Do Rotator Cuff Tears Heal on Their Own?
What Shoulder Pain May Mean — and the Next Steps for Recovery
If you’ve been searching “do rotator cuff tears heal on their own?”, you’re not alone. Rotator cuff injuries are one of the most common causes of shoulder pain in adults. The good news is that many types of rotator cuff tears improve with the right rehabilitation program, especially physical therapy focused on pain reduction, improving shoulder mechanics, and strengthening.
What Is a Rotator Cuff Tear?
The rotator cuff is a group of four muscles and tendons that stabilize the shoulder and allow you to lift and rotate your arm. A tear occurs when one of these tendons becomes damaged due to overuse, injury, or age‑related degeneration. Any or all of the rotator cuff tendons can be torn: the supraspinatus, infraspinatus, teres minor, or the subscapularis. Rotator cuff tears may sound scary, but they are actually very common, especially as we get older. These “wear and tear” or degenerative tears occur after years of use. Here’s the great news, rotator cuff tears can be pain-free and fully functional.
Signs You May Have a Rotator Cuff Tear
Common symptoms of a rotator cuff tear include pain when reaching overhead, weakness when lifting objects, night pain when sleeping on the shoulder, and sometimes reduced shoulder mobility. If all of these signs are present, you may have a rotator cuff tear.
Do Rotator Cuff Tears Heal with Physical Therapy? What We See In Our Clinics
Here are two real-life examples of common cases we see in the clinic.
Patient Example #1
A 45 year old man from North Mankato, MN began experiencing pain on the outside of his shoulder after hanging sheetrock while remodeling his bathroom. Over the next three weeks, he experienced pain after working out, after using his arms overhead, and mild pain at night. He reached out to us at ActivePT in Mankato because he had been a prior patient for an episode of back pain.
His exam showed normal motion and some rotator cuff weakness, a likely partial-thickness rotator cuff tear. Initially, he received treatment twice weekly to reduce pain and begin strengthening, including dry needling treatment. As his pain reduced, appointments were once weekly, then every other week to regain full function and strength. At his last recheck one month later, his strength tests were back to normal for all rotator cuff muscles, and he was able to exercise and sleep with no pain.
Patient Example #2
A 64 year old prior patient of ActivePT – Shakopee scheduled a free screening appointment to have her shoulder pain assessed. The pain started about two years ago and comes and goes. She doesn’t recall any injury. Her shoulder examination shows that she has lost about 50% of her overhead reach, she has pain reaching behind her back, and pain sometimes at night. Her supraspinatus and infraspinatus strength tests were weak. Her exam was consistent with a partial- to possibly full-thickness rotator cuff tear involving the supraspinatus and infraspinatus tendons.
During the first two weeks of treatment, she attended physical therapy twice weekly, focusing on pain-relief and restoring motion. As her pain lessened and motion improved, she was able to perform more strengthening at home, and her visits to the clinic were reduced. Today, she can raise her arm about 90% of her normal range of motion without discomfort. Most importantly, she reports that she is thrilled to be back gardening and participating in all of her favorite hobbies without pain.
Do Rotator Cuff Tears Heal on Their Own?
Let’s start by discussing the word “heal”. This word implies that the rotator cuff would go back to normal. Our most important goal when someone has a rotator cuff tear is to restore function, not heal the tendon. Throughout life, our rotator cuff tendons deteriorate, and they are never going to be perfectly healed, with or without surgery. It’s important to note that rest will not heal a torn rotator cuff tendon. Completely resting the shoulder can result in stiffness or, worse, a frozen shoulder.
So, do they heal? No, but with an effective physical therapy program, the torn region can effectively lay down scar tissue to produce a shoulder with little to no pain and no limitations. In some cases, patients still have some limitations, but are happy with the function of their shoulder. Without surgery, modern physical therapy has very high success rates. One report shows that non-operative treatment is effective in treating full thickness tears in 75% of cases.
Why Physical Therapy Often Works
Physical therapy treatment for shoulder pain focuses on strengthening the rotator cuff muscles, improving posture, shoulder mechanics, and restoring mobility. The most effective programs include a combination of hands-on treatment, stretching, deep tissue mobilization, joint mobilization, spinal mobilization or manipulation, progressive loading, and strengthening. In some patients, dry needling treatment is an effective addition to their program.
Be wary of rehab programs that only include exercises. We often see patients who fail to improve with a home exercise program. Effective rotator cuff rehab is not typically that simple.
The Role of Dry Needling in Rotator Cuff Treatment.
Dry needling is a medical term for inserting thin, sterile needles into muscles or surrounding tissue, often with electrical stimulation. This treatment is often added to a rotator cuff rehab program and is an effective way to reduce pain and stimulate the healing response in tissue.
What Recovery Typically Looks Like
Most patients improve within 6–12 weeks when following a structured physical therapy plan that progresses from pain relief to strengthening and return to activity.
When Surgery May Be Necessary
Surgery is sometimes necessary. Most patients respond to a thorough physical therapy program that includes pain relief treatments like manual therapy or dry needling, treatments to restore normal shoulder mechanics, and rotator cuff and scapular stabilizer strengthening exercises. Despite doing all things right, some shoulders just don’t improve enough with conservative care. Here are a few examples:
- You have a large, full-thickness tear that has not responded to a comprehensive physical therapy program for at least 8 weeks
- You suffer from intolerable night pain and are a healthy, non-smoking/non-nicotine-using surgical candidate
- You suffered a fall or traumatic injury at a young age, resulting in a large, full-thickness tear of your rotator cuff
Important note – surgeons will be very hesitant or may refuse to perform surgery if you are actively using nicotine. Research studies show that nicotine inhibits tendon healing after surgery. Consult with your medical team to help you with smoking, vaping, or other nicotine cessation before considering surgery.
Patient Example #3
A 40-year-old, healthy, right-handed electrician from Shakopee, MN was shoveling snow when he slipped and fell on the ice. He landed on his right hand with his arm outstretched. He felt sudden, severe pain in the outside of the shoulder and was immediately unable to lift his arm higher than his shoulder. He reached out to us for advice. His shoulder exam shows a resting pain level of 5/10, which increases to 8/10 at night. He’s able to reach up to shoulder height on his own. With help, his arm raises all the way up without any stiffness. His rotator cuff strength tests for the supraspinatus, infraspinatus, and teres minor are extremely weak. His subscapularis, elbow, wrist, hand, and upper back muscles are strong.
This gentleman did everything right, kept his arm moving, tried to strengthen, and we were able to reduce his pain somewhat, but his night pain did not subside. As we often do with a case like this man’s, we contacted a trusted orthopedic surgeon and scheduled an appointment while we continued physical therapy. By the time he saw the surgeon weeks later, it was clear that his large, full-thickness rotator cuff tear was not responding well enough to physical therapy to avoid surgery. At his age, excellent health, and non-nicotine-using status, he was an excellent candidate for surgical repair. He returned to therapy after surgery and recovered fully. He returned to work on light duty at 3 months and full duty at 5 months.
When Should You Seek Treatment?
Honestly, there’s no need to wait. But, if you want to start with self-care, consider an evaluation by a physical therapist if shoulder pain lasts longer than two weeks, interferes with your sleep, or limits your ability to lift or reach overhead. The earlier you start physical therapy, the faster and better your chances of a faster recovery. Your physical therapist can assess the severity of your problem and will refer you to an orthopedic surgeon if your shoulder is not responding well to physical therapy.
Rotator Cuff Treatment at ActivePT
ActivePT provides shoulder rehabilitation at multiple locations, including Shakopee, Mankato, Owatonna, Rochester, and all of our satellite locations. Schedule a free pain or injury screening appointment if you would like to have your shoulder pain assessed. There is no cost, and no referral is necessary for a free pain or injury screen.
Rotator Cuff Tear FAQ
Can you live with a rotator cuff tear?
Yes. Many people live with rotator cuff tears and experience minimal symptoms with proper strengthening and activity modification.
How do I know if my rotator cuff tear is serious?
Severe weakness, inability to lift the arm, or a traumatic injury may indicate a more serious tear that should be evaluated by a medical professional.
Should I exercise with a rotator cuff tear?
Yes, but exercises should be guided by a physical therapist to avoid worsening the injury.
Should I wear a shoulder sling or immobilizer if I’ve injured my shoulder?
No. While shoulder slings or immobilizers like this one may help if you wear them for brief periods of pain relief, you should not immobilize your arm if you have a rotator cuff tear. Immobilizing your arm can increase your risk for adhesive capsulitis (frozen shoulder). If you’re not sure if a sling is ok to wear for your problem, we recommend having your injury screened by a physical therapist who specializes in shoulder pain treatment.
What is the Easiest Way To Have My Shoulder Assessed?
We recommend starting with a free pain or injury assessment because it’s the fastest and simplest way to have your shoulder checked. There is no cost, and no referral is needed. Physical therapists, especially shoulder specialists, are trained to evaluate for rotator cuff tears. Once you and your physical therapist determine the problem, they can help you determine the best next step fo get your pain down and your function back.
Related Resources
- Dry Needling Treatment
- Physical Therapy Services
- Blog: Working from home – neck, back, and shoulder pain
References
Yamamoto A et al. Prevalence of rotator cuff tears in the general population. J Shoulder Elbow Surg. 2010.
Kuhn JE et al. Effectiveness of physical therapy for rotator cuff tears. J Shoulder Elbow Surg. 2013.
Arias‑Buria JL et al. Dry needling for shoulder pain. J Orthop Sports Phys Ther. 2015.
Kuhn, J et al. Effectiveness of Physical Therapy in Treating Atraumatic Full Thickness Rotator Cuff Tears. A Multicenter Prospective Cohort Study. J Shoulder Elbow Surg. 2013 October ; 22(10): 1371–1379. doi:10.1016/j.jse.2013.01.026.
