At PhysioDC, we hear this question all of the time. It is a vague question, because it depends entirely on what type of procedure/repair you had on your shoulder.
IN GENERAL, here is a basic protocol for many types of rotator cuff repairs, labral repairs, bankart repairs, and acromioplasty. It goes without saying that you should follow your doctor’s protocol exactly and check with your PT to make sure that you are doing the appropriate exercises at the appropriate times.
Week 0 to week 4: PASSIVE RANGE OF MOTION ONLY
Passive range of motion means that someone else (the physical therapist) is moving the arm without your help. The first month following most shoulder surgeries is incredibly boring for most patients, because they are not performing active and functional movements with the involved arm. As monotonous as this sounds, stick with the passive ranges and fight the temptation to progress yourself without the doctor’s permission.
One exercise that can be done during the passive phase is called a “pendulum” exercise. Take a look at the video below and marvel at the excitement.
Weeks 4 to 8: ACTIVE-ASSISTED RANGE OF MOTION
Get excited. Now you are allowed to have some participation in your rehab. Active-assisted motion involves the therapist moving your arm with some active assistance on your part. This can be done lying down or in a seated position. The purpose here is to re-introduce rotator cuff and scapular muscle recruitment.
Many therapists will also give the patient a set of pulleys that hook over the top of a door. Active-assisted ranges of motion can be done at home by using the good arm to pull through the pulley to assist the surgical arm into ranges of motion. This phase of rehab is not as boring, but many patients find this stage to be frustrating because re-introducing active participation tends to be painful. Stick with it.
Weeks 8 to 12: ACTIVE RANGE OF MOTIONMost doctors will clear patients for shoulder motion without any assistance after 8 weeks. Like with any new activity, take it in steps and realize that you will not have full, unrestricted motion immediately. Most patients, when lifting the arm up overhead, will notice that the head of the humerus bone will ride upwards and restrict motion. This is because the rotator cuff muscles lack full control of the shoulder. Practice moving through only the part of the range that looks controlled. You should notice over time that your range will improve.
Weeks 12 to 16: LIGHT RESISTIVE EXERCISE
Now that you are 3 months post-operative, you should be at the point where you can introduce light resisted exercises. A common mistake that patients will make at this point is adding too much weight too soon. Start with very light resistance for the first week and slowly work your way up. Using elastic bands and light hand held weights is common at this stage.
Listen to what your body is telling you as you begin resistance training. Sharp pain is not acceptable: ramp your resistance down and take a few days off to allow your muscles to recover.
Week 16 and beyond: RESISTANCE AND WEIGHT TRAINING AS TOLERATEDAfter four months of rehab, many of our younger patients will start a light routine in a gym setting. As mentioned before, it is a bad idea to stack heavy weights onto a freshly-rehabilitated shoulder. I will always leave our discharged patients with a few final thoughts.
- It is not worth your time to “max out” with heavy weights simply to see how much weight you can lift.
- Military presses, dips, preacher curls, and hand-stand pushups are not worth your time if you have ever had shoulder surgery.
- Many people will not be pain-free for up to a year following shoulder surgery. Make sure that you keep up with some strength training every week to keep the rotator cuff and scapular rotators strong.
- If a certain exercise causes sharp pain, don’t do it.
Image credits: Minerva Studio / Fotolia