Kinesiology THURSDAY – 5 Ways to Speed Up Recovery From Rotator Cuff Surgery
When PROM is all that’s allowed…
Most post-surgical protocols for rotator cuff repairs require the patient to be in a sling 24-hours a day, with breaks for passive range of motion (PROM) or pendulum exercises for up to four weeks to maximize protection of the healing tendons.
However, there is so much that can be done in this space of time it’s unbelievable. Don’t waste time within the first month on just pain management, surgical site assessments and squeezing a ball with the hand. Try these 5 key things on your next post-surgical rotator cuff patient and be amazed by the results.

1. Side lying thoracic mobilizations (to improve thoracic rotation) – Test the patient’s ability to perform 90/90 side lying thoracic rotation. This can be done with the injured arm held stabilized to the trunk. The scapula should “melt” to the table. If restricted, use a reverse natural apophyseal glide (NAG) technique or any other mobilization to free up the hypomobile segments.
T4 provides the sympathetic innervation to the posterior shoulder capsule. T8 marks the area of the myofascial superhighway between the latissimus dorsi and the lower trapezius. With prolonged sling wear or abnormal posture, the latissimus dorsi can become short/tight and the lower trapezius becomes long/weak. A long/weak lower trapezius is often associated with a tight upper trapezius, a common cause of shoulder impingement with arm elevation
2. Correction of anterior and posterior clavicle subluxation with MET – The sternoclavicular (SC) joint and the acromioclavicular (AC) joint are responsible for scapular upward rotation during arm elevation. The SC joint serves as the axis of clavicular upward rotation in the first half (0˚-90˚) of arm elevation, resulting in 60˚ of scapular upward rotation. The AC joint serves as the axis of rotation for the additional 30˚ of scapular upward rotation.
Mild subluxations of the medial or lateral clavicle may be present following rotator cuff surgery. The easiest way to assess this is at the medial clavicle. Is the medial clavicle displaced anterior or posterior? If the medial clavicle is displaced anteriorly (often due to prolonged protraction of the shoulder girdle), this will cause posterior displacement of the lateral clavicle.
It is simple to correct clavicular position with simple muscle energy techniques and fascial mobilization.
3. Suboccipital release – The upper trapezius attaches to the base of the occiput. Trigger points set up in muscles that are chronically short and the suboccipital region is a common place for restrictions in post-surgical shoulder patients. Releasing the fascia along the occipital base may aid in relaxing the upper trapezius muscle.
4. Soft tissue mobilization: The most common abnormal positions of the scapula post-surgically are: upward rotation and protraction. Trigger points in related muscles should be released to normalize scapular position an improve motion at the glenohumeral joint. Deltoid (especially posterior), upper trapezius, infraspinatus (inferior angle of scapula) and pec minor are key culprits in scapular malpositioning following shoulder surgery.
5. Kinesiotape for upper trapezius inhibition and deltoid inhibition (which assists in supporting the humeral head in the socket)