I tore my rotator cuff not once but three times. It's not looking very good for surgery. The surgeon wants me to do six months of physical therapy. How is that going to help?

Most experts agree that a good, solid effort at rehab should be attempted before considering surgery. As much as six months should be dedicated to this task. A physical therapist provides a supervised program with strengthening exercises, scapular retraining, and proprioceptive activities. Proprioception refers to the joint having a sense of its own position and being able to recognize where it is and respond to any slight changes in movement.

The therapist will also examine the position of the scapula (shoulder blade) and see how it moves. Most people don't realize it, but the coordinated motion of shoulder and scapula are really key to normal arm movement. If the natural rhythm and movement of the shoulder-scapular complex are off, the shoulder loses some of its stability.

If there is a problem in the way the scapula and shoulder move, the therapist will evaluate what's going on to see just what might be causing problems with scapular position or movement. Is there an imbalance between the different groups of shoulder muscles? Are the muscles balanced but weak?

Sometimes patients are even able to avoid surgery if the shoulder responds well to rehab. But if the patient fails to improve with conservative (nonoperative) care, then surgery may be the next step. The idea is to stabilize the shoulder as much as possible before disrupting the balance of soft tissues. Stronger muscles rehab faster after surgery, so it gives the patient an advantage before going in to surgery.