There are some factors to keep in mind with regards to a procedure like a rotator cuff repair. The procedure itself can be effective but structural failures are not uncommon. This can be further complicated when paired this with patient co-morbidities and related factors (age, smoking, diabetic, etc). Interestingly, structural failure does not seem to lead to poorer functional outcomes. Failure typically occurs within 3-6 months so protection is important. Recent literature suggests early mobilization may increase the risk of failure (though not be much) without additive benefit. It doesn’t seem early mobilization improves outcomes and it doesn’t seem longer immobilization worsens outcomes.
A recent consensus (cited below) suggested strict immobilization for 2 weeks, followed by protective PROM and gradual increase to AROM at 6 weeks and progressive loading at 12 weeks. The authors acknowledge their opinion and reference surgeons and scientists standing by a 6 week strict immobilization period.
There are a number a references that look at EMG (which has its limitations) activity for pendulums, ADL’s and specific exercises on the rotator cuff. I think a clinician rehabbing post-operative shoulders should have a basic understanding of movements and activities that load the rotator cuff. They can then make informed decisions on application of loading in the clinic. Pair this with progressive overload and specificity and I think a rehab professional has done what they can to help with a positive outcome.
Thigpen, Charles A., et al. “The American Society of Shoulder and Elbow Therapists’ consensus statement on rehabilitation following arthroscopic rotator cuff repair.” Journal of shoulder and elbow surgery 25.4 (2016): 521-535.
Reinold, Michael M., et al. “Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment.” Sports Health 2.2 (2010): 101-115.
Long, Joy L., et al. “Activation of the shoulder musculature during pendulum exercises and light activities.” journal of orthopaedic & sports physical therapy 40.4 (2010): 230-237.
Murphy, Cynthia A., et al. “Electromyographic analysis of the rotator cuff in postoperative shoulder patients during passive rehabilitation exercises.” Journal of shoulder and elbow surgery 22.1 (2013): 102-107.
Uhl, Timothy L., Tiffany A. Muir, and Laura Lawson. “Electromyographical assessment of passive, active assistive, and active shoulder rehabilitation exercises.” PM&R 2.2 (2010): 132-141.