Part 2: What Real Rotator Cuff Rehab Looks Like
- Made 2 Move Team
- 1 day ago
- 6 min read
About the Author: Hannah Breal, PT, DPT is the co-owner of Made 2 Move Physical Therapy in Charleston and Charlotte. She helps athletes and active adults rebuild strength, mobility, and confidence so they can move pain-free for life.
Made 2 Move Physical Therapy – Charleston | Daniel Island | Mount Pleasant | Charlotte
Last week we talked about why a rotator cuff tear isn’t the scary death sentence it’s often made out to be.
(if you missed it - click here to catch up!)
Today I want to show you what real rehab actually looks like, with a real patient case and exercise progressions.
The ONE Thing People Mess Up
Before we go any further - this is the ONE THING people mess up on:
As soon as their shoulder "feels" better, they stop doing the work, and they go right back into what overloaded it in the first place.
and then they get in this fun cycle:
Why?
because nothing changed.
The pain is a signal of a problem, and they didn't actually solve the problem.
(plus their shoulder probably got weaker and stiffer if all they did was rest.)
Pain free is NOT the finish line people (it's a great checkpoint though)
The goal isn't just to calm it down.
The real goal is to rebuild capacity, tolerance, and confidence so your shoulder can actually handle your workouts, sport, and life again.
Let's walk through a real patient so you can see how this actually plays out in real life (for someone who wants to be able to fully use their shoulder again).
What This Looks Like with a Real Human
let's call him John.
John came in with a stiff, painful, and weak shoulder after an acute injury, with an MRI that showed a "focal full thickness tear" in his supraspinatus and a partial thickness tear in his infraspinatus (2 of the 4 rotator cuff muscles)
He still had function and was mostly struggling getting fully back in the gym. He really wanted to avoid surgery.
Real quick: you can have the same exact diagnosis and NOT have any pain. I think for John, his mechanism of injury played a big role - it was an acute injury, not something that happened slowly over time. I've met plenty of people whose MRI said the same thing, but their shoulder was just stiff/weak.
John had done the typical band work on his own and was feeling better, but he had totally plateaued. He felt stuck and couldn’t get fully back into CrossFit or calisthenics without his shoulder screaming at him. He was also having trouble sleeping on his left side.
and get this - his doctor told him that since he was 50, all he really needed to be able to do was walk to the mailbox and back.
Which is… bold. and still haunts me to this day.
and that's why he came to see me!
Phase 1: Calm it Down and Get Access Back
He was doing a lot of random shoulder stuff and honestly, I think he was doing way too much compared to what his shoulder was actually capable of.
We stripped it down so his only shoulder work was what I programmed, based on his weaknesses we found in our evaluation.
Our goals:
- Calm down irritation
- Restore overhead and external rotation mobility
- Rebuild basic strength without flaring symptoms
- Keep everything tolerable to build a foundation
We started with:
- Daily overhead and external rotation mobility (GENTLE)
- Light single arm dumbbell press
- Bent elbow lateral raises (super light weight)
- External rotation work at different angles
- Intentional biceps loading (a simple bicep curl - he had been doing pull ups but wasn't ready and was having anterior shoulder pain)
We kept the weight lighter on his left side, based on what his shoulder could actually handle without him having more pain the next day.
This is where most people get stuck forever - going light on their injured side, modifying everything - and while it is a crucial phase, it's just step one. The goal of this phase is to decrease pain and build a solid foundation for phase 2 and 3.
Lemme be very clear about something: John was working out this entire time.
There is absolutely no world where I’m telling someone to stop lifting or stop training altogether for 6 months. (you have 3 other limbs!!!) Even in an early rehab phase.
What we did change was how his shoulder was being loaded.
Anything shoulder-related in workouts got modified or replaced with what I programmed for him. I was basically his quarterback for all things shoulder.
and then...
he started having less pain the day after workouts. He could sleep without his shoulder waking him up. He could move his shoulder day-to-day without nagging pain.
so we progressed into phase 2 (drumroll please...)
Phase 2: Build it UP (Strength/Mobility)
Goal here is to challenge the shoulder, build capacity and tolerance, and manage overall volume so pain doesn't creep back up.
- Added in sidelying external rotation and crossover symmetry exercises
- Single arm DB press - seated/kneeling (more challenging on shoulder mobility)
- Dumbbell bench press
- Straight arm lateral raises - increased weight here
- Bent over rows and more pulling patterns
- Gradual increases in weight and reps/sets
He also started making BIG improvements in his left shoulder mobility and was really only limited in his end-range external rotation, so we targeted it specifically with:
- ER liftoffs against a rig or doorway
- Prone liftoffs
These were all big weaknesses for him - we stayed here for a while and progressed his weight/reps/sets as he got stronger and had even less pain.
Phase 3: Return to Sport/Workouts
Our goal the entire time was for him to be able to do whatever the class workout said and to get back to his gymnastics movements (pull ups, handstand push ups, ring dips, etc)
As he earned certain movements back and could do them without flare ups, we started sprinkling them back into his actual workouts.
Think about it like this:
Once you have ACCESS to a movement or skill again, we want to start training it, as long as:
- It doesn’t add too much total shoulder volume to the week
- It doesn’t flare things up
- It's gotta be gradual though.
It's gotta be a part of the master plan:
^ me trying to explain a whole rotator cuff rehab plan in one single blog
You don’t go from “I haven’t snatched in 6 months” to “let’s send it with 95 pounds today.”
Now - John is fully back in the gym, doing all the things he loves, and he knows what he needs to keep working on so his shoulder stays healthy.
You’d look at him now and never know he had a shoulder injury.
What I really hope you take from this is that even if you’ve been diagnosed with a rotator cuff tear (even a full thickness tear) that doesn’t mean your shoulder is done.
It doesn’t mean surgery is inevitable.
It doesn’t mean you have to stop doing the things you love.
With the right plan and the right progressions, you can absolutely get back to moving, training, and trusting your body again.
Isn't that so cool?!
If you got this far, thanks for reading - you can obviously see how I couldn't fit this into a :90 second instagram post!
If You’re in Charleston, Daniel Island, Charlotte, or Mount Pleasant…
At Made 2 Move Physical Therapy, we help active adults and athletes and recreational athletes get out of pain and keep doing what they love.
We have three convenient locations:
Our team of DPTs can help you move, play, and live without limitations.
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Written by Hannah Breal, PT, DPT, Co-Owner of Made 2 Move Physical Therapy, helping Charleston and Charlotte move pain-free for life.
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