The "rotator cuff" is a group of four muscles and their tendons that keep the shoulder joint stable. Rotator cuff injuries are common and can result from accidents, such as a fall, or repeated overuse. The risk of injury generally increases with age. While rotator cuff tears are more common later in life, younger athletes and people with jobs requiring heavy lifting are often affected. Older adults can injure the rotator cuff if they fall on or strain the shoulder. If left untreated, a rotator cuff tear can cause severe pain and make it hard to use the arm. Physical therapists help people with rotator cuff tears ease pain and stiffness and restore shoulder and arm movement. They also help you improve your ability to safely do daily activities.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can see a physical therapist directly for evaluation and treatment without a physician’s referral.* To find a physical therapist in your area, visit Find a PT.

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*A referral may still be required by your insurance policy, corporate policies, or state practice laws (some states limit the type of treatment or number of visits without a referral).

On this page

• What Is a Rotator Cuff Tear?
• How Does It Feel?
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• How Can a Physical Therapist Help Before and After Surgery?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is a Rotator Cuff Tear?

The "rotator cuff" is a group of four muscles and their tendons (tissues that attach muscles to bones). These muscles and tendons connect the upper arm bone (humerus) to the shoulder blade (scapula). The rotator cuff’s main job is to keep the shoulder joint stable. Sometimes, the rotator cuff becomes inflamed or irritated due to heavy lifting, repetitive arm movements, or trauma such as a fall. This can lead to a tear of the muscles or tendons.

The extent (size and location) of a rotator cuff tear determines how severe it is:

• Full-thickness tears extend from the top to the bottom of the rotator cuff. This is a complete tear. It often causes a lot of pain, weakness, and loss of arm function. It usually requires surgery.
• Partial-thickness tears affect at least some part of a rotator cuff but do not extend all the way through. Physical therapy is the first line of treatment for mild to moderate tears and can help some people avoid surgery.

There are two categories of rotator cuff tears:

• Acute rotator cuff tears occur suddenly. They often occur due to trauma, such as a fall or lifting a heavy object.
• Chronic rotator cuff tears are much slower to develop. They result from repeated actions using the arms above the shoulder, such as ball-throwing sports or certain work activities.

People with chronic rotator cuff injuries often have a history of shoulder pain with movement. This condition is known as subacromial pain syndrome (also called shoulder impingement syndrome).

Rotator cuff tears also may occur along with injuries or irritation of the biceps tendon at the shoulder or with a shoulder labral tear. Your physical therapist will help you understand the details of your specific injury.

How Does It Feel?

People with rotator cuff tears can experience the following symptoms:

• Pain over the top of the shoulder or down the outside of the arm
• Shoulder weakness
• Loss of shoulder motion
• A feeling of weakness or heaviness in the arm
• You can’t lift the arm to reach up or behind the back
• You can’t do everyday activities due to pain and loss of motion.

How Is It Diagnosed?

Your physical therapist will complete a thorough exam to help pinpoint the cause of your shoulder pain. It will include:

• Learning details of your symptoms
• Assessing your ability to move your arm
• Identifying weakness
• Performing special tests that may indicate a rotator cuff tear

As part of the exam, your physical therapist may:

• Raise your arm.
• Move your arm out to the side.
• Hold your arm up at specific angles and ask you to resist.

Your response to these tests will help determine the next steps in your plan of care. In some cases, your physical therapist may refer you to a professional for imaging (such as ultrasound, MRI, or CT scan).

How Can a Physical Therapist Help?

If diagnosed with a rotator cuff tear, you will work with your orthopedist and physical therapist to decide if you need surgery or if physical therapy can help you recover without surgery.

If you don't need surgery, your physical therapist will work with you to restore your range of motion, muscle strength, and coordination. They will help you return to your regular activities. In some cases, you may learn to modify your physical activity to put less stress on your shoulder.

If you decide to have surgery, your physical therapist can help you before the procedure. They also can help you recover and regain your strength and movement after the procedure.

Regardless of which treatment you have — physical therapy only or surgery and physical therapy — early treatment can help speed the healing process. Early physical therapy can also help you avoid permanent damage.

If You Have an Acute Injury

If trauma is the cause of your injury, see a physical therapist or other health care provider as soon as possible. They can rule out the possibility of serious life- or limb-threatening conditions. Once serious injury is ruled out, your physical therapist will help you manage your pain and prepare you for the best course of treatment.

If You Have a Chronic Injury

A physical therapist can help manage the symptoms of chronic rotator cuff tears and improve your shoulder function. For larger tears that can't be fully repaired, your physical therapist can teach you strategies to improve shoulder movement. If physical therapy and conservative treatments do not improve your function, surgical options may exist.

How Can a Physical Therapist Help Before and After Surgery?

If your condition is severe, you may require surgery to restore use of the shoulder. Physical therapy will be an important part of your recovery. The repaired rotator cuff has a proven chance of reinjury after shoulder surgery. Therefore, working with a physical therapist is crucial to safely regaining full use of your arm. After surgery, you will need to wear a sling to protect your arm and shoulder as you heal. While your arm is in the sling, your physical therapist will provide treatments to reduce pain. They also will begin to gently restore your movement.

Once you are able to remove the sling for exercise, your physical therapist will begin your full rehabilitation program. They will design a treatment program based on your condition and personal goals and guide you through it. They will help you progress from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises.

Your treatment program most likely will include a combination of exercises to strengthen your rotator cuff and the other muscles supporting the shoulder joint. The timeline for your recovery will vary depending on the type of surgery performed and your general health. A modified return to sports, heavy lifting, or other strenuous activities may not begin until four months after surgery. A full return may not occur until nine months to one year after surgery.

After surgery, your shoulder will be susceptible to reinjury. It is vital to follow the post-op instructions provided by your surgeon and physical therapist.

Your post-surgery rehabilitation will typically be divided into four phases:

• Phase I (maximal protection). Phase 1 of treatment lasts for the first few weeks after your surgery when your shoulder is at the greatest risk of reinjury. During this phase, your arm will be in a sling. You will likely need help or training to do everyday tasks, such as bathing and dressing. Your physical therapist can guide you through new ways to safely do your daily activities. They may:
• Teach you gentle range-of-motion and isometric strengthening exercises.
• Provide hands-on treatments (manual therapy), such as gentle massage.
• Offer advice on reducing your pain.
• Use techniques such as cold compression and electrical stimulation to relieve pain.
• Phase II (moderate protection). This phase has the goal of restoring movement to your shoulder. You will reduce the use of your sling. Your range-of-motion and strengthening exercises will become more challenging. Exercises may be added to strengthen the "core" muscles of your trunk and shoulder blade. You may learn exercises for the noninjured rotator-cuff muscles that provide support and stability to your shoulder. You will be able to begin using your arm for daily activities but will still avoid heavy lifting. Your physical therapist may use special hands-on techniques to help restore your shoulder's range of motion.
• Phase III (return to activity). This phase has the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities but will still be unable to participate in sports. You also may not yet do yard work or physically demanding home- or work-related tasks. Your physical therapist will gradually advance the difficulty of your exercises by adding weight or by having you use more challenging movement patterns. Depending on your goals and your level of recovery, your physical therapist may give you a modified weightlifting or gym-based program for you to begin during this phase.
• Phase IV (return to occupation/sport). This phase will help you return to work, sports, and other higher-level activities. Your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. Your physical therapist may have you practice movements that mimic lifting heavier items onto shelves or teach you how to position yourself to do everyday tasks such as raking, shoveling, or housework.

Can This Injury or Condition Be Prevented?

A physical therapist can help you prevent or reduce your risk of a rotator cuff tear getting worse. It is crucial to seek help at the first sign of shoulder pain or discomfort. To avoid developing a rotator cuff tear from an existing shoulder problem, it is critical to stop doing actions that could make it worse. Your physical therapist can help you strengthen your rotator cuff muscles. They can train you to avoid potentially harmful positions and determine when it is safe for you to return to your normal activities.

To keep your shoulder healthy and prevent rotator cuff tears, physical therapists recommend that you:

• Avoid repeated overhead arm positions that cause shoulder pain. If your job requires such movements, seek the advice of a physical therapist to learn arm positions that pose less risk.
• Work with a physical therapist to include rotator-cuff muscle and shoulder-blade strengthening exercises in your normal exercise routine. The strength of the rotator cuff is just as important as the strength of any other muscle group.
• Practice good posture. A forward position of the head and shoulders can alter shoulder-blade position. This can lead to pain in the front and outside of the shoulder.
• Avoid sleeping on your side with your arm stretched overhead or lying on your shoulder. These positions can begin the process that causes rotator cuff damage and may be linked to increased pain.
• Avoid smoking, which can decrease the blood flow to your rotator cuff.
• Consult a physical therapist at the first sign of symptoms.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries, including a rotator cuff tear. You may want to consider:

• A physical therapist who is experienced in treating people with muscle, bone, and joint (musculoskeletal) problems. Some physical therapists have a practice with an orthopedic focus or experience treating athletes with this type of injury.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT , the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Ask about the physical therapists' experience in helping people with a rotator cuff tears.
• Be prepared to describe your symptoms in as much detail as possible and say what makes your symptoms worse.