Rotator Cuff Tears — What You Actually Need to Know - Lewis Physical Therapy & Sports Rehab

💡 What you’ll learn in this blog:

• Why rotator cuff pain doesn’t automatically mean you need surgery

• How MRI findings can be misleading

• The difference between traumatic vs chronic rotator cuff injuries

• What a “painful arc” actually tells us about your shoulder

• How PT restores shoulder strength, stability, and overhead confidence

🎥 Watch the Full Breakdown on YouTube

▶️ Watch Now on YouTube:

Understanding Rotator Cuff Tears in Active Adults

Rotator cuff injuries are one of the most common shoulder issues we see in active adults and CrossFit athletes. The moment someone feels a sharp pinch, achy shoulder pain, or difficulty lifting overhead, the thought immediately pops up:

“Did I tear my rotator cuff?”
“Is this going to require surgery?”

This fear is understandable — most people know someone who has had rotator cuff surgery, and the recovery is notoriously long. But the reality is that most rotator cuff issues in active adults do not require surgery. Let’s break down why.

When Rotator Cuff Tears Typically Need Surgery

Rotator cuff injuries become surgical considerations based on mechanism, symptoms, and response to rehab, not simply the presence of pain.

Surgical cases typically include:

1. Traumatic, high-force injuries

Slip and falls, forceful catching of a heavy object, or sudden jerking motions typically result in greater injury to the rotator cuff that can increase the likelihood of needing surgical repair.

2. The “shrug sign”

If someone tries to lift the arm and physically cannot — compensating with their upper trap — this suggests significant dysfunction. However, this sign alone typically does NOT mean you need surgery. Many patients that have success with PT will have this sign upon initial evaluation.

3. Failed conservative rehab (after ~3 months)

If an individual follows a structured, progressive PT plan and still cannot improve strength or function, surgical evaluation becomes more likely.

Why MRI Findings Can Be Misleading

Many adults in their 40s, 50s, and 60s show “partial tears,” “tendinosis,” or “degenerative changes” on MRI — even if they have zero pain.

Imaging is just one piece of the puzzle.
We care more about:

• Strength

• Functional movement

• Symptoms during daily activities

• Overhead capacity

• Pain patterns

A "positive" MRI does NOT automatically equal a surgical shoulder.

Understanding the Classic “Painful Arc”

Most active adults with rotator cuff pain still have:

✔️ Satisfactory overall range of motion
❌ But pain during a specific mid-range movement
✔️ Ability to move through the arc once they pass that painful zone

This “painful arc” is caused by the supraspinatus tendon being unable to keep the humeral head centered, allowing it to migrate upward and pinch under the acromion. Proper cuff loading restores this control.

What Rotator Cuff Rehab Actually Looks Like

A successful rehab program focuses on restoring mechanics — not avoiding movement.

Key components include:

• Early-stage isometrics for pain reduction

• Scapular control (lower trap, serratus, rhomboids)

• Gradual isolated rotator cuff loading

• Improving overall shoulder stability throughout the overhead motion

• Returning to overhead training with progressive volume

These programs take time, consistency, and structured progression — but the results are extremely strong when done correctly.

Most active adults return to pressing, kipping, pull-ups, overhead lifts, and CrossFit workouts without ever needing surgery.

🎙 Listen to This Episode on The Lewis Physical Therapy & Sports Rehab Podcast

Catch the full breakdown of how rotator cuff injuries happen, MRI myths, and the rehab progression we use at Lewis PTSR.

🎧 Listen on Spotify:
https://open.spotify.com/show/4A6iBs0CzkAwSu9rUVPfGX?si=lrea2AaWQSy5USIT90KXhQ

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