How Is Physical Therapy Supposed to Help My Torn Rotator Cuff?

A Reasonable Question

When I tell patients that physical therapy can help their torn rotator cuff, I sometimes see skepticism in their eyes. The logic seems backwards: if something is torn, shouldn't it be fixed? How can exercises repair a tendon that's no longer attached to bone?

It's a fair question, and patients deserve a clear answer rather than a vague assurance that therapy "usually helps." Understanding what physical therapy actually does—and doesn't do—helps you approach treatment with realistic expectations and genuine engagement.

A carpenter from Durango put it bluntly during his first visit: "Doc, I'm not trying to be difficult, but can you explain how stretching is supposed to fix a hole in my shoulder?" I appreciated his directness. Here's what I told him.

What Physical Therapy Won't Do

Let's start with honesty: physical therapy will not make your torn tendon grow back together. If fibers have separated from bone, exercises cannot reattach them. No amount of strengthening will spontaneously heal a full-thickness tear.

This is why some tears require surgery. When the tendon is completely detached and retracted, when muscle is atrophying, or when the tear is rapidly enlarging, surgical repair may be the only way to restore normal anatomy.

But here's what's crucial to understand: normal anatomy and normal function aren't the same thing. Many people with abnormal-looking MRIs have completely normal function. And the goal of treatment—whether surgical or not—is function, not a perfect-looking scan.

What Physical Therapy Actually Does

Physical therapy works by optimizing everything around the tear. Your shoulder doesn't rely on a single muscle; it relies on a coordinated system of muscles working together. When one component is damaged, the system can often compensate if the other components are strengthened and retrained.

The rotator cuff consists of four muscles. If your supraspinatus is torn, your infraspinatus, subscapularis, and teres minor can potentially take over some of its responsibilities. They won't do exactly what the supraspinatus did, but they may be able to provide enough stability and control that your shoulder functions well despite the tear.

Beyond the rotator cuff itself, your shoulder blade muscles play a critical role. The way your scapula moves and positions itself affects how much stress is placed on your rotator cuff tendons. Poor scapular mechanics—which are extremely common—can make a rotator cuff tear more symptomatic. Correcting those mechanics can make the same tear less symptomatic.

A physical therapist from Pagosa Springs I work with frequently describes it this way: "We're not fixing the tear. We're fixing how the shoulder moves so the tear matters less."

The Specific Goals of Therapy

A good physical therapy program for rotator cuff tears addresses several interconnected goals.

Reducing inflammation and pain comes first. Inflamed tissue hurts, and pain inhibits muscle function. Early therapy often focuses on calming things down through gentle range of motion, ice, and activity modification. You can't strengthen a muscle you can't activate, and you can't activate a muscle when pain is causing it to shut down.

Restoring range of motion prevents stiffness from compounding your problem. Rotator cuff tears often lead to guarded movement patterns. You unconsciously avoid certain positions, and over time the shoulder capsule tightens. Now you have two problems: a tear and stiffness. Therapy maintains mobility so you don't develop frozen shoulder on top of your existing injury.

Strengthening the remaining rotator cuff muscles builds the compensation system. Targeted exercises for the infraspinatus, subscapularis, and teres minor give these muscles the capacity to help stabilize the humeral head even when the supraspinatus isn't contributing normally.

Training the scapular stabilizers improves the foundation on which everything else operates. Muscles like the serratus anterior, lower trapezius, and rhomboids control how your shoulder blade moves. When they function properly, the entire shoulder complex works more efficiently.

Retraining movement patterns addresses habits that may have developed before or after your injury. Many patients have been moving their shoulders inefficiently for years. Therapy teaches your nervous system new patterns that reduce stress on damaged structures.

Why It Works for Some Tears and Not Others

The effectiveness of physical therapy depends heavily on tear characteristics.

Partial-thickness tears often respond well. Some tendon fibers remain attached and functional. Strengthening surrounding structures can offload the damaged area enough that symptoms resolve. Many patients with partial tears return to full activity without surgery.

Small full-thickness tears can sometimes be managed non-operatively, especially in older or less active patients. If the remaining rotator cuff muscles can adequately compensate, the shoulder may function well despite the anatomical defect.

Large or massive tears present more challenges. When too much of the rotator cuff is compromised, there may not be enough remaining muscle to compensate effectively. The shoulder loses the ability to center the ball in the socket, leading to abnormal mechanics and accelerated wear. These tears often require surgical intervention.

Patient factors matter enormously. A sedentary retiree with modest functional demands may do well with a tear that would disable an overhead athlete. Age, activity level, occupation, and personal goals all influence whether physical therapy is likely to be sufficient.

What Good Therapy Looks Like

Not all physical therapy is equal. Effective rotator cuff rehabilitation requires a therapist who understands shoulder biomechanics and tailors treatment to your specific situation.

You should expect a thorough initial evaluation that assesses your range of motion, strength, movement patterns, and functional limitations. Treatment should progress systematically, building on early gains. Exercises should be challenging but not painful—pushing into significant pain usually backfires.

Home exercises are essential. An hour or two of therapy per week won't change your shoulder if you're not reinforcing those efforts daily. Expect to receive a home program and expect your therapist to hold you accountable for doing it.

Progress should be monitored objectively. If you're not improving after six to eight weeks of consistent therapy, something needs to change—either the approach or the treatment plan itself. Therapy that isn't working shouldn't continue indefinitely.

The Therapy-Surgery Relationship

Physical therapy and surgery aren't opposing choices; they're often sequential parts of a complete treatment plan.

If conservative treatment fails, surgery becomes the next step. Having tried therapy first doesn't mean you wasted time—it means you gave your body an opportunity to adapt before committing to an invasive procedure. For the many patients who improve with therapy, surgery is avoided entirely. For those who ultimately need surgery, the strength and mobility gained during therapy often improve surgical outcomes.

After rotator cuff surgery, physical therapy is essential. The surgical repair reattaches the tendon, but rehabilitation restores function. Without proper post-operative therapy, even a perfectly repaired rotator cuff won't work well.

A rancher from Dolores completed three months of physical therapy for his rotator cuff tear. His pain improved significantly, but he still couldn't rope cattle without discomfort. We proceeded with surgery, and his recovery was notably faster than average—his therapist credited the strength he'd built before the operation.

Giving Therapy a Real Chance

The patients who get the most from physical therapy are those who commit fully to the process. That means attending sessions consistently, doing home exercises daily, and communicating honestly with their therapist about what's working and what isn't.

It also means patience. Tissue adaptation takes time. Expecting dramatic improvement after two weeks is unrealistic. Most therapy programs run eight to twelve weeks before we can fairly assess their effectiveness.

If you're skeptical about physical therapy—and I understand why you might be—I'd ask you to give it a genuine trial before concluding it doesn't work. Not a half-hearted effort, but a real commitment. The results often surprise people.

Your rotator cuff tear won't heal in the conventional sense. But your shoulder may function far better than you expect, and that function is ultimately what matters.

You can email Doctor Butzen at doctorbutzen@gmail.com if you have questions. He may request an office visit for complex concerns that require face-to-face discussion.