real Pain in the Shoulder

Rotator cuff tears occur either suddenly or gradually. Sudden tears, perhaps caused by falling, tend to result in intense, acute pain as well as a snapping sensation and immediate weakness in the upper arm. Gradual tears, which usually come from overuse, may start with mild pain but can worsen over time. The most common symptoms of rotator cuff tears include:

  • Pain at rest or at night
  • Pain when lifting, lowering, or rotating the arm
  • Weakness in the arm
  • Crackling sensation in the arm with certain movements

Causes and Treatments

The two main causes of rotator cuff tears are injury and degeneration, and this type of injury tends to become more common with age. A rotator cuff may tear partially or completely. Partial rotator cuff tears can sometimes be treated with rest, anti-inflammatory modalities, and physical therapy. 

Full-thickness (complete) rotator cuff tears usually do not heal on their own. When pain and weakness persist, surgeons can repair the rotator cuff. Dr. Samuel Koo from ProOrtho reports “shoulder surgery can now be done arthroscopically, which allows for a quicker recovery and less postoperative pain.”

Dr. Koo describes arthroscopy

Arthroscopy is a way of performing common orthopedic procedures through a minimally invasive approach. A small lens, called an arthroscope, is used to visualize the inside of the shoulder. The “scope” gives the surgeon a couple of advantages over open techniques. 

First, the shoulder is in a relatively tight space. When open incisions are used, visualization can be difficult simply due to the limitation in where the incision can be placed. Surgeons are often confined to a deep hole in which identification of the tissues can be extremely challenging. The scope, on the other hand, can be placed virtually anywhere allowing easy access to tight spaces using tiny incisions.

Second, anatomic structures in the shoulder are quite small. Modern arthroscopes display images on a LCD monitor in HD quality. Additionally, it magnifies the view so that objects appear bigger than they actually are. This gives the surgeon the feel of using a microscope without actually looking through one!

How Physical Therapy Helps With Rotator Cuff Tears

Although physical therapy alone can’t fully heal rotator cuff tears, it’s often the recommended treatment for them. That’s because the goal of treatment isn’t necessarily to heal the torn tendon; instead, the aim is to ease pain, improve strength, and restore joint shoulder mechanics.

Rotator cuff PT targets the small muscles around the shoulder that tend to be neglected in normal exercise and are thus prone to weakness and breakage. For most patients with rotator cuff tears, these exercises will help relieve the pain and strengthen the shoulder, canceling out the need for surgery. On-demand physical therapy gives rotator cuff tear patients more one-on-one time with your PT, so you can quickly start the path to less pain and better mobility. 

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