How to heal a torn rotator cuff without surgery

Considering surgery for rotator cuff pain or injury is common. Each year, nearly 2 million people in the U.S. seek care for shoulder pain related to their rotator cuff — and about half a million surgeries are performed. But surgery isn’t your only option if you experience this common shoulder injury. 

“There’s growing evidence that people recover from rotator cuff injuries similarly whether they choose surgery or focus on a conservative approach,” says Courtney Fitzpatrick, PT, DPT, a physical therapist at Hinge Health. “Physical therapists help many people recover from rotator cuff injuries — and most do very well with nonsurgical care.” According to the American Academy of Orthopaedic Surgeons, about 80 to 85% of people experience relief and improved daily function without surgery.

Read on to discover how you can support your shoulder’s recovery without surgery, including targeted exercises recommended by Hinge Health physical therapists.

What is a rotator cuff injury?

The rotator cuff refers to the muscles and tendons around your shoulder that help you move your arm in different directions. Because the shoulder is such a mobile joint — and the rotator cuff isn’t always addressed during regular workouts — it’s common to experience discomfort or pain in this area, especially with age.

Rotator cuff injuries are very common and often respond well to simple, nonsurgical approaches. Typical rotator cuff injuries include: 

• Tendonitis, or inflammation of the tendons connecting the rotator cuff muscles to bone. This could be due to a strain, which occurs when a muscle or tendon is overstretched. 

• Impingement, which happens when there’s less space in the shoulder joint — often because of anatomy — leading to irritation as the tendons and nearby structures rub against each other.

• Tears. Rotator cuff tendons can have partial tears or complete ruptures. While complete ruptures may need surgery, other tears may respond well to conservative treatments, Dr. Fitzpatrick says.

How does a rotator cuff tear occur?

A rotator cuff tear can happen from a sudden injury or gradually over time. Sometimes tears occur when the shoulder is doing more than it’s ready for. Common causes of a rotator cuff tear include natural changes in the tendons that come with aging, repeated overhead movements, sudden injuries such as falls, and having a history of shoulder issues like arthritis. These factors can make the rotator cuff more vulnerable, but strengthening and caring for the muscles and tendons around your shoulder can help reduce your risk.

Causes of a rotator cuff tear include: 

• Aging. “As you age, your tendons naturally change, much like how your skin gets wrinkles over time,” says Dr. Fitzpatrick. In fact, half of people ages 60 to 80 have rotator cuff tears — and don’t even know it, and that’s okay. Many tears don’t cause any symptoms or affect your ability to do everyday activities, like reaching for an object on an overhead shelf. 

• Overuse. If you do a lot of repetitive overhead movements — like playing tennis, swimming freestyle, or painting — you may be at higher risk for rotator cuff injuries. Your body is resilient, but without conditioning these muscles and tendons, repeating the same motions can put extra strain on them. Regularly stretching and strengthening these soft tissues can help support your shoulders, preparing them for these activities.

• Sudden injury. A rotator cuff tear can sometimes happen after unexpected events, like falling on an outstretched arm, quickly lifting something heavy before warming up, or doing a sudden, forceful movement, such as starting a lawn mower. Shoulder dislocations because of shoulder instability can also sometimes lead to a rotator cuff tear.

• Underlying shoulder issues. Having a history of shoulder injuries or conditions like arthritis can make rotator cuff tears more likely, Dr. Fitzpatrick says. 

Treatments for a torn rotator cuff

A rotator cuff can heal on its own after a tear, but you can still function normally and safely even when tears don’t completely heal. Conservative treatments like doing exercise therapy, applying cold and heart therapy, and in some cases, getting steroid injections can all help ease pain and promote recovery. Nonsurgical rotator cuff tear treatments include: 

• Try physical therapy and targeted exercises. Targeted exercises can help strengthen the muscles in and around your shoulder, easing pressure off torn rotator cuff tendons. You can do exercise therapy at home or work with a physical therapist (PT) who can guide you through movements tailored to your needs. A PT can identify whether you have any muscle weaknesses, stiffness, or mobility limitations. “A rotator cuff tear can affect everyone differently, which is why it’s so important to work with a PT,” says Dr. Fitzpatrick. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Physical activity increases blood flow and improves shoulder mobility, both of which support healing. In addition to shoulder-specific exercises, activities like walking, using an elliptical machine, or riding a stationary bike can all enhance your recovery. The PEACE and LOVE protocol is a great self-care approach for a rotator cuff tear. It suggests staying active and prioritizing movement, rather than complete rest, is the key to rehabbing your shoulder injury and protecting it from further damage.

• Apply heat and cold therapy. Ice helps quell inflammation and swelling, especially after an acute injury, whereas heat helps ease muscle stiffness and promote healing by increasing blood flow to the area. Alternating between these two methods can provide relief. Or stick to the one that works best for you.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can perform your targeted exercises and stay active when you have shoulder pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Enhance your diet. Eating a balanced, nutrient-rich diet can help support your body’s natural healing processes. Choosing foods that are loaded with key nutrients, such as omega-3 fatty acids and vitamins D and C can help combat inflammation and support tissue repair. Consider working with a registered dietitian for personalized tips on what to eat to support your overall health.

• Try complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for shoulder pain relief, such as massage, acupuncture, dry needling, or chiropractic care.

• Consider steroid injections. If rotator cuff pain is so intense that you can’t do physical therapy or exercise, your doctor may recommend a steroid injection. This can help relieve inflammation and pain so that you can do the movements you need to heal.  Injections are also a good option before considering surgery. About two-thirds of people experience relief for at least three months after receiving cortisone injections in the shoulder, according to the American Academy of Orthopaedic Surgeons.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce shoulder pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

How exercise can help heal a rotator cuff tear

Movement is medicine, and exercise is one of the best ways to support healing if you have a rotator cuff tear. In fact, research suggests exercise therapy can be just as effective as surgery for many people.

After a rotator cuff tear, it’s common for the muscles around your shoulder to become extra tight or lose strength as a protective response. While your body’s natural instinct is to guard the area, this can sometimes lead to more discomfort and a slower recovery.

Targeted exercises help rebalance this response and encourage healing. Hinge Health physical therapists recommend finding your “movement sweet spot,” or the level of activity that strengthens your shoulder and increases your joint’s range of motion without aggravating it.

“Targeted exercises increase blood flow to the injured tendon, promoting healing, restoring function, and decreasing pain,” says Dr. Fitzpatrick. “Many people do well with conservative treatment because other muscles in the shoulder can step in and provide extra support as your rotator cuff tendon heals.”

It’s important to remember that healing from a rotator cuff tear takes time, and progress may be gradual. Some people may feel discouraged if they don’t see fast results and consider surgery sooner than they need to. Sticking with your physical therapy plan and giving your body the time it needs to heal can lead to meaningful improvements and may help you avoid surgery altogether.

These gentle exercises can help a rotator cuff heal by strengthening and stretching the muscles that surround and support your rotator cuff. All of these moves gradually increase movement to improve flexibility, mobility, and strength without aggravating the injury.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

When to see a doctor

Conservative treatments help many people, but not all rotator cuff tears respond to these methods. If you’ve tried the above nonsurgical approaches or are experiencing any of the following symptoms, talk to your healthcare provider:

• Significant impact on ability to use your shoulder or arm

• Persistent or worsening pain

• Worrisome or unusual symptoms, including numbness or weakness

Depending on the specifics of your injury and what activities you hope to return to, surgery may be recommended to help you get back to the things you love. For instance, surgery may be suggested for people who want to participate in higher-demand sports or physical activities faster. If you do need surgery, physical therapy and the above targeted exercises can help you restore strength afterward, research suggests. 

PT tip: Practice patience 

Recovery takes time, and it’s normal for symptoms to improve gradually rather than all at once. “Having ups and downs is part of the process,” says Dr. Fitzpatrick. “Setbacks can happen, especially when you’re feeling better and start doing more activities. Think of each setback as a learning opportunity to come back even stronger.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Over 460,000 Rotator Cuff Surgeries per Year Reported in the United States by iData Research. (2018, July 4). IData Research. https://idataresearch.com/over-460000-rotator-cuff-surgeries-per-year-reported-in-the-united-states-by-idata-research/

3. Rotator Cuff Tears: Frequently Asked Questions - OrthoInfo - AAOS. (2017). Aaos.org. https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears-frequently-asked-questions/ 

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