Dr. Reza Jazayeri is a double board-certified orthopedic surgeon and sports medicine physician and Director of Longevity & Optimization at DOCS Health. He completed his orthopedic surgery residency at NYU-Hospital for Joint Diseases and his sports medicine fellowship at Kerlan-Jobe Orthopaedic Clinic. Learn more about Dr. Jazayeri’s training and approach.
About this guide
Stay in the gym, protect the repair. This guide gives athletes and bodybuilders a muscle-group-by-muscle-group timeline for returning to lifting after rotator cuff repair. It covers two surgeries side by side:
- Rotator cuff repair alone (RCR)
- Rotator cuff repair with biceps tenodesis (RCR + BT)
The goal is to minimize muscle loss and preserve conditioning while protecting your repair as it heals. Your own timeline may differ based on tear size, tissue quality, and what was found at surgery. Your surgical report and Dr. Jazayeri’s instructions always come first.
Your surgery: what each one protects
The rotator cuff sets the pace for your shoulder in both surgeries. A biceps tenodesis adds a second clock for your elbow: anything that bends the elbow or turns the palm up against resistance is delayed.
On a phone, swipe horizontally to view all table columns.
| Consideration | RCR alone | RCR + biceps tenodesis |
|---|---|---|
| What was fixed | Torn cuff tendon reattached to bone | Same cuff repair, plus the long head of the biceps moved and anchored lower on the arm bone |
| Sling | 4 to 6 weeks | 4 to 6 weeks |
| Main thing to protect | Lifting, pushing or pulling with the shoulder | The shoulder and resisted elbow bending / palm-up turning |
| Elbow bending | Free active motion (no weight) from week 1 | Passive only until week 4 to 6; no resisted curls until about week 8 |
| Biceps curls | Light curls, elbow at side, ~week 6 | Light curls ~week 8; heavy curls 4+ months |
| What sets the overall pace | Cuff healing | Cuff healing (the biceps usually heals first) |
Tear size shifts the clock. Large or massive tears, or a repair that includes the subscapularis (front of the cuff), typically run 2 to 4 weeks behind every shoulder milestone below. Subscapularis repairs also delay pressing, chest work, and outward rotation.
At a glance: what you can train, and when
You can train most of your body within the first two weeks. Chest and the surgical shoulder come back last.
Legs, core and cardio come back weeks before chest and shoulder. Earliest start, small-to-medium tear. Large or subscapularis tears run 2 to 4 weeks later.
| Body part | Weeks 0 to 6 | Weeks 6 to 12 | Months 3 to 4 | Months 4 to 6 | Month 6+ |
|---|---|---|---|---|---|
| Cardio | Light/limited: Walk, bike | Light/limited: Elliptical | Training/progressing: Running | Training/progressing: Rower, swim | Training/progressing: Full training |
| Legs and glutes | Light/limited: Machines | Light/limited: Belt squat | Training/progressing: Hack squat | Training/progressing: Squat, deadlift | Training/progressing: Full training |
| Core | Light/limited: Floor core | Light/limited: Forearm plank | Training/progressing: Planks | Training/progressing: Ab wheel | Training/progressing: Hanging raises |
| Non-surgical arm | Light/limited: Seated, stable | Training/progressing: Train freely | Training/progressing: Train freely | Training/progressing: Train freely | Training/progressing: Train freely |
| Biceps: RCR alone | Light/limited: No-weight bend | Light/limited: Light curls | Training/progressing: Cable, DB curls | Training/progressing: Heavy curls | Training/progressing: Full training |
| Biceps: with BT | Not yet/protected: Protected | Light/limited: Light curls wk 8 | Light/limited: Cable, DB curls | Light/limited: Heavy, mo 4 to 6 | Training/progressing: Full training |
| Triceps | Light/limited: No-weight | Light/limited: Pushdowns | Light/limited: Kickbacks | Training/progressing: Overhead ext. | Training/progressing: Most; no dips |
| Back and traps | Light/limited: Squeezes | Light/limited: Band rows | Light/limited: Cable rows | Training/progressing: Pulldowns | Training/progressing: Pull-ups |
| Shoulder | Not yet/protected: Passive only | Light/limited: Active motion | Light/limited: Band rotation | Light/limited: Light raises | Training/progressing: Pressing |
| Chest | Not yet/protected: Not yet | Not yet/protected: Not yet | Light/limited: Wall push-ups | Light/limited: Machine press | Training/progressing: Bench |
Biceps tenodesis mainly delays biceps work; grip, band rows and chin-ups also shift about 2 weeks later.
Exercise timeline by body part
Times are from the day of surgery for a small-to-medium tear. Each one is the earliest start, if you are pain-free and have met the milestones below. Where the two columns match, the cuff is setting the pace.
Cardio and conditioning
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Walking, incline treadmill (hands off the rails) | Week 1 | Week 1 |
| Upright or recumbent bike (no weight on the surgical arm) | Week 1 to 2 | Week 1 to 2 |
| Elliptical, legs only (no arm handles) | Week 6 | Week 6 |
| Stair climber (light touch with the non-surgical hand) | Week 6 | Week 6 |
| Jogging and running | Month 3 | Month 3 |
| Rowing machine, arm bike, assault bike | Month 4 to 5 | Month 5 |
| Swimming (breaststroke first, freestyle later) | Month 4 to 6 | Month 4 to 6 |
Legs and glutes
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Leg extension, leg curl, seated calf raise, hip abductor/adductor machines | Week 2 | Week 2 |
| Leg press (sling on, hold with the non-surgical hand) | Week 2 to 3 | Week 2 to 3 |
| Glute bridges, hip thrust machine | Week 2 to 3 | Week 2 to 3 |
| Belt squat, bodyweight split squats | Week 4 to 6 | Week 4 to 6 |
| Hack squat, pendulum squat (pads rest on the shoulders) | Month 3 | Month 3 |
| Safety-bar squat | Month 3 to 4 | Month 3 to 4 |
| Dumbbell lunges, dumbbell RDLs, trap-bar deadlift (light) | Month 4 | Month 4 |
| Barbell back squat (bar position stresses the shoulder) | Month 4 to 5 | Month 4 to 5 |
| Conventional deadlift, heavy pulls | Month 5 to 6 | Month 5 to 6 |
Core
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Crunches, dead bugs (legs only), reverse crunches | Week 2 | Week 2 |
| Ab machines that don’t load the arm, standing Pallof press (non-surgical arm) | Week 4 to 6 | Week 4 to 6 |
| Forearm plank, side plank | Week 10 to 12 | Week 10 to 12 |
| Full plank, cable crunches, ab wheel | Month 4 to 5 | Month 4 to 5 |
| Hanging leg raises | Month 5 to 6 | Month 5 to 6 |
Non-surgical arm
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Single-arm machine and dumbbell work, seated and stable | Week 1 to 2 | Week 1 to 2 |
Training the healthy arm helps the surgical side keep strength through the “cross-education” effect. Stay seated or supported, and never brace with the surgical arm.
Grip and forearm
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Ball squeezes, putty, finger work (in sling) | Week 1 | Week 1 |
| Light wrist curls and reverse wrist curls, forearm supported | Week 2 to 4 | Week 4 to 6 |
| Dumbbell hammer holds, farmer’s carry | Month 3 to 4 | Month 4 |
Biceps
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Active elbow bending, no weight | Week 1 | Week 4 to 6 |
| Light dumbbell curls (1 to 5 lb), elbow at side | Week 6 | Week 8 |
| Cable and dumbbell curls, progressive | Week 10 to 12 | Week 12 |
| Hammer curls, preacher curls | Month 3 | Month 4 |
| Heavy barbell and EZ-bar curls | Month 4 | Month 4 to 6 |
Triceps
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Active elbow straightening, no weight | Week 1 | Week 1 |
| Light band or cable pushdowns, elbow at side | Week 8 | Week 8 |
| Dumbbell kickbacks, heavier pushdowns | Week 12 | Week 12 |
| Overhead triceps extensions | Month 4 to 5 | Month 4 to 5 |
| Close-grip bench, skull crushers | Month 6 | Month 6 |
| Dips | Month 9+ (or avoid) | Month 9+ (or avoid) |
Back and traps
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Shoulder-blade squeezes, no weight | Week 1 to 2 | Week 1 to 2 |
| Light band rows | Week 8 to 10 | Week 10 |
| Seated cable rows, machine rows, light shrugs | Week 12 | Week 12 |
| Chest-supported dumbbell rows, face pulls | Month 3 to 4 | Month 3 to 4 |
| Lat pulldown (light, to the front) | Month 4 | Month 4 |
| Barbell rows, heavy shrugs | Month 5 to 6 | Month 5 to 6 |
| Pull-ups and chin-ups (chin-ups last after BT) | Month 6 | Month 6 to 7 |
Shoulders (surgical side)
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Pendulums, therapist-guided passive motion | Week 1 | Week 1 |
| Assisted motion (wand, pulleys) | Week 6 | Week 6 |
| Active motion, gentle isometrics | Week 6 to 8 | Week 6 to 8 |
| Band external and internal rotation | Week 10 to 12 | Week 10 to 12 |
| Light lateral raises and front raises (to shoulder height, thumbs up) | Month 4 | Month 4 |
| Light dumbbell overhead press | Month 5 to 6 | Month 5 to 6 |
| Barbell or heavy overhead press | Month 6 to 9 | Month 6 to 9 |
| Upright rows, behind-the-neck press | Avoid long-term | Avoid long-term |
Chest
| Exercise | RCR alone | RCR + BT |
|---|---|---|
| Wall push-ups, gentle isometrics | Week 12 | Week 12 |
| Machine chest press, light, shortened range | Month 4 to 5 | Month 4 to 5 |
| Incline push-ups, then floor push-ups | Month 4 to 5 | Month 4 to 5 |
| Dumbbell bench press | Month 5 to 6 | Month 5 to 6 |
| Barbell bench press, light | Month 6 | Month 6 |
| Flyes, pec deck (deep stretch) | Month 6 to 9 | Month 6 to 9 |
Sport and high-risk lifts
| Activity | RCR alone | RCR + BT |
|---|---|---|
| Golf, tennis, light throwing | Month 6 | Month 6 |
| Olympic lifts, kipping, CrossFit, overhead throwing sports | Month 9 to 12 | Month 9 to 12 |
| Combat sports, contact sports, heavy competition lifting | Month 9 to 12, with clearance | Month 9 to 12, with clearance |
Training rules
- Start every new exercise at about 30% of your old working weight. Add no more than about 10% per week, and only if the shoulder stays pain-free.
- Keep the elbow close to the body for early rows, curls and pushdowns. Arms out to the side or overhead come later.
- No sets to failure, forced reps, or heavy negatives for the first 6 to 9 months.
- Machines before free weights, dumbbells before barbells. Machines guide the path; dumbbells let each arm find a safe position.
- Never brace with the surgical arm. Get on and off equipment using your other hand.
- A fall onto the arm is the most common way an early repair fails.
- Physical therapy comes first. Gym work adds to your therapy; it never replaces it.
Milestones, not just dates
The calendar is a guide; your shoulder decides. Before each step forward, you need to reach these milestones:
- Before light resistance: wound healed, pain controlled, near-full passive motion
- Before overhead work: full, pain-free arm raise overhead without hiking the shoulder
- Before pressing and pulling heavy: strength at least 80% of your other side
- Before sport or competition: strength at least 90%, full motion, and surgeon clearance
Call the office if you notice
- A sudden pop, tearing feeling, or new weakness lifting the arm
- After BT: a new bulge in the upper arm, or sharp pain in the front of the arm
- Fever, redness, or drainage from an incision
- Pain that wakes you at night and is getting worse, not better
Your Surgical Athlete plan
Protecting your muscle starts before surgery, not after it.
- Before surgery: Metabolic Report Card labs check hormonal, metabolic and nutritional markers, so we can fix gaps before the operation. Targeted amino acid supplements start one week before surgery. We also discuss whether peptide therapeutics fit your recovery, and set up a muscle-centric diet to limit muscle loss while your arm is in the sling.
- In the operating room: orthobiologics such as PRP or bone marrow aspirate concentrate (BMAC) may be used to support tendon-to-bone healing, when appropriate for your repair.
- After surgery: you keep training everything the repair allows, using the timeline above.
Let’s talk openly about your training
I work with many athletes and bodybuilders, and I know anabolic steroids, peptides, and supplements are often part of the picture. That conversation is welcome in my office, without judgment. Being honest lets us plan timing, decide what to continue, taper or stop, and support healing. Please don’t stop or change anything on your own before we talk.
Related recovery resources
- Athlete’s Guide: Return to Training After Orthopedic Surgery
- Rotator cuff repair
- Bio Fertilization™ and rotator cuff repair
- Download this recovery guide (PDF)
Your comeback starts before surgery
Ready to plan your recovery? Call 1-844-JAZ-0911 or email [email protected] to schedule a consultation with Dr. Jazayeri at DOCS Health in Beverly Hills or Westlake Village.
This guide is for education only and isn’t a substitute for personal medical advice. Timelines vary with each tear, repair, and patient. Always follow your surgeon’s and physical therapist’s specific instructions.
Medically reviewed by Reza Jazayeri, M.D. on
