A significant percentage of the population has “unstable” shoulders, or shoulders that have the ability to move into ranges that place one at risk for orthopedic injury. Also known by the medical community as “multi-directional instability,” loose shoulders are fairly easy to identify. If you suspect that you have an unstable shoulder, ask yourself the following questions:
1. Have I ever dislocated my shoulder? Shoulder dislocations are extremely painful and will often require a trip to the emergency room for relocation. Having one shoulder dislocation also places you at increased risk for additional dislocations. Shoulder dislocations are also often accompanied with labral tears and are a hallmark sign of instability.
2. Does placing my shoulder in certain positions make me feel nervous? Unstable shoulders produce a feeling of apprehension when placed in stretch positions, particularly when the shoulder is rotated externally. (see picture above)
3. Does my shoulder shift in the joint easily? Reports of shifting, “clunking,” and sudden movements in the head of the humerus bone are often reported by people with instability.
4. Am I generally excessively flexible in joints other than my shoulder? There is a correlation between multi-directional instability in the shoulder and laxity in other joints such as the knees, elbows, and fingers.
5.Have I been diagnosed with a connective tissue disorder? There are a few conditions that are manifested by laxity in joints, muscles, and other soft tissue structures. Marfan’s and Ehlers-Danlos syndromes are two such examples of disorders that may lead to shoulder instability.
A great many people who have unstable shoulders are able to manage daily life without any surgical intervention. A key to stabilizing the shoulder deals with training the surrounding rotator cuff muscles to keep the head of the humerus firmly in the socket. Here are a few exercise ideas that can serve to stabilize the shoulder.
As always, make sure that you are under the guidance of a doctor before beginning any exercise routine. Some people do have instability in one direction more than others, so it is quite important to identify what directions are more susceptible to movement prior to starting a program.
Exercises to Stabilize the Shoulder
1. Most unstable shoulders are loose in the anterior direction. This exercise makes the internal rotators of the shoulder work in a shortened position and comes highly recommended!
2. There is a great (and affordable) piece of exercise equipment called a “Body Blade” that provides a fun way of tiring out the rotator cuff muscles in a safe manner. In our clinic we use the body blade “CXT” model with patients and have them oscillate the body blade while their elbows are maintained securely at their sides. I am sure that there are numerous videos of body blade demonstrations online, check them out.
3. Isometric exercises are a very safe way of beginning a shoulder stabilization program!
4. Stand facing a wall at arms length. Hold a weighted ball in your hand and gently push the ball with the palm of your hand directly into the wall while keeping your elbow locked. Make small, tight circles with your hand pressing into the ball, twenty-five times clockwise then twenty-five times counter clockwise. Adjust the weight of the ball in accordance to what makes you adequately fatigued. (see photo on right)
This exercise will also work with a “cuff weight” wrapped around your wrist as an alternative to a weighted ball.
Read More About Shoulder Issues
• What Does a Shoulder Labral Tear Feel Like?
• When Can I Start Working Out After Shoulder Surgery?
• How Do I Deal With A Shoulder Dislocation?
• Is Sleeping On My Side Bad For My Shoulder?
• Why Won’t My Shoulder Rotate?
• Managing Expectations When Recovering from a Labral Repair
I practice yoga & read that the “Downward Dog” pose places your shoulder in A unnatural stressed position especially on the tendons. I am having a RCR soon and wanted to know if I should avoid this pose once I return to yoga.
Debby I would wait a good long while after the surgery before even trying to attempt downward dog. You need to have ideal strength first. It would also be worth your time to modify the position (turn hands slightly outwards, or less total flexion of the shoulder).
If you try it again once everything is healed and strong (6+ months after surgery) and it still hurts, I would scrap it altogether.
Hey there,
I had a snowboarding accident and broke my collarbone. I had surgery 12/31/13 and just a couple of months before that I was getting into weight lifting. I was wondering when I can start slowly getting back into it because I am starting to see the muscles that I gained (not very much to begin with) start to fade away. I dont want to re injury it but I also dont want to be fearful of weight lifting the rest of my life.
When can I start again :o?
Lucas it should take six (6) weeks for the bone to heal. The surgery may even add another week or two in terms of healing time. You are going to be a bit weak for a while after the healing period: Get the okay from the doctor to start up again SLOWLY.
My guess would be a slow return to weight training starting at the beginning of March.
Hi I had rotator cuff surgery with my bicep tendon reattached on dec 17 2013. I work fulltime as a CNA and due a lot of heavy lifting plus I deal with combative residents when do you see me returning back to my duties
Barb I would guess maybe at 6 months post op??? It also depends on how your rehab is going now (strength, mobility etc.). Heavy lifting requires very good strength of the rotator cuff and surrounding scapular muscles.
Hi Dan,
I had labrum surgery and 4 anchors put in my shoulder last May. My shoulder is getting stronger but at times it feel sharp pain, especially if I am lying down on that shoulder. I am 25 and exercise regularly. Do you think it could have re-torn somehow?
If the pain is mostly from lying on that shoulder I would guess that it is not a re-tear. Lying on your side takes the shoulder and forces it forward, which is not a great place for it to be especially if it is slightly weak. My advice to you, avoid sleeping on that shoulder.
Sounds great, thank you for the reply Dan!
Dan-
I am a fit 41 year old with a small partial supraspinatus tear, and impingement…Over the past year I have tried PT , which has helped , and had a prp shot, which has also helped. I don’t have pain at rest , but I am still impinging during several movements including anything overhead. I would like to get back to painfree weightlifting, golf, tennis, and putting on my coat. I have full range of motion, and nearly equal strength to my “good” shoulder, but still hear noises and get pain when I impinge.
Assuming I get a competent surgeon, and do the proper pt post op what kind of outcome should I expect from surgery, and do you think surgery is the prudent move? Do you think I should try a cortisone shot before surgery.
Thanks,
Scott
Try everything that you possibly can prior to surgery. Surgery is no guarantee that your pain will go away. Realize that as we age, the acromial space where the rotator cuff tendons sit becomes more narrow.
A surgeon could perform an acromioplasty, which would increase the space, but you would be looking at six months or more of rehabbing your shoulder to the point where you could try some of your old activities. It would also be worth your time to find the best PT or osteopath in your area to get a consult. Ask around.
I am going to be 12 weeks out from rotator cuff, bicep. and peak tear surgery. My surgery is very aggressive. I have full range of motion, I am doing band training and light weight lifting. I have been doing that since week 4 with bands. Weights since week 6. Everything I read it seems people take a lot longer to get to this point. I get some stiffness after exercise but the next day it goes away. Is this to quick?
If the doc and the PT are OK with your quick progression I suppose that it is okay. I am a bit conservative, so my opinion would be to wait until at least 16 weeks to start weight training. The rubber band resistance normally comes in to play at about 10-12 weeks.
Hey Dan, I had anterior and posterior labrum surgery on my left shoulder with four pins put in from diving and repeat partial dislocations from baseball. I am now 7 months post surgery on my non throwing arm and I am still worried about hitting and doing certain workouts in the gym like pull-ups, pushups and back squats. Is it normal at 7 months post op to be where I am right now? Should i not be worried about re-injuring it if I dive or slide ? Any info helps
Thanks,
Max
Max I would transition in to those types of exercises, with the permission of your doctor of course. I have found that a “Gravitron” assist for pull ups is a great way to build strength and confidence while doing the actual pull up motion. There should be a gym near you that has one. In terms of push ups, start with a wall push up and progress to the modified position (the type that many females will do on the floor).
In terms of swinging a bat, mimic that motion with a cable machine, there should be an attachment that allows you to simulate holding a bat-like object. Go through slow, lightly weighted swings to start.
In terms of the time frame that you mentioned. Most young people (under 25) will be right about at your pace. Be patient and progress slowly.
It might also be a good idea to get some direct supervision from a trainer who is versed in post-operative rehab training. There is one specific certification that trainers can get, called “MET”, or “Medical Exercise Trainer”. MET’s are the only type of trainers that I would trust enough with progressing you in a safe fashion.
I fell 8 months ago fracturing my right shoulder (since then i have had tendonitis, partial torn rotator cuff and bursitis in the same shoulder). Four weeks ago – i had surgery to repair the damage in that shoulder. I was in a sling for 24 hrs post-op. I am doing physical therapy, but sometimes my shoulder feels like when i broke it. Will wearing the sling again help ease the pain?
It might give the shoulder a rest and make it feel better, but you want to be careful not to allow the shoulder to become too weak from disuse. I usually tell patients that it is OK to use the sling again, as long as it is only for shorter periods of time. Otherwise if the pain is persistent I would check in with the doctor to get the shoulder evaluated.
Hi Dan, Thank you so much for this post. It was something that I referenced often during my recovery. I am 12 weeks post labrum/rotator cuff/bicep tendon surgery. My PT has been very consistent with what you have posted in your timeline. I am young and in good shape, which I have been told is helping me heal faster. I started strengthening exercises last week. I have been cycling for about 8 weeks and light ab exercises as well. I have been doing wall pushups for a week now and they are extremely easy. I’ve also been doing pushups at a 45 degree angle, either on a table or machine. When can I attempt normal pushups? Is it dangerous to get in that position and apply my weight too soon? Or is it something that I can attempt, see how it feels, and take it from there?
Again thanks so much for this article. It helped me clear my head when I was wondering if I was ever going to get better. The timeline of what to expect really helped.
-Duncan
Also one more thing…When can I start to Run?
Regular push-ups? At least 16 weeks post-op, with the blessing of your PT and doc. The danger now isn’t that you would dislodge an anchor, it is more likely that you could over-strain the rotator cuff and cause some lovely tendonitis.
We generally steer away from full resistance training, even with the youngsters here at PhysioDC, until 16 weeks. In terms if running, you are probably clear to jog a bit, but the danger here would be losing your balance and falling. Get the ok from the doc, and I would start on a treadmill simply because it is more controlled.
Sorry for the late response. I just wanted to say thank you for your help. From you answering people’s random questions about their recovery, and giving a straight, honest answer, it really helps. Thanks Dr. Dan!
On December 4th, I had a labral, rotator cuff repair and capsular shift. I started PT twice a week 3 weeks post op. Mostly doing stretching exorcises but per MD orders nothing posterior. After your great report, I am wondering what you would recommend post op to replace military press with? What are some good exercises I can do to rebuild my shoulders and delts back up without injuring anything? Thank you Sir.
Ryan I wouldn’t even worry about serious deltoid strengthening until a good 4-6 months after the surgery.
In so far as early post-op goes, here at PhysioDC we start people lying on their backs and work on bringing the arm in an overhead type motion. Progressively (over many weeks) we start to angle the table upwards so that the arm lifts slowly start to simulate a more upright position.
You would of course need a table that can change angles, or you would need to rig up your bed with progressively more pillows over weeks to change the angles. Run that idea by your PT and se what he or she thinks. You would need to have permission to do so!
Hi
I had rotator cuff surgery end of october 2014. I started PT 2 weeks after surgery. I was allowed surgery passive ROM at 6 weeks with limitations for forward flexion to 90 and ER to 30. I gained the ROM with help from my PT. At 6 weeks, I was allowed out of the sling. The pain was on and off and was minimal. After 6 weeks, I was working on AAROM with PT, UBE, pulleys and PROM. My ROM was improving gradually and pain was again minimal on and off. Now I am at 12 weeks, and I started strengthening. My PT showed me isometrics for ER and IR. I tried them at home and was ok doing them. At the same time, my PT has been working on scapular stabilization- and keeping my shoulder blade down with all the exercises. I also started using light band for the ER and IR. I have a difficult time doing standing forward flexion past 90 degrees, my shoulder hikes past 90 degrees and PT stops me from going further. I also have difficulty with standing shoulder abduction, so my PT has me doing sidelyin shoulder abduction upto 90 degrees. I have lot of pain when I do this, and I leave PT with higher pain levels than what I came in with. Is it normal to have this much pain, at 12 weeks ? Please reply.
Yes this happens quite a bit. You are starting to strengthen the shoulder, and this is a common side effect. It sound to me that your PT is very careful and knowledgeable. I would still ice the shoulder after your sessions, and keep the PT notified of your pain levels.
How come even at 12 weeks I am still having lot of pain with side lying shoulder abduction. Standing abduction is even more painful. Can I have impingement again ?
You might still be having some impingement pain, but that is to be expected when the rotator cuff muscles are weak from surgery. It will probably take several more months for you to regain appropriate strength. Be patient and consistent about strengthening under the direction of the PT and doc.
Hi. I just had my bicep reattached & shoulder surgery. How soon can I start back walking on my treadmill?
Cindi I would get the docs permission before walking on the treadmill. The time frame kind of depends on exactly what the doctor did. The biceps is used a bit with normal arm swing, so you may have to wait a little while until the doc clears you.
I had a large SLAP tear, with Bicep involvement December 9th, 2014. I had multiple bone spurs removed from my Humerus. I’m 12 weeks post-op, and have remained active, although not to the degree I was before. I’m a Group Fitness Instructor. This Surgery really humbled me. I’m going to Physical Therapy twice a week, and doing the exercises on my own several times a day. I’m 54 and very fit for my age. I still have pain in the effected shoulder, especially after doing my exercises. I’m thinking I won’t go back to teaching anytime soon. I taught HIIT, Step, Spin, Body Pump, and Zumba. My shoulder is still very week. Do you agree about teaching? I just don’t think it’s worth the risk.
I would definitely put the teaching on the back burner for a little while, but if it is fun for you Sharon you could still do it (once the doctor clears you). It is possible to do a quick demonstration of a movement and then coach people through the exercise verbally.
In the short term take the time to do the prescribed exercises and be patient in terms of reaching your goals. It is going to likely take another 3-5 months to get back to more function.
Hi Sir, I had my 3rd dislocation of my right shoulder last week and I’m planning to do an athroscopic repair this July. I’m a university student and I only have 2 months at home post surgery. Can I do pt at my college too? Thanks
I am sure that you could. I would go to student health and see if they have a PT on staff. If not, I am sure that there must be a PT clinic nearby you at school. If you Googled PT clinics in the university area something should pop up.
Thank You so much. Hope my surgery and post op pt goes well and I can live a normal life :)
38 yrs of age, ex D1 baseball player
10/24/14 was my surgery date for the following:
Anterior labral tear – 4 anchors
Posterior labral tear – 3 anchors
10 bone spurs removed
Debridement
I basically tore my labrum in 2 so says my surgeon after delaying surgery for 18 yrs. Dislocated my shoulder playing baseball (Div 1)
Started PT day 21 and then went twice a week. Attended 48 sessions. 6 month checkup dr clears me from PT. advises to continue in gym as I have been since 2 weeks after surgery – didn’t start lifting weights till 4 month (10lb max and clearance from dr)
I do band work daily at gym or home.
My routine is as follow:
Cardio,stretching,band work daily
Mon/Thurs – shoulders, biceps, triceps, forearm
Wed/fri – back, chest
Tues – legs (all I did for 4 months lol)
I am not doing heavy weights by any means BUT I do high reps
My question to you is why can’t I get my right arm bicep/tricep (surgery side) to tire or get tight from working out? My left arm will be dead and swollen from the workout but my right arm feels like I am not benefiting from the workout. I tried my best to tire my right arm by doing double the amount of reps but to no avail….I got frustrated and ran out of time, 2hrs
Don’t get me wrong there are days where my shoulder won’t cooperate so I have to skip the weights for a day or so
Have you ever heard of such? Should I be alarmed? What should I do?
Also my internal/external rotation is nowhere near where it should be But my dr told me it could be a yr or longer before that gets back to normal
Any advise would be greatly appreciated
Thanks
MIckey
Mickey that is quite strange, I don’t think that I have ever heard of someone saying that. I would not be alarmed by this, if anything it may be a testament to how well your rehab has gone.
I would still make sure though that despite your lack of fatigue that you do allow a few days per week to rest the shoulder.
Hi, doc
I had a 12-7 o clock labral tear repair on Jan 15th (4 months ago). Recently I’ve been doing pullups, military presses with 20 lb dumbbells, curls with 30’s, tricep dumbbell presses with 40 lbs, lateral and front raises with 10’s and pushups in PT. I start a job this Saturday working at a grocery store where I’ll be unloading trucks some days. Most of the boxes are 20 or 30 lbs, but some are as much as 50, and my PT says I should not have a problem but I’m a bit nervous. Do you think that’s rushing it? Or seeing as I’m able to perform the exercises I mentioned above do you think I’ll be ok? If I don’t work, I’m in a tough bind, but I don’t want to mess this up. What do you reccommend?
Alex I would default to your PT given that he or she has “hands on” experience with your progress.
It does look as if you have been building up gradually with the weights which is great preparation for your job. If that is going well I am guessing that work will not be too much of a strain on you.
If the PT is okay with it Alex, you will probably be fine. If you are already handling what you just mentioned above without pain then this bodes well.
That’s good to hear, I would just be devastated to have gone through all this to mess it up but it sounds like it should be fine. At this point in my recovery, it would take something traumatic to retear it correct? Or not? What all would potentially cause a retear at close to 5 months out?
getting tackled, falling down the stairs, maxing out a biceps curl, dislocating your shoulder……….
I’m about 4 weeks post op from full thickness rotator cuff tear and biscep tendon repair. Dr. has had me out of my sling for about 2 weeks now only using it to leave the house. I have been doing pendulum exercises plus using my good arm,to aid in gaining Rom and also keeping my elbow close to my body and moving my hand thumb up away from my body, my question is this, I’ve been doing these exercises now,for 2,weeks and have had significant improvement in my Rom, I feel like it’s almost to good to be true , I go to the Dr again this week should I be alarmed and also how often should I got to pt when its ordered?
Thank you,
Jason
It sounds like things are going well, just stick to the doctor’s recommendation of what exercises to do and when. PT will probably be about 2 times per week. If things continue to go well it might even be less than that after a few weeks. The doctor’s prescription should also specify how many times per week PT is ordered.
Hi, I have been having continuous pain on my shoulder joint for 3 days now, it’s been approx 5-6 weeks now, i don’t know what the cause is, recently after taking of my sling I tripped and landed on my operated hand when I was getting into bed, but there was little pain, after a few days the pain seems to come and go, it’s everytime I move my shoulder it hurts, also I am not sure weather the new phisio workouts I been been instructed to do is causing the pain/ weakness, should I go see my doc, what would you recommend??
To be safe Dan I would talk to the doc about it. Falling on the hand can jar your shoulder and compress it into the joint. Ease off the physio for a few days and let it heal.
Hi,
I’m a 57-yr-old, physically fit woman who had a very bad fall from my horse (I was thrown into an arena wall, and my right shoulder took all of the impact).
I had a bone spur removed, repair of a 1.9-2 cm full tear of the supraspinatus muscle, as well as bicep reattachment (at the top, near shoulder).
I am 5 wks out from surgery. Previous to this, I participated in weight training, zumba, turbo kick, as well as riding my horse 3 xs a week.
My question is regarding how the shoulder should feel at this point. Sometimes it doesn’t feel too well connected. I’ve been walking with a friend (1-2 miles around the neighborhood) and it seems to make it achey. I’m doing very small passive ROM exercises 3 xs a day and pretty much dying from boredom. Would it be ok to do some lower body work using machines at my local Y? What do you recommend for lower body while recovering from this? My pain is manageable (taking 2 Tylenol every other day or so when I can’t stand the pain).
Thank you!
Sue
Your shoulder should probably feel quite sore given the accident and the surgery. There is also appreciable weakness from the disuse and swelling. That will come back slowly, and the weakness can give you that feeling of “disconnect” that you mentioned.
It would probably be fine to do lower extremity exercise, but please clear it with the doc and your PT. You shouldn’t do anything that would require significant standing balance in regards to the leg exercises. Machines would probably be better than standing cables etc..
Thank you for the quick response. Yes, I’m seeing surgeon next week, hopefully to have sling removed. I was planning on using the outer/inner thigh machines (seated only) among others. I’m doing (left arm only!) bicep curls with a 5 lb weight 3 xs a day/24 reps and tri kickbacks. At least one arm will be in shape…. I was wondering about reclining bike specifically for lower body, something with cardio and no use of arms…I think that might be easier on my rc than the walking, actually.
The recumbent bike should be fine given that it is stable.
One more question, please. What usually causes reinjury? 4 wks out, I banged the front of my shoulder while trying to get out of a car (I saw stars, it hurt like heck). I was wearing my sling, didn’t feel or hear any popping or tearing, just pain. Shoulder seemed sorer then for the next few days, but I had also started the passive rom therapy, too. As I stated earlier, I’m not taking heavy duty pain meds. Not that terrible. Of course, I will ask my surgeon next week, but I’m curious how re-tears ‘usually’ occur. And I was SICK, after following all directions from doc, etc., that it could happen by such a random event.
Usually reinjury occurs from tractioning the arm or bracing the arm in front of you for a fall. Your car bump probably didn’t disrupt the anchors. It certainly may have inflamed things a bit though.
Dr. Dan,
Also big thanks for the blog and hopefully response, I had shoulder surgery July 2014 so I am coming up on 1 year. The surgery was for a torn rotator cuff, torn labrum, and bone spur. I think over years of working out and shoulder bumps etc there was a lot of damage. After the surgery in July I spent a few weeks using the ROM chair and getting at home PT 3x a week for the first month, after 1 month the Dr. said I was at the 2 month mark and could start going to PT. The next month I went to PT and the 3rd month I did PT using their items and methods on my own. After 3 months my dr. said I was at the 6 month mark in terms of range of motion etc. and that I would not have to come in any more. I went home and tried easing in to weights etc. over the next few months and saw gains in strength and range of motion. Now, basically at the 1 year mark I have hit a slow crawl in terms of recovery – I seem to be stuck around 80-90% strength and range of motion for the last 2-3 months and have not gone past there. Should I see my dr again could it be that I re injured it or should I wait longer? Obviously you have mentioned not going for heavy lifting any longer, I am 27 and would hope that would not be the case for me just yet. Thanks again.
Brett I would do a follow-up visit with a sports medicine PT and have everything assessed. Give him/her all of your information and get a program that is appropriate for you at this stage. I do think that the range of motion will still improve, but your gains will likely be slow.
In terms of lifting “super heavy”, I wouldn’t do it. Look what you have already done to your shoulder. I am willing to bet that if you go too hard you will end up on the surgeon’s table again at some point. Let pain be your guide.
Hi Dr,
I hope I can get a response here as I am anxious for an answer!
I dislocated my left shoulder 2-3 years ago. I never really stuck with the Physical Therapy like I should have, and had 3 subluxations of my shoulder after, then nothing. Then this month, it came out twice and I had to have someone put it back in! This happened 2 times with 2-3 weeks in between!
I did an MRI to figure out if I had a tear, and it turns out I do have a tear of the labrum and need surgery. First, will the surgery fix this issue permanently so that I do not have to worry about dislocating again (unless I fall into a ditch again, of course…)
Second – I work out 5-6 days a week (cardio, strength training) and want to know when I can at least start running on a treadmill or outside again after my surgery. How about legs/abs? I know I won’t be doing dung bells or kettle bell-swings anytime soon, but I’d like to know that I don’t have to wait 4 months to start running – at least!!!
Please let me know. Thanks!
Carissa the surgery is designed to stabilize the shoulder, with a good outcome you should not dislocate again.
In terms of the post-op protocols, you will not be doing much of anything for the first two months. If you wanted to sit on a recumbent bicycle to get your cardio fix that would probably be fine, but you would need the doc to sign off on it. After the first two months you will be slowly brought back in to more exercise.
The running thing is tricky because the shoulder anchors need to be healed in to place, and you need to have enough strength in your rotator cuff muscles to support your arm swings. I tell most people not to start running until at least 12 weeks post-op, and the first week or two of running needs to be at an absurdly slow pace.
I need surgery to smooth out the labrum and shorten the bicep, I’m guessing the tendon? How long after can I resume doing body weight exercises such as pushups and dips? I see in the final thoughts it says military press, dips and a couple other exercises are mentioned to not be worth your time if you ever had shoulder surgery. Does this mean dips are not recommended at all after surgery? I love dips and would be disappointed.
Jeff it wouldn’t surprise me if your dips contributed to this problem in the first place. In my opinion they are not worth your time. That exercise places your shoulder in a compromised position with almost full weight bearing through it……not a great idea.
Hi Dan
Great blog and thanks for taking time to answer questions!
I am a 23 year old male, with very good previous strength and conditioning. I subluxed my shoulder and I had anterior labral repair 10 weeks ago. This consisted of two anchors at 5 o’clock and 3 o’clock. Everything else in the shoulder was normal. The tear was ‘short’
My recovery has been somewhat different to the majority and has been surprisingly fast and painless (a good thing!) I am at the stage now where I am unsure how quick to progress and push myself.
My timeline is as follows.
Week 1: out of sling (sling in bed only until 3 weeks)
Week 1-3 – raises, external rotation, broomstick movements, rotator cuff stretching, arm lifts, standing mini press, weight shifts (large focus on squeezing scapula)
Week 3 – surgeon follow up – ‘excellent progress, forward elevation to 90 degrees, external rotation to 30 degrees. Do not push or strain but happy for him to steadily return to all levels of activity’
Week 3-4 – with light theraband – raises, external rotation, scapular pinches
Week 4-7 – with theraband – shrug, punch, int & ext rotation, Ys, side lying db rotation etc etc
Week 7-8 – 3kg (db to start) horizontal on medicine ball – 2 inch wide lift, scissor, low exaggerated wide press, rotation control, wide overhead press, seated bent over pull, low row, Ben over row, 3-5kg medball slam, Pilate ball overhead bouce against wall. (Focus on strengthening in danger zones)
Week 8-10 – full range of motion – progressed from 3kg on above exercises and cleared for heavier weight training by physio.
Week 10 – able to deadlift 100kg+ , bent over row heavy, bicep curl heavy. Shoulder and chest press @ 15kg with no pain or weakness
I had a very specialised sports shoulder surgeon and physio who both predomenantly works with professional athletes, which is maybe why I have been pushed. My question would be weather it is sensible to keep raising my weight training at around 5-10% per week as a guide, or wait till the more typical 4-6 month mark to begin the heavy weight training. In addition, have you seen or worked on similar patients with a more aggressive recovery strategy on a more simple labrum surgery.
Many thanks!
I would wait. I am a little bit biased Daniel because of the population that I see, but I always think that it is better to be safe than sorry. Your protocol is super aggressive. As always, listen to what your shoulder is telling you. If anything starts to feel sharp, back off.
I am 3 weeks post op on small rotator cuff tear-2 anchors. The other night I was undressing and felt a pop and then pain.
I’ve been to PT a total of 8 visits since surgery and was well ahead of schedule.
After pop I iced and went back to ibuprofen- pain has not fully subsided but is not excruciating either. I am still in sling consistently- although doc says I can use hand in “assistive stuff” like stabilizing the steering wheel or typing on a computer.
Should I be concerned? Not needing a set back at this point.
It sounds to me like one of the tendons gliding over a bone. It can cause some pain for a while. Normally, you would have to apply a lot more stress than that to get an anchor to pop loose.
If you are concerned you can always talk to the doc about it.
I had rotor cuff surgery dec.3rd can I use a elipical?
My guess is probably yes, but make sure that you clear it with either your PT or the doc. START SUPER EASY.
Hello! I had an inferior capsular shift and anterior stabilization on my left shoulder about a year and one month ago. My rehab and recovery process has been going very well so far. About 3 and a half months ago, I created and started a weight loss exercise program modified for my situation and I do it in my home gym. All of my weight training is done with dumbbells. However, I’m having trouble determining which chest exercises I can do with dumbbells and without a bench at home that are safe for me. So far I’ve limited my chest workouts to a light bench press with dumbbells lying on an exercise mat. I was wondering if you could suggest several chest exercises that I could do with dumbbells?
Dumbbells are a bit more tricky with unstable shoulders because of the positioning when they are down at your chest / shoulder level with bench pressing. I would try something different altogether for the chest. Wall push-ups, modified push ups, or maybe even rubber band resisted pec flies in a standing position are safer in my opinion.
In terms of bench pressing motions, a straight bar is probably safer than dumbbells.
Hi there I am a PT and avid Cross-Fitter. I had surgery involving a Biceps Tendonesis, 2cm Cuff Repair and Subachromial Decompression 10 days ago. Will I ever again be able to do Pull-Ups, Handstand Push-Ups, Snatches, Overhead lifts? I used to compete but wondering if there will be movements I should not do? Desperately want to get back to Cross-Fit again. Interestingly handstand push-ups and pull-ups never caused me pain it was cleaning a bar and a wide hand overhead grip that was difficult for me before surgery. Thanks in advance
The question in my opinion that you should be asking is not “WILL I ever again be able to do pull-ups etc. again”. The question you should be asking is “SHOULD I ever again do pull-ups etc.”.
I don’t know the specifics about your case, but I am going to make the guess here that many of the exercises that you have been doing at the very least contributed to your need for surgery. We could argue that if you are older, these cuff and biceps injuries could have been cumulative over years of varying activities. If you are young, it becomes more likely that the overhead activities that you described are directly responsible for these injuries.
If you go back to Cross-Fit, I would have somebody sit down with you and carefully modify out several of the exercises. The overhead exercises and handstand push ups in particular ought to be changed to something else. One of the hallmark signs of a good Cross-Fit gym is one that will examine your movements and make adjustments based on pathology. If your box doesn’t do that, find another one.
I had labral repair and shoulder stabilisation 8 weeks ago. I am very active and a rugby player, 20 years old. I have full range of motion and no pain doing any exercise with theraband. I want to know if it is possible that my shoulder healed much faster? And will I be able to start resistance exercise.
Thank you in advance
B. Kriel.
It probably did heal quicker because of your age and your fitness level, but I still wouldn’t rush the protocol. I can’t tell you how many times I’ve seen someone who started resistance too early and regretted it.
Thank you very much. I appreciate the help.
Hi Doctor,
I had Arthroscopic Bankart Repair surgery on my right shoulder in November 2015 (3 anchors were put in) and did the full course of rehabilitation and PT. I started weight training in April 2016 and then had to quit starting June since I travelled a lot and and couldn’t stay in a place for long. Now I am starting training again but my shoulder feels stiff and sore now and there is slight pain when I do shoulder press and pull overs. There was no pain when I was lifting before. Is there a risk of damage due to training? Could you also give me a list of exercises that I should avoid doing? Both my surgeon and my gym trainer tell me that there is nothing to avoid and I should just be careful with the weights (I am 30 years of age).
You might be rubbing the rotator cuff a tiny bit against the acromial shelf above it. I would ditch the overhead pressing motions for a few weeks. If you go into deep range with the pull overs I would ditch those too. Keep everything below shoulder level for a little while and rebuild the strength. I am a HUGE fan of scapular retraction over an exercise ball, and internal / external rotations either with rubbers bands or light cable resistance.
The scapula winging has gone down a fair bit to almost nothing now and only a little bump near upper scapula very slightly comes out a bit barely enough for someone to notice is when I lift arm past 70 degrees as my shoulder still struggling from labral tear to go back 90 degreesyes I have told my pt and he gave me exactly what u said, scapula stabilisation exercises, slowly it feeling better. The first time I felt pain in my scapula was literally same week my shoulder randomly felt 2 or 3 tears. Weird enough the first snap feeling was in my scapula rhomboid region bordering scapula bone. The last question to ask is can these have the possibility to resolve through pt and things like that?? And thanks for the fast reply also
I think that ultimately you may be able to resolve this through PT. It may take some time though, so make sure that you stay compliant with the routine.
I am 8 months post-op rotator cuff surgery, and contemplating returning to Crossfit…is there any movements that I should avoid? My mobility is still limited, especially external rotation…I’ve been working out in a traditional gym for about 4 months now, but am so fearful of re-injury that I don’t know how to progress with my strength training.
If the range is not full, I would definitely avoid the overhead squats with the “lock out” of the arms overhead. Start with the unweighted motions and slowly work your way up. Once the range progresses a bit, it would be a good idea to use PVC piping or some other means of doing the overhead motions without weight.
NO HEADSTAND PUSH-UPS EITHER!
I am so happy I found this site. I am 8 months post op from rotator cuff surgery and was told I “probably have scar tissue” when I mentioned to my surgeon that I was having achiness in the front of my shoulder. I have excellent range of motion and have been gradually introducing new strength training exercises. Although I must admit when I was 5 months post op I felt so good I did some overhead triceps extensions and cable flyes (using light weights) which I now realize I should not have done. My question is, how do I get rid of this scar tissue? Is it permanent?
If your range of motion is ideal, I don’t think that scar tissue is the problem. (Scar tissue doesn’t go away per se.)You may be slightly impinging the rotator cuff with certain movements. Make sure that the scapular strength is ideal (middle traps, lower traps, serratus anterior). It is also worth noting that many people are not pain-free until a year or more after the op date.
I am 7 weeks post op shoulder arthroscopy ( past hx left shoulder rotator cuff repair 2014), had subacromial debridement, distal clavicle excision and remove granulomas from fiberWire. I’m doing PT faithfully. I am taking it slowly due to this second surgery.
What time frame would I expect to go back activities such as running and lifting weights? Any other suggestions when I need to worry about persistent pain or decreased ROM?
Thank You!
Since it is a second surgery, and it does appear that the doc did quite a bit of work, I would say at least 16 weeks until you will be cleared for light exercise. Take your time with this. This is likely to hurt and ache for some time. As ling as you note small improvements form week to week I would say that it is coming along. Talk to the PT about maybe getting a set of pulleys to do light range of motion at home if it is otherwise too painful.
Hi, I have nerve pain which I believe to be coming from the Median Nerve. My forearm is semi-numb up to my wrist.
I have a sharp pain when I extend my elbow straight out.
I had rotator cuff surgery and impingement clean up on September 22nd.
Is this normal to have from this kind of surgery 7 weeks out?
How long before it would be safe to jog 1 mile at a slow pace?
Thank You, Dave R 64 Y.O.
If you were kept in the sling for a long time that could easily cause something like that. The elbow doesn’t like to be flexed for prolonged periods of time. I would spend some time out of the sling if you are not already (with the doc’s permission).
In terms of jogging, you probably need to wait until at least 12-16 weeks, and get the clearance from your doc as well.
55 yr old active male, I had full labrum tear and long bicep tear, both repaired on august 4th
Did therapy for 3 months then Started very light weights curls- 2lbs, then 3 lbs, 5 lbs, 7.5 lbs, 10 lbs and
By week 15 started 15 lbs curls.
Also lite weight chest and back and shoulders.
the last time I worked out, the next day my bicep and a little bit of my shoulder have been hurting and burning for over a week!
Do you think I re injured my bicep?
Probably a bit of tendonitis. Lay off it a bit, ice etc.. If the long head of the biceps had a big tear in it, you would likely feel it in the muscle belly of the biceps. It would feel all bunched up, or you would be in a huge amount of pain. If the pain doesn’t go down the ortho can probably help. It is worth a visit to have it checked out.
I am having rotator cuff surgery on Dec. 23rd. How soon could I begin running again? I ref high school basketball and am wondering how much I need to rest?
At least 12 weeks post-op. Get permission from the doc. The swinging motion of the arm is the concern here. It takes six weeks for the cuff to heal, and more time after that for the rotator cuff to strengthen. Take your time and stick to the protocol.
Hey dan,
I had surgery in November to fix 2 tears. Last night I woke up with my bad arm under my head and it took me a while to get it back to a normal position because it hurt so bad. All day today there has been this sharp stabbing pain while lifting up my arm and doing little movements. Should I be worried?
Talk to the doc about it. It is pretty rare for someone to tear an anchor while sleeping, unless if it involves hard thrashing movements. It does sound to me however like you should perhaps be wearing a sling when you sleep to keep you from elevating your arm like that. Having the arm overhead is going to inflame the rotator cuff and the other soft tissue structures. I would talk to the doc or the doc’s assistant about this.
Hi, I am around 6 weeks after surgery. I have been tending to accidently wake up laying on the arm that was operated on and have had aching pain because of it. I know I really need to re position or sleep in a chair but why is laying on that arm causing the aching pain? Are anchors coming loose or more tears occurring?
You are probably forcing the head of the humerus forward when you roll on to the side. This is not a great position for the shoulder to be in. Your sleeping positioning is probably slowing down the healing process, but my guess is that it is probably not doing anything to the anchors.
Hi! I did a bankart surgery for my front- and back instability in my right shoulder about 9 months ago (which was caused by a trauma that also tore off my biceps partially). I did all the exercises as my PT instructed and I got my range of motion back pretty much in full after 6 months. Everything felt good and positive. Then my PT told me that I could start doing more shoulder exercises like military presses etc. But approximately 1 month ago I probably took too much weights for my shoulder at the gym, and since then I have felt a constant sore/burning feeling in the frontside of the shoulder, like it’s inflamed? I rested without doing any more exercises for the shoulder at all and about 1 week after I started to feel better again. Then I tried some regular push ups (which was no problem at all before this happened 1 month ago). But then this burning feeling came back and a clicking sound appears more often from the shoulder. It is defenitely in the front because I can touch the scar from the surgery and feel a little pain. So now I have a constant light pain… tt has become better again, but not fully.
So my question is if it’s right of me to rest and not doing anything? Or should I do the exercises given by my PT even though I have this pain? When will the pain go away if it’s inflamed? I’m scared to do any exercises and make it worse…
Thanks,
Kalle
I would lay off until the pain is basically gone. That may take several weeks but it would be worth it. I would nix the military presses permanently.
i had a bankart leisure surgery last october in my right shoulder also some bone shaving . i did the physical therapy and rehabilitation after 6 weeks which lasted for 8 weeks . i started going to gym last month using only machines and a slightly weights using dumbbells or free bars , losted lots of my muscles and shape , am craving lifting weights again and at the same time so afraid , i don’t do push ups or dips at all but sometimes i feel pain at the back of my shoulder so i decided to rest
my questions are
* when should i lift again like before ?
* how long does it take my shoulder to come normal like the other one again ?
* is there any supplements or vitamins that will help in recovery ?
* is it okay to use the incline bar at bench press or not?
Thanks in advance for ur help
1. You could probably start a light weight routine now. Emphasis on light. Build very slowly.
2. Normal recovery could take up to one year. Be patient with the strengthening and allow for a day of rest in between gym sessions.
3. Good general nutrition is a good idea to expedite healing. I am not an expert in the vitamin category.
4. I would be very conservative with the bench press, and using a straight bar is probably better than using dumb bells.
Hi Doc, I just found this page after asking you this question on a different one!
I had posterior labrum repair which failed. At about 4 months out I added squats back in with my durgeons ok, and they HURT badly in the back of my shoulder.
When i got back up to 315 for 10 my shoulder loudly popped and hurt even more. The surgeon said it was nothing to worry about but -something- retore my labrum! Since you are an expert on this, do you think I would be ok attempting back squats again after this 2nd surgery? I feel my mistake last time may have been restricted ROM and then putting a weight on my shoulders with my hands way back?
There are plenty of other ways to do squats, why bother putting your shoulder in a compromised position? Get yourself used to doing other forms (goblet, dumb bell, lunges, etc.).
Fair point, I used to be a olympic lifter and had a 220kg front squat so I know that lift works almost as well as back squats
Would you feel the front squat is a safer option? Goblets could be dangerous too because of the stress involved holding a heavy dumbell?
Thank you again for your time, if if were in your area I’d be in to see you in person no doubt
I was considering buying a safety squat bar for my garage as that doesnt have much shoulder involvement, would you say that is a valid alternative?
If a safety squat bar is what I think it is, I would say that is a viable alternative. And in terms of the goblet squat, it would have to be with a reasonable amount of weight. Holding it close to you with both hands is a safe option as long as the weight is manageable. Be safe!
I had bankart repair surgery now it is my 8th week my physiotherapy is going on can I ride my bike. or what restrictions I have to follow. Please help
That might be a bit early to be riding your bicycle. With my patients here at PhysioDC, I would normally say about 12 weeks. I would also add that you would need to start cycling in a very controlled way, without bumps and quick turns. You can of course also ask the doc directly when it would be okay to start riding.
Thank you so much for your advise
Hello,
I am 6 weeks Post-op Arthroscopic surgery to repair a large Full-Thickness insertional Tear of the supraspinatus. I had a question regarding Physical Therapy. My Surgeon provided my Physical Therapist with Physical Therapy Instructions for an Arthroscopic Rotator Cuff Repair and Mini Open Rotator Cuff Repair. The Instructions suggest that at 2-3 Months Post-Op, I should do isotonic exercises with an emphasis on eccentric strengthening of the rotator cuff . The instructions also suggest that I add push-ups. The instructions state that “the push up movement should be pain free.” I should begin with wall push-ups and as strength improves progress to floor push-ups (modified – hands and knees, or military – hands and feet) as tolerated.
I would like to ask your opinion. Would it be dangerous to perform military pushups 2-3 months post op?
Also how would I know if I tore my sutures during physical therapy? Would I be in excruciating pain?
Thank you.
A military push up is the most demanding of the three you mention. I think that 2-3 months is a bit soon, and I would start with the wall push ups first. (I usually start patients with wall push ups at 12-16 weeks). Once you can do the wall push ups pain-free for a week I would then consider bumping you up to the modified push ups. etc..
If you tore the anchors you would be likely be in a lot of pain.
Ive gotten my surgery on July 19 2016 and since im all the way in April now I was wondering if im ok to do floor push ups instead of wall push ups when I try to push ups my arms get shaky and then I get worried that my shoulder will slip out again so do I just try to do push ups until it stregthens ? I feel like my arm will always shake/tremor and it hurts a little after I do acouple
Maybe transition to the floor push ups where you are on bearing weight through your knees rather than your feet? I believe that they are referred to as “modified push ups”? They are easier to do than regular push ups, but more of a challenge than wall push ups.
Hi Dan I have had posterior and anterior labrum repair with AC joint excision, I am coming up to 10 weeks and my rehab has gone really well, I introduced static bike week 7 and I wonder when will I be able to ride out on the road again?
Some say this week is fine but I’ve been unable to contact my physiotherapist.
I would normally think that 12-16 weeks would be a normal window for that. Biking outdoors does put more of a piston-like force through the handlebars, so the first time you try it needs to be a very level surface without bumps etc..
Hello, the info I give you may make you laugh, but it is what it is. I had rotator cuff surgery on my right shoulder about 21 months ago and have fully recovered, and now recently (3 weeks ago) have had a rotator cuff tear/repair done on my left shoulder. I also have 4 levels fused in my neck C3-C7 and 3 Lumbar fusions L3-S1. I’m 48 years old, train as if I’m training for the Mr. Olympia. Normally 5 days on 2 days off. Can bench press over 325 for reps, shoulder press (front) 275, incline dumbbell press 120’s and lying down “flies” with up to 80-90 lb. dumbbell’s. Leg pressed 1,300 x 8 and leg extensions of 300 for 10-12. I avoid squats and deadlifts all together. I would like to get back to training like this once I heal again! Do you find this reasonable and feasible or am I kidding myself at this time in my life? I’m not your everyday bodybuilder/weightlifter. Are there specific exercises that you would suggest for each major body part that you think are OK, and ones that you might avoid? Thanks!
Whooooo! It does sound like you are shredding your shoulders. I would avoid anything that causes impingement. Pull ups, incline presses, dips, and preacher curls tend to be irritating for the acromial space. I would keep all exercises at shoulder level or below. You don’t need to tell me whether or not you are kidding yourself.
We just did a podcast on exercise modification and aging (on the website). Give it a listen.
Hey Dan I had a slap tear repair on my right shoulder. It is my second time, first time went well but I dislocated playing soccer with a really hard hit. I have recently gotten back to lifting, my surgery was December 20th. Everything is going well and I get no pain when lifting yet afterward I will sometimes have pain in shoulder blade area/ front of shoulder. I am keeping low weight high reps, always 15 reps. I am wondering if this is scar tissue breaking up or possibly the shoulder stretching out a bit since my surgeon overly tightened it. Insight would be much appreciated.
I would bet that the strength is still coming along. I would maybe lessen the weight a little bit and give longer times in between workouts to recover. I am a huge proponent of doing the “I” “T” and “Y” over an exercise ball in these cases as well.
Thank you I will definitely do that. I have no luck with shoulders, I have a possible labrum tear in my other shoulder which is annoying to lift with. Usually after I workout I have a lot of clicking and some aching pain in back of shoulder. Surgery isn’t an option and it’s not dislocating just subluxes every now and then when externally rotated behind back (throwing position). Do you have any opinions on lifting with this. MRI isn’t an option either I’m broke. I try to stay away from all overhead movements and anything that will overly aggravate it.
Strengthen up the rotators. I am a huge proponent of the “body blade CXT” for strengthening purposes. It isn’t that expensive, and would probably be a good investment for you given your shoulder instability issues. It might be a good idea to get some instruction from a PT on how to use it if you decide to pursue that option.
Hello, I am 18 weeks Post-op Arthroscopic surgery to repair a large Full-Thickness insertional Tear of the supraspinatus. My Doctor gave me the Ok to start doing Push ups at 15 weeks. I started doing wall push ups for a week. Then I did modified Knee push ups for a week. Now, I have progressed to doing Military Floor Push ups. II do around 200 pushups three times a week. I am a little sore the next day. However, I dont experience pain doing the pushups. Do you think its ok for me to be doing 200 military push ups three times a week? I am listening to my body and I am not over doing it. However, I dont want to re-injure my shoulder,.
That is a whole lot of push ups Charlie. The sheer number of those are probably causing some irritation. Cut that number way down and only start adding reps when there is no pain afterwards.
Hi Dan, you mention some patients have pain for a year. I’m now 17 weeks post labrum repair and my shoulder often hurts especially if I stress it.
While I’m here can I ask your opinion on the safety of shrugging exercise with a shug bar for a repair on the posterior labrum? I’m still unsure which exercises are no nos beyond the obvious dips, overhead presses etc
If you keep the shoulders within range (don’t let the shoulders hang at the bottom-most portion of the range) it should be okay. I would get the okay from the doc and your PT, and start with obscenely light weight.
Hi Dan, I worry I overdid it as despite doing high reps with controlled form my shoulder has been hurting for a few days since doing the shrugs
There was no pop crack or sudden pain but it began to hurt in the back of the shoulder the next day and has been painful to sleep on that side for the last few days
At 17 weeks it should be hard to reinjure without a traumatic event , do you agree this could be muscle and inflammation pain? I had an in office scope done 2 weeks ago where they stuck a 16 gauge needle in through the portal scar in the back (sadly that couldn’t show a good image of the repair)
Thank you again for all your time!
I had labrum slap repair 9 weeks ago and I’m looking to speed up the healing process as much as possible. I feel like PT is holding me back from what I could really do at this point. What are some home exercises and range movements I can do. I’m a quarterback and need to be back by week 12.
Throwing and doing full speed football drills at twelve weeks is a very bad idea. I would double that time expectation. If things are still going very well, I would ask the doc and PT to start gentle throwing at week twelve (that is still early by the way). Stick to the protocol regardless of how frustrated you may feel. Trust me. I have seen what happens when younger people don’t follow the conservative rehab route.
Hi Dan. I am almost 11 wks post op rotator cuff repair, biceps tenodesis, acromioplasty and resection of distal clavicle. I have posted questions here before. I am moving through final phases of active assisted passive rehab. My grip has deteriorated since surgery—-initially I could make a fist or squeeze the rubber ball on the Breg Slingshot 2 without problems and in spite of post op arm and hand swelling. Now most of the swelling has dissipated except mild to moderate in the hand and wrist which I must control by elevation and finger exercises which are difficult due to stiffness/limited ROM. Squeezing the rubber ball has become very difficult and the palm of my hand is sore when I try. I have tingling in the 1-3 fingers along the median nerve distribution. My ortho doc says to just keep using elevation and be more aggressive with my shoulder ROM exercises. Does squeezing the rubber ball aggravate or help since that is painful? I just started Naproxen OTC but don’t know if that is really going to help if this is all just due to edema and accompanying stiffness. Have you seen this before? Should I see someone else for second opinion (he has a partner who is a hand surgeon) or just continue his instructions–what about squeezing the ball when it hurts the palm?
Thank you.
I would get a second opinion. It may also be a good idea to back off the squeezing for a week or so. The median nerve sounds like it may be irritated, the question is where this is happening.
Hi Dan. I got worked into the AM schedule of the hand doctor’s PA whom I already know and he confirmed median nerve irritation but wants to try a night splint first before nerve conduction study though that irritation came on well after surgery and in conjunction with my hand edema.
He injected cortisone into the 4th MC flexor tendon pulley which was inflamed. I see him back in 6 weeks after most of my active rehab is over—he did not feel sense of urgency at this time.
Thank you for your advice which is along the lines of what I thought too.
ABB
One last thing Dan–I was in pillow sling for 6 wks in NEUTRAL position instead of in internal rotation. Now at almost 5 wks out of sling I am doing well in rehab except for extreme limited internal rotation such that in standing relaxed position the operated upper arm remains neutral while the opposite side is slightly internally rotated (normal). So when I try the usual internal rotation exercises with cane or pulley, I cannot internally rotate the operated shoulder enough to get my forearm behind me without over-extention which rolls the humeral head quite anterior against the capsule (rather than simply having the upper arm only slightly extended at my side while bending my forearm at elbow behind me). The sleeper stretch. is also difficult as my shoulder wants to move up and anterior to accomplish that. Suggestions? I am going to point out this problem to PT tomorrow.
Thank you!
Gentle PROM into internal rotation (lying on your back) with the therapist applying a gentle posterior force to the head of the humerus. You can sort of do that yourself by using your other hand to apply pressure to the head of the involved humerus. There is a good photo of the self stretch in Dr .Shirley Sahrmann’s book, I think it is called “Diagnosis and Treatment of Movement System Impairments”.
Is this the supine position with arm abducted 90 degrees and elbow flexed 90 degrees (starting with forearm up) and then rotating downward towards table surface (opposite the classic supine external rotation with cane assist)?
Yep.
Hi there! I dislocated my shoulder over two years ago and I occasionally feel like my should is “weak” when I lift it in certain positions. This usually comes after sleeping on it weird or doing some kind of exercise. Usually no pain involved. Have. It had any MRIs/ diagnostic tests. Can’t nesassarily say that my shoulder feels loose. I’m a 29 year old male. And I lift weights and surf al lot with typically no pain/ problems. Would you say this is insanity? Or just weakness in the shoulder. No movements make it feel like it’s going to pop out usually. Any input would be great! Thank you!
Instability ** sorry for the typos, using an iPhone haha
My guess is that you have a small labral tear. When the shoulder dislocates there is a very high probability that the labrum tears. It doesn’t sound like it needs to be repaired given that you don’t have much in terms of symptoms. I would work a few times a week on training the rotator cuff. A visit to a PT might be a good idea to have it assessed.
i myself have had 2 surgerys on my shoulder,one to repair a tear in glenohumeral ligament and 2nd a bone graft to stop my shoulder subluxing posterioly,my shoulder now slips down in the joint 6 month nearly 7 post op,is this normal,it is also frozen
I don’t think that this can be accurately assessed until that frozen shoulder is totally gone. Unfortunately it may take many months to run its course.
Great! That’s you for the quick response. That’s what I was thinking. Today it’s felt fine all day but I work at a computer and when I go to lift my arm from the mouse it feels as if I have to use extra effort to lift it
Hello! I’m about to undergo my 2nd shoulder surgery (Right arm) in as many years. Last one November of 2015 (Same arm). This time around I have a posterior labrum tear, paralabral cyst, biceps tenodesis, and a distal clavicle excision. I have my own woodworking business where I custom make furniture, how long should I wait until I start building again? Also, how long should I wait to resume weightlifting and playing baseball? I’m 29 years old and it’s from an old military injury that was never fixed while active duty. Thanks!
There is a lot going on here, I would guess that it will be at least 3 months until you are comfortable enough to use that arm for moderate force activities such as woodworking. Weight lifting is a minimum of 16-20 weeks, baseball probably a few months after that.
Dan, how soon after rotator cuff repair and biceps tenodesis can one resume sit ups? Thanks again.
Hmmm. I guess it depends on how you place your hands. I would start by keeping the hands folded over your stomach. That type of sit up could feasibly be done 6 weeks after the surgery? (Run it by the doc as well, because it may also depend on how extensive the surgery was.)
If you need a lower abdominal fix in the interim, I would stick to exercises that focus on leg movements.
Well I am at 19 wks postop and have been doing the hands behind the head internal and external rotation without problems—seems this would be the same hand position for sit ups.
I have been diagnozed to have a loose left shoulder. During the years have had a pain in the back of this shoulder near the spine. It is a lot of cracking sounds in a special place there when I rotate the arm and can feel some soreness in this place afterwards. I also often feel stifness in my left chest now and when I sit many hours bent forward. Now when I massage back og my left upper trap. it feels like some muscle fibers move away under the trap. Haven’t touched there before. Is it common that you feel that kind of things when you have a loose shoulder? I cannot feel the same thing on my right shoulder.Hopefully I can get rid of the loose shoulder by doing a lot of rowing exercises that my doctor has recommended.
It is common to feel these things, even if you do not have a loose shoulder. It is very often a result of posture, sitting at a desk for long hours etc.. I do agree with the doctor, strengthening the shoulder blade muscles is a good idea.
Thank you very much Brian,
I think it is also a combination of weak muscles and RSI because I feel most of the pain when im typing with my left arm. Even worse if I type on a mobile than a keybord. It seems that it helps a lot when Im lying down and take a weight in my hand and rotate my arm backwards to strenghten my shoulder. It also seems to help when I stand up and have my arm hanging down and holding a weight in my hand and begin to move the arm in small circles. It seems to be the same exercise 4 you have. I have read a lot of the flexibar that I really consider to test because I think it can execise a lot of muscles deep within.
Excuse me it should be Dan of course instead of Brian in this place :) Thanks again!
Hi Dan,
I am now 6 months post op RTC repair with acromioplasty and biceps tenodesis. I have written you before.
PT recently released me to continue my stretches and strengthening exercises and most are coming along well with exception of two things. First, it has been difficult to progress from abducting to horizontal with a one lb dumbbell to a 2 lb weight. My drop arm test is normal so I assume I am dealing with weakness of the supraspinatus which will take more time to strengthen. Opinion? The other problem is while doing external or lateral rotation with the T-band, I more recently now experience moderate deep lateral upper arm pain (but none without the band) which sometimes radiates down into my forearm (like a toothache). I don’t have pain with dumbbell curls for biceps so don’t believe that to be an issue unless the long head tendon is rotating in the groove to cause this. How about coracobrachialis? Could that be a consideration for this deep ache during and after both dumbbell abduction and lateral rotation with T band? My only limited ROM is internal rotation apparently due to tight lateral rotators or posterior capsule in spite of modified sleeper stretch which I do properly.
Thank you! Avery Brinkley Jr. MD
I do think that the abduction and scaption strength will improve with time. I tell patients with the described exercise to keep the range only to what you can perform without elevating the head of the humerus. Use a mirror for this and compare it to the unaffected side.
The pain down the arm could be referral from one or more muscles that you mentioned, or from the RC slightly grazing the acromion.
Hi doctor Dan
I’m currently 6 months postop after a bankart repair on my right shoulder. I have started my motion rehab after 6 weeks of operation (don’t know why but the doctor said I should have the sling on for 6 weeks). Anyways I began my rehab from week 7 doing simple stretching exercises leading to simple rubberband exercises. BUT I was forced to join the military around week 16 (I’m a Korean citizen required to do the mandatory service). Therefore from week 16 I literally had to stop any rehab exercises until recently I was able to have my own time. My questions are following:
is it a fatal setback for a patient to go through stoppage during the rehab course?
Also I keep on feeling muscle stiffness around the shoulder and neck muscles with strong sense of impingement on the top right corner of the labrum, is the pain normal?
For the next year and a half, I am limited to receive professional rehab treatment from a trained physical therapist which means I have to do the exercises base on youtube.. will this make a huge difference for my rehab?
Finally, is it best to avoid usage of my right shoulder even in simple daily activities or should I use it regardless of the muscle pain?
It probably was not ideal to nix the rehab at 16 weeks, but usually by that point there is a sufficient amount of strength and range of motion. My guess is that you probably still need to do some work with the rotator cuff and scapular support strength. There are plenty of resources out there for you to look at.
To answer your third question, it is not a bad idea to use the shoulder for daily tasks. I would probably stay away from overhead type reaching motions, especially if they are painful.
Thank you so much for the quick detailed reply sir, you are truly a kind hearted doctor.
Just have few more questions after I read the reply:
1. How long (roughly) will it take for me to be able to do steady pushups and pullup exercises if i say I will start diligent rehab day by day from now?
2. Do you recommend me to take another MRI scan for my shoulder before I restart my rehab? (I still have muscle and aching pain even after daily office activities which makes me worry about whether the bankart repair got displaced)
3. Is there lower chance for patients who nixed the rehab like i did to regain full shoulder condition compared to those who kept on their rehab since day 1?
Thank you again sir.
I would have to assess you to tell you it might take to get back to push ups and pull ups, and what your total prognosis is. It is really “case by case”. Another MRI can’t hurt, especially if you are concerned about a re-tear. If a diagnostic test clears you, you would most likely be okay to start back up with rehab. I would ask a PT all of your questions in person.
I had surgery on my labrum 4 weeks ago and still feel a lot of pain. It also feels like it is locking up on me. Is this normal ?
It is still quite early. This is a common occurrence. Let the PT and doc know what is going on as well.
It will be 6months on March 1st from when I had labrum surgery and a post capsular release. I really did not need surgery but wanted to be able to play baseball at a high level again.The injury occured when I was 25 years old doing chest flys and now im going 32. I could lift as much as I want and basically do anything with no pain after the injury. Except when I exerted myself over 85% velocity, I would have a snapping sensation right where the longhead meets the labrum. All the signs of a slap tear. Surgeon went in and found it and fixed and cleaned things up in the shoulder. 1 month after surgery, I was 100% full range motion with physical therapy and strength. The goal was to start throwing March 1st and I waited till middle of January to start training. I have felt no pain what so ever working out but a week ago doing crossoverjacks. I felt the same thing with the bicep tendon like a very minor rolling over something snaping sensation. On a scale from 1-10 the pain was like a .25. Just very disheartening after investing all this money to fix my arm to throw, to feel that at this point in the game. I guess I will really find out in March once I start throwing. My question is, is it normal to feel that once an awhile post labrum surgery. And what should I expect to feel once I start throwing again? I will start light toss and working my way up on a throwing program. Any feedback would be helpful. Thank you
Many people will not be 100% capacity until up to one year after the surgery, especially those who are high-level demanding such as throwers and pitchers. This is a normal occurrence to answer your question. I would invest in a “body blade CXT” by the way, it is a great RC strengthening tool for throwers. When you start throwing, I would expect to feel a bit of ache and soreness. Make sure you allow for adequate rest in between throwing sessions.
Hi Dan,
I found this article and your replies helpful thats why i am asking u my problem, Pain in my right shoulder started many year ago when i used to play cricket & one day i throw ball very rigorously while playing and my shoulder started to pain. i was doing weight training on and off when this happened. my pain limited to some range of motion like while lifting my arm for side raise or front raise but the pain use to disappear within few days without medication. then i left everything and almost 9 yrs have passed and i have started gym again a month back but during all this 9 years i use to have pain on sudden fast sharp movements or lifting weight inappropriately or throwing something and that pain use to go away within one or two days and every time i have pain there was only one or two motion that were restricted especially side raise or front raise. now again i have pain i did dead lift for the first time and i m feeling pain again, and yes one more thing i cannot do push ups (Dips) it starts pain just after 2 to 3 reps. I wanna ask is it rotator cuff damage? do i need surgery? will i be able to weight lift again after surgery.
Ur reply will be much appreciated.
Thanks & Regards,
MZK
I would definitely have this assessed by either a PT or an orthopedist. There may be a rotator cuff issue, or there may be a labrum issue. If you are not having much pain with normal activities I would guess that the course of action would be structured exercises and rehab rather than surgery. I do think that you will have to modify some of the gym exercises that you are doing. I would stay away from “dips” permanently for example.
Hi, about 5 weeks ago I had shoulder surgery. The procedure was a decompression and a partial arcomioplasty. I have been doing the pt exercises on a regular basis. In your opinion when should i start weight liftinging again? Thanks for the time!!
Probably after 12 weeks, with lighter rubber banded type exercises probably okay by 8 weeks. Make sure someone signs off on your progression (MD or PT).
I have had two shoulder dislocations within the past 4 years or so on the same left shoulder. All of a sudden over the weekend, my shoulder started to feel like it was “loose”. Anytime I try and move it around, I am terribly afraid that my shoulder will pop out of its socket again. Also anytime I move it around, there is this slight grinding noise. The pain is starting to come up my neck a bit and slightly over to my left collar bone. . I’m not sure what is going on but I need help. What could this possibly mean?
Shoulder pain can refer to different areas around the shoulder. This does sound like instability is an issue. I would think that a visit to an orthopedist would be a good idea.
Hi Dan, quick question.27 YO, I had a posterior reverse bony bankart repair with a piece of the glenoid coming off done almost 4 weeks ago. I start PT in a few days, but my surgeon wants me in the immobilizer for the full 6 weeks. I play ice hockey goalie, and of course itching to get back on the ice. The arm that was repaired is my catching glove side, and I play in rec league with no physical contact, just the force of catching a puck. Obviously, I am going to be extremely careful here, I do not want to mess this up but my question is when do you think roughly I could start doing some practicing again? Not any games, but just able to get out there and play carefully.
It depends obviously on what the doc says, but I would guess that you might start to be able to practice a bit at or about 16 weeks? I would definitely take your time with this.
Hello Dan. I’m a 26yo male. Nearly one year ago Ive had a Bankart repair. I once particularly hurt my right shoulder by pulling and reaching out too far, and afterwards I *cleverly* continued lifting weights for about a year. I should point out that this shoulder was already weaker even before this (goes back + 2yrs in total). One day, when pain, strenght and mobility were getting worse, I used my limited intelligence and underwent an MRI that revealed a torn labrum. I’ve had it repaired arthroscopically – I believe the labrum was torn 1 to 7hrs o’clock – and surgeon used just two anchors. After 5 sleepless weeks in a sling I had a tough rehab at the PT for over 3-4 months (lots of clicking and popping.) On the 3rd month I started swimming weekly for strenght and continued doing so, along with my daily stretches/rotator cuff work. Today, almost one year later, my ROM is quite exellent for having had surgery, but I still lack a noticeable amount of strenght. Pain now only occurs when crawl swimming (breast stroke is ok) or trying reaching far overhead. Giving a high five to someone or trying to catch something quickly are some of the things that are still somewhat uncomfortable and dont feel all that confident to me. At this point, swimming, along with comprehensive bandwork, usually results in increased stifness the day after for at least 48hours. Ive requested an MRI a couple of months ago to ensure that the surgery did not fail. The surgeon said it looked ok. For almost one year post-surgery, is it your opinion that my shoulder could still improve or get stronger? Should I go back to the PT again? What are you thoughts or is your advice? I thank you. From Belgium – A
You might be able to increase the strength, but it does depend at least partially on if there is demonstrable weakness in any muscle or muscles that support the shoulder blade or shoulder joint. I would have the shoulder evaluated by a fresh set of eyes on the problem, perhaps a new PT? I would ask specifically to have the lengths and strengths of all associated structures and muscles tested. This should give you a good idea if specific training is in order.
My issue started with pure weakness in my left arm during a lifting session. I gave it a week, and still had the same thing. Little to no power pressing outwards or upwards with my left arm. Pain and “clanking” have now started however, I have totally stopped lifting until getting results for my MRI that I had today. Range of motion and flexibility are nowhere near the same now along with the continual lack of power coming from my arm, especially on shoulder and chest presses (it’s difficult to push myself up out of bed now without a feeling of unstableness and pain). Just wondering what you think of my issue Dr.. It has been going on for about a month now and anxiously waiting for the results.
Difficult to say based on what you said. It may be a tear in one of the rotator cuff tendons, or perhaps weakness just from shoulder instability. Don’t do anything extreme for the time being until you have a concrete diagnosis. Don’t worry, your arm is not going to fall off.
Hi Dan
I had a bankart repair of my right shoulder about 10 weeks ago.
Two days back, a few hours after doing my regular PT (external rotations and flexion) I felt a lot of pain in my right shoulder. At present, the pain is nonexistent but when I try to position my arms at certain places it hurts around the sutures.
My surgeon is out of the country for a few weeks and is not responding to the emails so I was thinking if this is something to worry about. What do you think?
At 10 weeks you are probably safe. I would give it another few days to subside. I would also let the PT know so that he /she can adjust accordingly.
Thanks Dan.
It did go back to “normal” after a few days. Maybe it was just a setback but then I can’t take my arms overhead and when I lift my arms the humerus head moves up along. Also, I feel something in my scapular region on my right (injured) side protruding outwards as compared to the other side.
Hey
My name is Zac and I know I have unstable shoulders. I have had labrum surgery twice on my right shoulder. It has been 5 years since my last surgery and I still have a issue with my shoulder being dislocated, it will come out forwards an backwards and rarely it will feel like it’s on top. I don’t feel like a 3rd time would be the charm. I have done pt as well as worked my shoulders out over a period of months. Is there anything with exercise I could try different to help or mainly focus on certain ones?
Ugh, sorry to hear that Zachary. I would maybe talk to a different orthopedist about a capsular repair or a “remplissage” procedure. Those tend to tighten up the shoulder joint. In terms of basic things that you can do, I would ask your doc or PT about trying out a “body blade” with stabilization exercises. Given that it sounds like you can dislocate in multiple directions, I would start with keeping your elbow at your side and using the body blade in your hand with a small oscillatory side-to-side motion. You should be able to find that on youtube I think.