I need a pep talk. I’ve done nine months of shoulder rehab (first with a physical therapist, then on my own). Despite all that, my torn rotator cuff repair didn’t work. Now I’m faced with a second operation and more rehab. To be honest, I just don’t feel up to it! How can I motivate myself to keep up the exercise regimen when it didn’t work the first time?

It might help to consider that the rehab program didn’t fail you. In fact, you probably got benefits from it that you aren’t aware of — benefits that will make the second surgery go better for you than if you had not been so faithful.

There are many reasons why repaired rotator cuffs aren’t always successful. It’s not usually because the patient followed a rehab program for weeks to months. If anything, poor patient compliance may be a contributing factor to a failed response.

Most of the time, the absence of tendon healing or a retear occur because of the size of the tear (massive, full rupture affecting more than one tendon) and/or the age of the patient (older adults don’t do as well as younger adults). Degenerative changes in the damaged tendons and surrounding joint and soft tissues are also important risk factors for delayed or nonexistent healing. The longer the time between injury and repair, the more the body tries to heal itself by filling in with fatty tissue instead of strong tendon cells.

The rehab program following a second (revision) rotator cuff surgery will probably be less aggressive than your previous program. The first six weeks after surgery are in a shoulder sling with an abduction pillow. The pillow abducts the arm or in other words, keeps it a little bit away from the body. This position reduces the tension placed on the healing tendon tissue. You’ll be able to take the arm out of the sling to keep the elbow, forearm, wrist, and hand moving. But no formal exercise program just yet.

After six weeks in a sling and pillow a physical therapist will move the shoulder joint through its motions passively (without your assistance). You probably won’t be allowed to help move the arm for a full 12 weeks after surgery. By the end of four months, a strengthening program is started. The therapist will help you prepare to return to work and create a rehab program that will enable you to meet your work demands.

Hopefully, all will go well for you. You’ll get a break and you’ll have someone to guide and encourage you. With good results, you will see progress that will encourage you to reach your goal of full return-to-activities, including work.