If you’ve been told you have a rotator cuff tear and surgery was presented as the obvious next step, it’s worth pausing before you book the OR. For the majority of rotator cuff tears, physical therapy produces outcomes comparable to surgery. Not slightly worse. Comparable. And PT doesn’t come with the recovery time, the cost, or the surgical risk (plus you have to do PT after the surgery anyway!)
What a rotator cuff injury actually is
Tendinopathy is degeneration of the tendon without a structural tear. Partial tears are partial disruptions. Conservative PT is first-line treatment and is highly effective. Full thickness tears are complete ruptures. The surgical decision depends on age, activity level, functional demands, and how the shoulder responds to PT.
What the research actually shows
Multiple high quality randomized controlled trials have found that PT outcomes are equivalent to surgical outcomes for pain relief, strength, and function in the majority of patients. The key word is skilled. A program of 20 minutes on a machine with a printout of exercises is not the same as 1-on-1 care with a Doctor of PT who is manually treating the shoulder and systematically progressing loading.
But heres the thing, the studies that show that PT is comparable to surgery are based on the low quality, generic PT described above. In other words, even bad PT has comparable outcomes to surgery. In our experience providing high level, performance Physical Therapy, the outcomes we get with patients in the clinic are head and shoulders above both surgical outcomes and low quality PT outcomes.
Our three phase approach
Phase one: manual therapy to reduce pain, restore range of motion, and address the impingement mechanics compressing tissue with movement. Phase two: progressive rotator cuff and scapular strengthening. Phase three: return to full activity, overhead mechanics, and whatever the patient is going back to.
When surgery makes sense
Surgery is the right call when the tear is acute and traumatic, when high quality PT has failed over a meaningful period, when there’s complete loss of cuff function, or when the patient is a competitive overhead athlete. For the majority of rotator cuff injuries we see, those criteria don’t apply.
At Land and Sea PT in Oceanside, we work 1-on-1 with a Doctor of PT every session. If you’ve been told you need surgery for a rotator cuff tear and want an honest second opinion, we’d be glad to take a look.
If you want to contact us or book an appointment, check our business profile page.
Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.