Shoulder Rehabilitation Protocols for Physical Therapists

Relative Guidelines

  1. Should be relatively pain free
  2. Do a little frequently rather than overload
  3. Quality more important than quantity
  4. Isometric to eccentric to concentric core strengthening
  5. Closed chain to open chain
    1. Closed chain – forearm towel slides on a table, ball rolls on a table
  6. Train muscles in a coordinated, synchronous pattern vs. training individual muscles – reestablish force couples for scapular stabilization and elevation


  1. Rehabilitation is done proximal to distal
  2. Lumbar muscles and trunk strength, progressing scapular progressing to shoulder progressing to upper extremity
  3. Compare the kinetic chain thought process of the leg with that of the shoulder i.e. lumbar to hip girdle to leg

Rotator Cuff Rehabilitation

  1. PROM until 150 degrees
  2. Be sure gleno-humeral motion is fluid rather than compensatory scapular-thoracic motion allowing for the increase range
    1. Soft tissue mobilization and stretching
    2. Scapular positioning
  3. Supine progression (gravity assisted)
    1. Active and active assisted ROM
  4. Start eccentric cuff work at 150 degrees
  5. Progress eccentric cuff work from 150 degrees down to 90 degrees
  6. Then – start concentric cuff work from 90 degrees up to 150 degrees
  7. Start closed chain cuff work at 90 degrees if tolerated

Rule of Thumb

  1. When a patient can lower arm from 150 degrees down to their side with control, start active elevation and rotation
  2. Then progress strength and kinematics

Physical Therapy Cautions

  1. If arm is too painful to elevate, then take a step back as the rotator cuff is not ready
  2. Scapular positioning is very important – learn to set the scapula
  3. Check for anterior or posterior tightness
  4. Control Scapula with all PROM exercises
  5. Careful repeated checks for dysynchronus motion of scapular/gleno-humeral motion
  6. Avoid abduction at 20 degrees with arm extended
  7. Avoid elevation-arm extended with palm down – pronation
  8. Avoid shrug sign indicative of weak supraspinatus and dysynchronus rhythm
  9. Avoid open chain exercises until very late inclusive of classic Codman pendulum exercises which can lead to tension on the rotator cuff suture line
  10. Many of the classic home exercise programs such as towel pulls and broom handle exercises if done incorrectly encourage compensatory scapular-thoracic motion rather than true gleno-humeral motion