Bed Rest is NOT Recommended for Either Adhesive Capsulitis or Rotator Cuff Injury
Zero days of bed rest should be prescribed for either adhesive capsulitis or rotator cuff injury—both conditions require early mobilization and active rehabilitation, not immobilization. The concept of prolonged bed rest is contraindicated and potentially harmful for these shoulder conditions.
Adhesive Capsulitis Management
Early mobilization with stretching exercises is the cornerstone of treatment, not rest. 1
- Gentle, progressive stretching exercises should begin immediately upon diagnosis, with most patients improving through nonsurgical treatment 1
- A specific four-direction shoulder-stretching exercise program has demonstrated 90% patient satisfaction rates, with significant improvements in pain and function 2
- Surgery is only considered after ≥6 months of failed physical therapy, not after a period of rest 1
- Treatment protocols combining intensive rehabilitation with other modalities (such as distension arthrography) show that one week of intensive passive and active physiotherapy is beneficial, emphasizing movement rather than rest 3
- Continuous passive motion (CPM) for 1 hour daily over 20 days provides superior pain control compared to conventional physiotherapy, further supporting active movement over rest 4
Key Pitfall to Avoid
The natural history of adhesive capsulitis involves gradual resolution, but immobilization or prolonged rest can worsen stiffness and delay recovery 5, 1. The condition is characterized by fibrosis and capsular contracture—rest would only perpetuate these pathological changes.
Rotator Cuff Injury Management
Complete rest from the aggravating activity (such as throwing) is recommended until asymptomatic, but this does NOT mean bed rest or shoulder immobilization. 6
- Rest refers specifically to cessation of the provocative activity (e.g., throwing in athletes), not general immobilization 6
- Rehabilitation should begin immediately, including rotator cuff and scapular stabilizer strengthening, proper mechanics restoration, and range of motion exercises 6
- The American Academy of Orthopaedic Surgeons found inconclusive evidence for or against specific exercise programs, but notably found no evidence suggesting adverse effects of exercise programs on rotator cuff disease 6
- A progressive throwing program over 1-3 months (depending on injury severity) should be initiated once pain-free motion and strength are achieved 6
Important Distinction
For rotator cuff tears specifically, activity modification and exercise are recommended over complete rest 6. Even in cases where surgical repair is delayed up to 4 months, outcomes remain favorable, suggesting that controlled rehabilitation during this period is appropriate 6.
Clinical Algorithm
For both conditions:
- Day 1: Begin assessment and initiate appropriate rehabilitation program
- Adhesive capsulitis: Start four-direction stretching exercises immediately 2
- Rotator cuff injury: Stop provocative activities but begin strengthening and ROM exercises 6
- Never prescribe bed rest or prolonged immobilization for either condition
The answer to "how many days of bed rest" is zero days for both conditions—early mobilization and targeted rehabilitation are essential for optimal outcomes.