For the majority of patients, shoulder surgery is a one-time event that has a major impact on their lives. It may be routine for you, as a healthcare professional, but for patients, the procedure is mired in uncertainty. Anxiety and fear are common. The more you can help prepare them, the more likely they are to have a positive recovery experience. Some of the essential elements of recovering from shoulder surgery are1,2:

  • Ample rest to allow healing.
  • Proper hydration.
  • Physical therapy.
  • Shoulder compression sleeves.
  • Therapeutic cold and/or heat as appropriate.

It’s important for patients to understand that they play a key role in their own recovery and that being proactive may help them return to normal activity more quickly. Participating in physical therapy is a great way to help promote recovery and achieve a safe return to a typical daily routine.

When to Start Physical Therapy

Depending on the type of surgery, physical therapy for shoulder surgery may start on the day after the procedure. Patients may begin with simple, short exercises, and then gradually work up to more challenging routines. The length of physical therapy and the type of exercises varies from person to person. In general, most people can expect at least a few weeks of physical therapy. In many cases, surgeons recommend physical therapy for about six weeks following surgery. Some surgeons even recommend physical therapy before surgery to safely improve strength and range of motion.3

Best Physical Therapy Exercises for a Fast Recovery

The primary goals of physical therapy post-shoulder surgery are to strengthen the muscles and tissues surrounding the joint and to help patients recover as quickly as possible. Additional objectives include improving range of motion, decreasing pain, and improving overall functional use. Here are the stages of recovery and some typical exercises for each stage:

Immediate Post-Surgical Phase

The shoulder could be immobilized for several weeks after surgery, except during physical therapy.4 In many cases, exercises prescribed may be limited to those that do not require active range of motion, lifting weights, or excessive stretching. Some examples are:

  • Shoulder pendulums for gentle mobilization.
  • Isometric exercises for strengthening.
  • Wrist flexion and extension.
  • Hand gripping exercises.
  • Neck active range-of-motion exercises.

Protection Phase

For the initial weeks and potentially months after the procedure, soft tissues in the shoulder joint are in the healing process, so it is important not to introduce too much activity during physical therapy. The goal during this phase is to restore passive range of motion while still avoiding lifting any heavy weight. Appropriate physical therapy activities may include:

  • Assisted active range-of-motion exercises.
  • Gentle joint mobilization.
  • Prone rowing to neutral.
  • Isometric exercises for strengthening.
  • Shoulder flexion and abduction active range-of-motion exercises.

Movement Phase

Several months after surgery, patients may start to regain full range of motion and restore strength and flexibility. During the last weeks of this phase, many patients start to return to functional activity but are still limited to lifting only very light objects. Recommended exercises may include:

  • Dynamic stabilization exercises.
  • Internal and external rotation with resistance bands.
  • Lateral raises.
  • Prone rowing.
  • Prone extension.
  • Prone horizontal abduction.

Advanced Strengthening Phase

The remaining recovery time is dedicated to returning to normal activity levels by increasing strength, flexibility, and active range of motion. At this stage, physical therapy generally includes:

  • Advanced conditioning exercises.
  • Adding more weight to the strengthening exercises listed above.
  • Continued range-of-motion stretching.5,6


Physical therapy may not always be the most exciting way to spend one’s time, which is why compliance may be an issue for many patients—especially as they begin to feel better. If this is the case with some of your patients, find a few physical therapy apps that may help them stay motivated to do their exercises at home.

Additional Tips for Shoulder Surgery Recovery

In addition to participating in physical therapy, patients may help promote their recovery using these tips:

Rest

It may be difficult for patients with active lifestyles to slow down for the several months it takes to fully recover from shoulder surgery. Stress the importance of getting ample rest and good, quality sleep, especially in the several weeks immediately after the procedure. 

Explain to patients that the body needs to conserve energy so that it can commit the necessary resources to repair damaged tissues for a faster recovery. Muscles and tissues actively repair themselves during sleep, so patients who struggle to sleep because of pain or anxiety may not heal as quickly.7

Hydration

Staying hydrated also contributes to the healing process. Recommend that patients keep a water bottle nearby to replenish fluids and increase circulation of oxygenated blood.8 This is another opportunity to employ a mobile app with reminders to consistently drink water throughout the day.

Shoulder Compression Wraps

Using a shoulder compression wrap that delivers both therapeutic heat and cold may help with the recovery process. In the initial healing phase, patients should use only cold to help reduce swelling and help control pain. As recovery progresses, therapeutic heat may be used to help relax sore muscles before or after physical therapy.2

Endnotes

  1. How long is the recovery period after shoulder surgery? Premier Orthopaedics. https://www.premierortho.com/physical-therapy/long-recovery-period-shoulder-surgery/. Published 2014.
  2. Marcin J. Treating pain with heat and cold. Healthline. https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold. Published 2017.
  3. What to expect: rotator cuff surgery. Upstream. https://urpt.com/blog/what-to-expect-rotator-cuff-surgery/.
  4. Rotator cuff surgery study suggests changes in rehabilitation needed. Hospital for Special Surgery. https://www.hss.edu/newsroom_changes-rotator-cuff-surgery-rehabilitation.asp. Published 2012.
  5. Rotator cuff and shoulder conditioning program. OrthoInfo. https://orthoinfo.aaos.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/. Published 2012.
  6. Shoulder - Torn Rotator Cuff. Massachusetts General Hospital Orthopaedics. https://www.massgeneral.org/ortho-sports-medicine/conditions-treatments/pdfs/Rotator%20cuff%20repair%20rehabilitation%20protocol.pdf.
  7. Delucchi J. Sleep: the secret ingredient of injury recovery. OrthoCarolina. https://www.orthocarolina.com/media/sleep-the-secret-ingredient-of-injury-recovery. Published 2018.
  8. Mateo A. 5 signs of dehydration and what you can do to [sic] about it. Bicycling. https://www.bicycling.com/health-nutrition/a25051470/signs-of-dehydration/. Published 2018.