Recovering from any shoulder injury or surgical repair, such as an arthroscopic anterior stabilization procedure, can take many weeks and requires patience and effort on your part. We recommend a rehabilitation protocol to protect your shoulder while you work on rebuilding your range of motion, strength, and flexibility.
Phase 1 – Immediate Post Surgical Phase
Phase 1 lasts for the first 21 days after your surgery. Your goals are to protect your shoulder, reduce inflammation and pain, and start to rebuild your range of motion. During phase 1, you need to take several precautions to protect your shoulder, including:
- Wear a sling 24/7 except for when you shower
- Keep your shoulder immobile
- Don’t engage in active or passive range of motion
- Don’t lift anything with the healing shoulder
- Keep the surgical site clean and dry
During phase 1, you only practice active and passive range of motion movements with your hand, wrist, and elbow. You work to normalize your scapular (shoulder blade) position, mobility, and stability. You begin isometric exercises in week 3 and may find that cryotherapy reduces pain and inflammation.
Phase 2 – Protection Phase
During phase 2, which includes weeks 4-5 of your recovery, you work to restore your passive range of motion without overstressing your shoulder while the tissue heals. You need to follow your surgeon’s restrictions, especially for external rotation, and should not engage in any active range of motion exercises or lift anything with your recovering shoulder.
You continue to wear your sling except for showering and physical therapy. During your physical therapy sessions, your therapist works to improve your passive range of motion with movements including:
- Full flexion and elevation (lifting your arm to the front and side)
- Full internal rotation
- External rotation up to 30 degrees while your arm is at a 20 or 90-degree angle
- Rotator cuff isometrics while in a neutral position (isometrics are static exercises)
Phase 3 – Intermediate Phase
During phase 3, or weeks 6-7 of your recovery, you work to increase your external rotation and start to transition from passive range of motion to active range of motion exercises to enhance your strength and endurance. You also begin to cut down on how often you wear your sling. However, you must still take precautions, including:
- Avoid aggressive range of motion exercises and stretches
- Don’t lift anything with your affected shoulder
- Avoid activities that stress your shoulder when it’s in an abducted position with external rotation — this means no push-ups or pectoral flys
You and your physical therapist work on gentle passive range of motion exercises, including external rotations, while your arm is at 45 and 90-degree angles. You also start to work on active range of motion movements such as gravity resisted positions. You and your therapist also work on stretches, including:
- Cross arm stretch
- Side-lying internal rotation stretch
- Shoulder joint mobilization
These movements help enhance strength in the small muscles that connect your chest to your shoulder and the muscles in your back that help you retract your shoulder blade.
Phase 4 – Strengthening Phase
Phase 4 lasts from week 8-12. Your goals during this phase of recovery include increasing your external rotation range of motion, maintaining progress in active range of motion exercises, and normalizing your muscular strength, stability, and endurance. While your activities gradually progress, you need to take care not to stress your shoulder and avoid any contact sports or activities.
In phase 4, you continue to stretch and increase your passive range of motion in physical therapy, as well as the strength-building movements you started in phase 3. You and your therapist work on extending your passive range of motion to your full tolerance.
Phase 5 – Return to Activity Phase
During phase 5, your goals are to return to your work, sports, and other recreational activities safely and without pain. While you can start to get back to your normal activities, you shouldn’t throw or perform any overhead athletic movements until at least four months after your surgery. You can start to add weight lifting into your routine, but avoid wide-grip bench presses, military presses, and behind-the-head lat pulls.
During your physical therapy, you continue to work on your stretching and strengthening program. They can guide you in your upper body weight lifting. You begin with low weight and high reps, ensuring that you maintain perfect form and follow your surgeon’s precautions. You can also return to golf and tennis during this phase, although you need to avoid serving in tennis until you reach four months post-op.
Finally, at the end of recovery, you need to meet specific criteria before returning to sports and other recreational activities, including:
- Get clearance from your surgeon
- Have pain free shoulder function
- Restored range of motion for your activities
- Your strength in the treated shoulder should match the other shoulder
If you’re looking for expert orthopedic shoulder surgeons in the Austin area, contact Austin Shoulder Institute today. We support you before, during, and after your arthroscopic anterior stabilization surgery repair.