--- title: "Rotator Cuff Repair Rehab Protocol | Dr. Avi Chezar" description: "Full rehabilitation protocol after arthroscopic rotator cuff repair: rest, passive and active movement and strengthening over 30 weeks, stage by stage." canonical: https://www.catef4u.com/en/physiotherapy/rotator-cuff-rehab translation-of: https://www.catef4u.com/physiotherapy/rotator-cuff-rehab last-updated: 2026-11-03 language: en source: catef4u.com --- # Rehabilitation After Rotator Cuff Tear Surgery > Full rehabilitation protocol after arthroscopic rotator cuff repair: rest, passive and active movement and strengthening over 30 weeks, stage by stage. Full arthroscopic protocol – rest, passive movement, active movement and advanced strengthening 30 weeks of rehabilitation5 stages Written and edited by Dr. Avi Chezar · Department of Orthopedics – Emek Medical Center · [Download PDF (Hebrew)](https://www.catef4u.com/img/rotator-cuff-rehab-protocol.pdf) ## Goals of rehabilitation - **Protecting the integrity of the surgical repair** in the first stage - Reducing pain and inflammation and restoring **passive range of motion** - Gradually achieving **full active movement** - **Strengthening the shoulder muscles** and returning to daily and sporting activity ## Important rules throughout rehabilitation - **Arm in a sling** for the first 4 weeks – also at rest - Do the exercises **3 times a day on your own** - Use **local heat before** exercising and **cold afterwards** - **Do not move on to the next stage** without reaching the goals of the current one - Until 3 months after surgery – **do not work into significant pain** - For any question you can contact us: [**052-422-4623**](tel:+972524224623) ## Rehabilitation timeline | Stage | Weeks | |---|---| | Rest | 0–4 | | Passive movement | 5–10 | | Active movement | 11–18 | | Early strengthening | 19–25 | | Advanced strengthening | 25–30 | ## The stages of rehabilitation ### Stage 1: Rest – weeks 0–4 | arm in a sling #### Goals of this stage - Protecting the integrity of the surgical repair - Reducing pain and inflammation - Keeping the ability to perform activities of daily living (ADL) #### Exercises – 3 times a day - **Pendulum movements** – standing, bent forward 90°. The arm hangs and swings gently forwards and backwards and in circles. - **Wrist and finger movement** (AROM) – 3 times a day - **Biceps activation** – bending the elbow without any resistance - **Isometric activation** of the scapular (shoulder blade) and neck muscles - **Cold compresses** – as much as possible in the first days; after that, after each exercise session or as needed #### Precautions – mandatory - **Pendulum movements only!** – no active movements (AROM) of the shoulder - Do not lift objects with the operated arm - No stretching or sudden movements - Do not lean or put weight on the operated arm - Removing the sling is allowed only for exercises, and at rest as comfortable ### Stage 2: Passive movement (PROM) – weeks 5–10 | sling removed *Second clinic review: 3 months after surgery* #### Passive range-of-motion (PROM) goals - **Forward flexion** – up to 140° - **Abduction** – up to 90° - **External rotation** – up to 50° - **Internal rotation** – hand behind the back #### How to do it - Start lying down, with **AAROM** (active-assisted movement) - Use **local heat before** exercising and **cold afterwards** - Progress gradually, according to how it feels and the level of pain #### Precautions - Passive movements only – do not force the range of motion - **Do not move on to the active stage** if a reasonable passive range of motion has not been reached - If the active range has not been reached – continue stretching exercises until the goals are reached ### Stage 3: Active movement (AROM) – weeks 11–18 | from AAROM to full AROM *Third clinic review: 5 months after surgery* #### Goals of this stage - Allow the soft tissues to heal while avoiding excess tension on the repair - Reach a **full active range (AROM)** - Reduce pain and inflammation #### How to do it - At first: **AAROM only** (active-assisted movement) – taught lying down - As movement improves – you can move on to **full AROM** - Goal: reach an active range similar to the passive range achieved - **Until 3 months after surgery** – do not work into significant pain; after that, mild pain is allowed #### Precautions - Active movements with **mild pain only** - Start active-assisted and progress gradually - No sudden movements - Do not lean or put weight on the operated arm - **Do not progress to the strengthening stage** before reaching as full an active range as possible ### Stage 4: Early strengthening – weeks 19–25 | bands and movements against gravity #### Goals of this stage - Maintaining the full range of motion achieved - Gradually restoring strength in the shoulder muscles - Gradually returning to daily activity #### Exercises - **Elastic bands (Theraband)** and strengthening aids – as instructed by the physiotherapist - **Abduction with the thumb pointing up** – external rotation of the arm while lifting (protects the cuff mechanism) - **Lying on the stomach:** abduction and extension of the shoulder - **Elbow activation** – bending and straightening - **Activities of daily living (ADL)** as able #### Precautions - Only once an active range similar to the passive range has been reached may you progress to strengthening - Increase the intensity of the exercises gradually ### Stage 5: Advanced strengthening – weeks 25–30 | return to activity #### Goals of this stage - Gradual return to full activity #### Exercises - If a full range of motion has not been reached – complete it at this stage - **Strengthening the shoulder muscles** – with gradually increasing resistance - **Proprioceptive training** – balance training and joint position sense - **Return to gentle sporting activity** → gradually back to full activity #### Precautions - **Do not lift more than 3 kg** - No sudden lifting or sudden movements - **Do not lift objects above head height** without approval ## Official document The official protocol document is in Hebrew: [view the full document (PDF, Hebrew)](https://www.catef4u.com/img/rotator-cuff-rehab-protocol.pdf). [**Official protocol document** – Page 1 of the full protocol, in Hebrew (PDF). – Open the PDF →](https://www.catef4u.com/img/rotator-cuff-rehab-protocol.pdf) ## Planned clinic reviews 1. **First review** – 2 weeks after surgery – removal of stitches 2. **Second review** – 3 months after surgery – progress check 3. **Third review** – 5 months after surgery – confirming range of motion The review dates may change at the treating physician's discretion. ## When should you contact a doctor? - Fever above 38°C - Pain that is not relieved by painkillers - Heavy discharge from the wound - Sudden swelling of the arm - New numbness in the hand ## Further reading from leading medical sources - [Rotator Cuff & Shoulder Conditioning Program — OrthoInfo (AAOS)](https://orthoinfo.aaos.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/) – A structured exercise program for strengthening and rehabilitating the shoulder and rotator cuff - [Conditioning Program — full exercise guide (PDF · AAOS 2025)](https://orthoinfo.aaos.org/globalassets/pdfs/rotator-cuff-and-shoulder-conditioning-program-2025.pdf) – The illustrated exercise booklet to download and print – PDF file --- Canonical HTML: https://www.catef4u.com/en/physiotherapy/rotator-cuff-rehab Hebrew original: https://www.catef4u.com/physiotherapy/rotator-cuff-rehab Site index for agents: https://www.catef4u.com/llms.txt _This Markdown is the text-only variant of the page above, served for `Accept: text/markdown`. It is an English translation of Dr. Avi Chezar's Hebrew page. Medical information here is general and does not replace a personal consultation._