Having any type of surgery can be a scary proposition for people, and arthroscopic shoulder surgery is no different. In addition to the procedure itself, you know you’ll have to spend some time recovering in the hospital and at home and then have a period of recouping your shoulder through physical therapy ahead of you. It seems like a lot, but you can do it, and the benefits of having it done and building your shoulder strength back up sooner rather and avoid risking further injury by putting off the surgery makes the procedure well worth it.
Our last couple of blogs explained what you should expect from day one and the immediate aftermath of the surgery, but what about the next stage? After you get through those first few days, it’ll be time to start exercises that slowly build your shoulder strength back up and ensure you have the full range of motion and use of your shoulder and arm without risk of re-injury. Some people mistakenly think the moment the pain resides they’re good to start using their shoulder for anything and everything just like they did before injuring it. This is not the case, and doing so can be dangerous.
After going through the trouble of surgery, the last thing you want to do is rush things and hurt your shoulder again. Everyone’s body is different, so no two people are going to react exactly the same to arthroscopic shoulder surgery or some of the most common and effective recovery exercises. So, it’s important not to expect to follow any one recovery guideline that hasn’t been personalized for you and have the results turn out exactly how you want them too. You’ll need to consult with your doctor on what’s best for you and your situation. And you should do this before you have your surgery done so that you have a plan in place that you’re familiar with and ready to follow after you come home from surgery. You and your doctor may need to alter it some after seeing the immediate surgery results, but you should be able to mostly follow the details of your pre-planning.
But generally, these are some of the exercise best practices that work best for people following surgery.
Your first six months of recovery time following the surgery are the most crucial time for properly healing things up. During this time you’ll want to be extra careful with the range of motion you use and the levels of stress you put on your shoulder and arm. Remember, you do not want to rush things and overdo it. You’ll pay for it in the long run if you do. You can get back to being the same person you were before, but if you’re going to do so, you have to give it some time and careful consideration.
It’s during this first month and a half that your tendon will need to heal to the bone, and in order to pull that off as effectively as possible it needs a similar environment that a fracture healing in a cast or splint would. So, your shoulder will be in a cast this whole time, right? No, not exactly. While that certainly would be extremely effective in healing your shoulder from the surgery, it would introduce another problem entirely. If your shoulder was casted for six weeks, you’d have an extremely difficult time moving it properly afterwards because the joint would shrink and tighten, which would severely hamper your range of motion.
Instead, many doctors believe most patients need to experience what’s commonly called “passive motion” during the first six weeks in order to prevent tightness and build a full range of motion. Only then will you be OK to stop worrying about flexibility as much – but it’s not quite time to return to your regular exercise routine even then. This is a very tight line to walk, but the hope is that your flexibility is restored and your shoulder is healed and tight instead of loose, which can lead to re-tears.
After the first week to 10 days, it’s fine to begin using a stationary bike to keep your cardio activity going, but avoid treadmills and elliptical, as you can easily lose your balance and really hurt yourself. You should also be moving your hand and elbow a decent amount during this time to avoid stiffness. But you absolutely should not reach for or carry anything in that hand during the first six weeks. You should have your sling on even in your sleep to prevent unintentional reaching in your sleep or when your alarm goes off.
Between weeks two and six, you will probably be OK to try:
- One-armed aerodyne
- One-armed light kettlebell swing
- Air squat
- Step-up/down boxes
- One -arm rowing
- One -arm farmer’s carry
- Careful situps
- Back extensions
- Sled drags
In all of the resistance exercises, the one arm being used is the non-injured one, and the weight should be light enough that you don’t need to move the injured arm at all.
During the six weeks that follow, you still can’t go full-bore working out just yet. The sling will come off, but you should only be doing gentle strength exercises with the injured arm during this time. By month three, however, you can probably begin using dumbbells and resistance bands on the operative side, but you still don’t want to go all-out until month five. Anything sooner and you risk a re-tear. Take it easy, and you’ll get back to your old self eventually.
The short answer is it depends on your condition and severity of the injury. Everyone heals at their own speed, so stay patient and follow your surgeon’s instructions. To help answer specifics on the timeline of recovery and progression with therapy please refer to our post-operative protocols found on the website.
You can do things like walk immediately. Usually, you will be in a sling for a period of 2 to 6 weeks depending on the type of surgery. During that time you can remove the sling to extend the elbow several times a day. You can also typically type at a computer or text on a cell phone with an arm in sling within a few days. Please see our protocols for specific instructions on how to progress your workouts.
You will usually start physical therapy within the first 10 days. To begin with, physical therapy will focus on keeping your muscles supple with passive motion. This will help you when it’s time to practice exercises to rebuild your strength and flexibility.
Your physical therapist will give you “homework” exercises. This will progress in phases. Once you have met the goals/ criteria and met the appropriate timeline for a phase you can progress to the next one.
Passive motion is when your physical therapist moves your muscles and joints for you. It’s a common part of early post-surgical rehabilitation. Your therapist gently moves your arm to maintain your muscle tone and flexibility as you recover.
That really depends on your recovery. As you work through your physical therapy, you will progress to different activities that prepare you for your sport, but listen to your therapist and don’t push yourself too hard. Do not go back to your sport until you have a follow-up appointment with your surgeon and he gives you the all-clear.