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 MOTION
We routinely use these balls for shoulder exercises and postural exercises. Most people can readily perform exercises leaning over the “55 CM” diameter ball. For those under 5’4″ in height, a “45 CM” ball may fit better. For sitting on the ball to exercise, most people will find the “65 CM” ball sufficient.
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 TOLERATED
We love this product for shoulder stabilization exercise.
- 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
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!
Hi den i sufferd my shoulderproblem approx 8 to 9 month then in 31 march. I get a surgery of shoulder disloaction. Now 2morow i go to the gym then again i have sufferd a lill pain.. but my elbow is also sweeling when i wake up to the bed…
What should i do…please suggest..
Hmmm. I would see a doc or a PT about this. It sounds like the strength of certain muscles may not be up to speed yet. A good PT should be able to look at your shoulder and shoulder blade and determine what needs to be strengthened.
Sir i had a bankart lession surgery of my right shoulder can i start gym or workout again plz help me for the best
You need to get permission from the surgeon prior to starting a gym routine. Most surgeons want at least 12-16 weeks prior to starting a gym routine.
But sir i had surgery 1 year ago
And also tell me which exercises i shouldn’t do
But sir i had surgery 1 year ago
And also tell me which exercises i shouldn’t do
Tell me something doc
If it was a year ago you could probably start a gym routine, but I would start it very slowly and with light weight. I would only advance the weight if you can do the routine for a week or so without sharp pain. I would also take at least one day off in between gym workouts.
If you check out the shoulder exercises on our website, that could give you some good ideas as to where to start.
Hii Den sir…..
My shoulder dislocate about 2 month ago…..
Am I reday to start cardio exercises ni gym?
I would get permission from the doctor first. I would start maybe with a stationary bicycle or recumbent bicycle, this is safer that jogging.
Hi dan
I had a car accident in2011 in which my shoulder got fractured ,it was operated and there are 2 scews in my shoulder..i m running from last 3 months around 5 kms..my weight is 108..and for tightness in body i want to lift weight nd do some dips etc,but i have pain also in my shoulder and sometimes i feel that my shoulder got locked or something like that..so plz tell me what to do to lift weight..
Stay away from dips and inclined presses. They tend to place the rotator cuff tendons in a vulnerable place. You are probably better off with the types of exercises that you can do leaning over a ball (check out our shoulder exercises online). I also like lat pulldowns and rows. If you want to work out the chest I would do it with a straight bar rather than dumbbells as the straight bar limits your range a bit.
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.
Yep.
I spent much time reviewing some of Dr. Sahrmann’s book but my remaining question is how does one keep a hand on the humeral head when that hand is necessary to push the operated side towards the table top? My PT told me that without another person assisting, I should retract my scapula (rhomboids) at the same time to counter the anterior glide of the humeral head. Plz comment.
The shoulder that is being rotated moves into an “active” internal rotation while the other hand is securing the head of the humerus in an anterior to posterior direction. I will typically insturct patients to try to gently reach the hand towards the table while maintaining 90° of elbow flexion. It is preferable of course if you have someone else to apply the pressure and a passive stretch.
You could also try the prone internal rotation exercise in Dr. Sahrmann;s book. The table and a towel roll is used as a passive block to anterior humeral head translation.
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.