Part 1: The Truth About Rotator Cuff Tears
- Made 2 Move Team
- 18 hours ago
- 5 min read
About the Author:Ā 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 ā Charleston | Daniel Island | Mount Pleasant | Charlotte
"They told me I have a rotator cuff tear."
If youāve ever heard that, your brain probably went straight to panic mode.
One, it's scary to hear the word "tear," and two, as humans, we're really good at thinking about allllll the things that could go wrong.
And that's okay. That's normal. You are NOT alone.
Thereās a lot to unpack about rotator cuff tears and shoulder pain, so instead of screaming everything I know at you in one email that no one has the focus to read, this will be a two-part series.
Today (part 1) - what this diagnosis actually means, answers to FAQ's, and some of my go-to exercises.
Next week (part 2) - I'll break down a real patient case and specific exercise progressions so you know what the full PLAN looks like.
Should You Keep Reading?
You should keep reading if:
- You have shoulder pain or weakness
- You can still move your arm and use it (even if itās uncomfy)
- Youāve been told you have a rotator cuff tear
- You want to stay active and confident in your body
Most of our patients come in asking questions like:
- Do I need surgery?
- Am I making this worse if I keep lifting?
- Should I stop going overhead forever?
- Did I just permanently hurt my shoulder?
Ā Understanding Rotator Cuff Tears
When you hear the word "tear," most people picture a piece of paper ripped in half.
But a rotator cuff tear is more like a quilt with some fibers fraying.
You still have lots of fibers.
You still have multiple muscles sharing the load.
The quilt still works.
So a "tear" does NOT automatically mean youāre doomed, destined for surgery, or headed for a lifetime of babying your shoulder.
The part that surprises almost everyone (me included):
Nearly HALF of full thickness rotator cuff tears exist in people with zero pain or limitations. Theyāre walking around living their lives with no idea they even have a tear.
ISN'T THAT WILD. THE BODY IS WILD.
Translation: your MRI is not a crystal ball. It does NOT determine your future.
Your shoulder is resilient and adaptable.
Common Questions Answered
If you're still freaking out and not sure what this looks like for you, here's what I tell my patients:
Q: Do I need surgery?
A: Not automatically. Many people improve with the right strength and movement plan. This is going to depend on your function, your symptoms, your goals, and type of injury.
Q: If I feel pain, am I making it worse?
A: No. Pain is more often a sign of irritation, sensitivity, or under-preparedness, not irreparable damage. That does NOT mean you should push through intense pain though! (above a 4/10)
Q: Should I stop lifting overhead?
A: No. We need to modify movements (weight, reps, speed, range of motion, using dumbbells instead of barbells, etc) instead of avoiding any use of your shoulder: avoidance makes things worse long term.
Q: Are there movements I should avoid forever?
A: Almost never. You do need to be smart about progressing back into certain movements if you haven't done something in a while, but we CAN get your shoulder fully capable again.
Q: Will this get better?
A: Yes. With the right plan and consistency, most people regain full function. If you rush into injections, you stop using your shoulder altogether, or you keep pushing through intense pain, this process will be harder and slower.
Important Rules for Shoulder Rehab
Before we talk about specific exercises, I have two rules for you:
1. Donāt completely push through intense pain.
Pain is feedback and means something needs to change. Adjust load, range, speed, or volume until the movement is tolerable. Pushing through pain will make your shoulder MORE pissed.
In general, as a PT, I'm cool with my patients feeling discomfort up to around a 3/10 as long as it returns to baseline quickly.
2. Donāt completely rest your shoulder.
On the other end of the spectrum, avoiding ANY discomfort or completely resting your shoulder will turn into more discomfort, stiffness, and weakness.
The goal is to find something in the middle: be like Goldilocks.
Something I see all the time that keeps people weak and stuck in pain is that their rehab never actually progresses:
- They spend weeks doing super easy, low level exercises.
- āPhysical therapyā never moves past table work, manual therapy, or shoulder pulleys.
- Their shoulder never gets challenged enough to actually adapt and get stronger.
And then they wonder why nothing is changing.
## Bridging the Gap with Exercises
Look - it's okay to start with easier, more gentle movements if you're experiencing a ton of pain, weakness, or stiffness. We just can't stay there.
Your rehab has to eventually move toward real strength, real movement, and real life.
What do you need your shoulder to be capable of and how do we get there?
That's what we have to solve.
Here's some of my go-to exercises to bridge that gap:
- An overhead press, like this half kneeling single arm kettlebell press
- A single arm pull, like this dumbbell bent over row
- Isolation exercises, like a bent elbow lateral raise, a sidelying external rotation, and a seated external rotation
- Challenging the rotator cuff in different positions, starting with a classic elbow-by-side rotation, and progressing to a banded genie and 90/90 rotation + press
- Controlled mobility work, like this lying external rotation stretch or this overhead-on-bench move.
## Just an FYI
These are examples, not a prescription for you.
You do not need all of these at once.
Donāt stack all of these on top of already high training volume. More is not always better. Ya can't solve a volume problem with more volume.
What you do need depends on your pain, history, function, and where you're at in the process (I'll explain all of that next week - stay tuned!)
## Coming Next Week
Iāll take you behind the scenes of what real rotator cuff rehab actually looks like, how I program and progress exercises, and how one of my patients rebuilt his shoulder after a tear. (I saw him Monday and he's crushing it and is back to pull ups, overhead lifts, overhead squats, ring dips, handstand push ups... allllll the things)
If Youāre in Charleston, Daniel Island, Charlotte, or Mount Pleasantā¦
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.
Want to understand your body better, move with confidence, and stay active for life?
I write a weekly letter on pain, movement, and health ā sharing how I actually think about injuries, training, and taking care of your body (without the fear-based nonsense).
If this sounds like your kind of thing, you can sign up to get the letters here.
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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