My physician told me not to start physical therapy until one month after my rotator cuff surgery. My next door neighbor had the same surgery last year and his doctor told him to start right away. Am I missing something? Should I be concerned that I won’t get recover as quickly?

There are a lot of different post-operative rehabilitation protocols for rotator cuff surgery and varied research to support which are most effective. One of the more widely used protocols, which seems to be the one that was used by your neighbors surgeon, involves immediate post-operative passive range of motion for the first six weeks followed by strengthening and active range of motion exercises. This protocol when developed was based on an open repair of the rotator cuff versus the current standard of arthroscopic repair, in which the inflammatory response, risk of scarring, and prolonged stiffness is considered to be less common. With the advent of arthroscopic surgery resulting in decreased risk of prolonged stiffness , it may not be as important to start passive range of motion immediately after surgery.

A recent study published in the Journal of Bone and Joint Surgery suggests that it may be more important to focus rehabilitation on decreasing retear rates using a period of immobilization after surgery rather than starting passive range of motion immediately after surgery in order to minimize stiffness. One hundred participants who met specific criteria and underwent arthroscopic repair of the rotator cuff were randomly sorted into two groups. One group was immobilized after surgery for four weeks, the other was immobilized for eight weeks. After the allotted time of immobilization each participant underwent rehabilitation with a physical therapist that included passive range of motion then progressed to active range of motion and strengthening.

At follow up conducted at six months and 24 months after surgery, there were no statistical differences between the groups with retear rates, passive range of motion or clinical scores. There were more reports of stiffness by participants who were immobilized for eight weeks compared to those immobilized for four weeks. With no benefit in healing or diminished retear rate gained by immobilization for 8 weeks, it is deemed most beneficial to promote immobilization for four weeks after rotator cuff repair. The retear rate in this study was 10 per cent, compared to previously reported rates of 20 per cent-40 per cent in studies that involved early passive range of motion before four weeks.
Your surgeon likely wants to minimize the chances of retear of the rotator cuff repair while at the same time decreasing risk of prolonged stiffness, thus choosing to immobilize your shoulder for 4 weeks before beginning physical therapy.