Rotator Cuff Pain and Tears: How PT Can Help
By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026
Your shoulder has been aching for weeks. It hurts to reach into the back seat, put on a jacket, or sleep on that side. Then an MRI or ultrasound shows a rotator cuff tear, and the first question on your mind is whether it means surgery.
Rotator cuff problems are very common, especially after age 40, and the right path depends on how the problem started, your symptoms, and your goals. This article explains what the rotator cuff does, what an injury feels like, why not every tear causes pain, how physical therapy can help, and when to see a surgeon.
The short answer
The rotator cuff is a group of four muscles and tendons that keep your shoulder joint steady as your arm moves. Rotator cuff pain and tears become more common with age, and many tears cause no symptoms at all: in one population study, about 65% of the tears found were in people without symptoms (Minagawa et al., 2013). For many people with rotator cuff pain, and for many tears that develop gradually, exercise-based physical therapy is a recommended starting point. A sudden loss of strength after a fall or injury needs prompt evaluation by a physician, and decisions about surgery are made with an orthopedic surgeon. In California, you can see a physical therapist without a referral.
What does the rotator cuff do?
Your shoulder is a ball-and-socket joint with a large ball and a shallow socket, which lets it move in almost every direction. The rotator cuff wraps around the ball and keeps it centered in the socket while bigger muscles, like the deltoid, lift and move your arm.
The four rotator cuff muscles help you:
• Lift your arm out to the side and overhead
• Rotate your arm in and out, like reaching behind your back or brushing your hair
• Keep the shoulder stable during lifting, throwing, and reaching
What does a rotator cuff injury feel like?
Common symptoms include:
• A dull ache deep in the shoulder or the outside of the upper arm
• Pain when lifting your arm, especially between shoulder height and overhead
• Pain lying on the affected side at night
• Weakness when lifting or rotating the arm
• Trouble with everyday tasks like reaching up, reaching behind your back, or getting dressed
Rotator cuff problems generally fall into two groups:
• Gradual (degenerative) problems build up over time with age and repeated use. This includes tendon pain without a tear and many tears found in people over 50.
• Sudden (traumatic) tears happen with a specific event, like a fall on an outstretched arm, catching something heavy, or a sudden pull. They often cause sudden weakness and need prompt medical evaluation.
Is every rotator cuff tear a problem?
Not necessarily. Tears are surprisingly common, and many people with them have no pain. In a study that screened an entire village in Japan, full-thickness rotator cuff tears were found in 22% of people. The rate rose with age: about 11% of people in their 50s, 15% in their 60s, 27% in their 70s, and 37% in their 80s. About 65% of the tears were in people who had no symptoms (Minagawa et al., 2013).
That means a tear on an MRI doesn't always explain shoulder pain, and pain doesn't always mean a tear is the cause. Your physician and physical therapist will match your imaging to your symptoms, history, and exam.
How can physical therapy help?
For rotator cuff tendon pain, the 2025 rotator cuff tendinopathy guideline gives its strongest recommendation to exercise therapy, including progressive resistance training and movement control exercises, adjusted to each person's pain and goals (Desmeules et al., JOSPT 2025). For tears that develop gradually, a large multicenter study found that most people who completed a structured physical therapy program for an atraumatic full-thickness tear did not go on to have surgery during the study's follow-up (Kuhn et al., J Shoulder Elbow Surg 2013).
A physical therapy evaluation may include:
• How and when your symptoms started, and whether there was an injury
• Shoulder motion in every direction
• Strength testing of the rotator cuff and shoulder blade muscles
• How your neck and upper back move
• A review of any imaging and physician notes you have
• Screening for signs that need a physician's or surgeon's evaluation
A typical plan may include:
• Progressive strengthening of the rotator cuff, shoulder blade, and upper back muscles
• Exercises that gradually restore overhead motion
• Hands-on treatment, when it helps you move more comfortably
• Guidance on sleeping positions, work tasks, and returning to the gym or sports
• A home program you can keep doing on your own
Physical therapy doesn't guarantee a specific result, and it isn't the right fit for every tear. If symptoms remain severe after a period of good conservative care, the 2025 guideline recommends referral to a musculoskeletal specialist. Physical therapy also plays an important role in recovery after rotator cuff surgery.
At Nova Physical Therapy in North Hollywood, shoulder recovery is one of our core services, and every plan starts with an evaluation so treatment fits what we find.
For more on pain when lifting your arm, read our post on shoulder pain when raising your arm.
When should I see a surgeon?
Every situation is different, and surgery is a decision you make with an orthopedic surgeon. Reasons to get a prompt evaluation from a physician or surgeon include:
• Sudden weakness or loss of arm lifting after a fall or injury, especially if you're younger or very active
• Being unable to lift your arm at all
• A shoulder that looks out of place after an injury
• Weakness that keeps getting worse
• Pain and weakness that haven't improved after a period of consistent physical therapy
• Questions about whether your type and size of tear is likely to do better with surgery
Call 911 if shoulder, arm, or jaw pain comes with chest pain or pressure, shortness of breath, sweating, or nausea. These can be signs of a heart attack (American Heart Association).
Also see a physician promptly for a hot, red, swollen shoulder, fever, numbness or tingling spreading down the arm, or night pain that doesn't change with position.
We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.
Do I need a referral for physical therapy in California?
Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.
Frequently asked questions
Can a rotator cuff tear heal without surgery?
Torn tendons generally don't grow back together on their own, but many people with tears, especially gradual ones, regain comfortable, useful shoulder function with exercise. Whether surgery makes sense for your tear is a decision made with your surgeon.
Is a partial tear serious?
Partial tears are common and often managed with exercise-based care. Your physician can explain what your imaging shows and what it means for you.
How long does rotator cuff physical therapy take?
Many people notice improvement within several weeks, with continued progress over a few months. It varies depending on the problem, your goals, and how consistently you exercise.
Should I stop using my arm?
Usually not. Gentle use within a comfortable range helps prevent stiffness. Heavy overhead lifting may need to be reduced for a while.
Can I lift weights with a rotator cuff injury?
Often, yes, with changes. Lighter loads, modified exercises, and a gradual return can keep you training. A physical therapist can help decide what to adjust.
Do I need an MRI?
Not always. Your physician decides whether imaging is needed, often after an injury, with significant weakness, or when symptoms aren't improving.
Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above.
About Nova Physical Therapy
Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from shoulder problems, back and neck pain, sports injuries, work injuries, auto accident injuries, and knee pain, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.
Schedule an evaluation
If shoulder pain or weakness is making it hard to reach, lift, or sleep, an evaluation can help sort out what is driving it and which next steps fit you.
Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online
Disclaimer
This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Imaging results should be interpreted by your physician, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.
References
1. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8–12. Link
2. Kuhn JE, Dunn WR, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013. Link
3. Desmeules F, Roy J-S, Lafrance S, et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 2025. Link
4. American Heart Association. Warning Signs of a Heart Attack. Link