Now that your rotator cuff arthroscopic surgery is over, it’s time to focus on rehabilitation and recovery. While every patient recovers at their own pace, there are four phases of recovery. Combined you’ll need around 22 weeks to reach your full recovery.
Phase 1 – Immediate Post Surgical Phase
Phase 1 lasts for the first 10 days after your surgery. Your goal for phase 1 is to protect your shoulder. Your physical therapy focuses on diminishing pain and inflammation. You’ll gradually increase your passive range of motion to prevent muscular inhibition.
You wear a sling and abduction brace, during the day and while you sleep. During your initially physical therapy, your therapist moves your arm through some gentle movements while you are supine (lying on a treatment bed). These passive movements prevent your muscles from wasting and protect your range of motion.
Your therapist leads you through some gripping exercises and introduces sitting scapular depression and retraction movements. They also teach you some neck and upper quarter stretches.
At home, you also begin to practice some external rotation movements. You will make 20 repetitions, five times during the day. You can also apply an ice pack to your shoulder for 15-20 minutes every hour to control inflammation.
During physical therapy, you continue to practice your external rotation movements and supine passive range of motion movements. Your therapist will increase the range of motion in your movements. You will also practice neuromuscular rehabilitation.
At home, you continue to wear your sling day and night, practice your external rotation movements, and apply ice for up to 20 minutes six or seven times a day. Make sure to keep your incision site clean and dry.
During these first 10 days, you shouldn’t:
- Lift anything
- Extend your shoulder
- Move suddenly
- Support your body weight with your hands
Phase 2: Protection Phase
Phase 2 lasts from day 11 through week six. Your goals are to focus on healing and gradually restore your full passive range of motion. You work on re-establishing dynamic shoulder stability. Inflammation and pain should decrease during phase 2.
You continue to wear your sling, but you can remove it for physical therapy sessions and at-home exercises. During therapy your practice your passive range of motion movements and increase your flexion up to 90%. In addition to your external rotations, you introduce internal rotations with abductions of at least 45 degrees. You also practice internal and external rotations in your scapular plane. You will also introduce overhead pulleys for passive motions.
In weeks 3-4, you should progress to a full passive range of motion and 170 degrees of flexion. You continue to work on your scapular stabilization and strengthening. Your therapist initiates isotonic elbow flexion.
During weeks 3-4 you also start to apply heat before your range of motion movements. The heat loosens your muscles and releases tension. Additionally, it’s time to get into the pool to practice your passive range of motion movements with the light resistance provided by water. Still, you can’t use any resistive exercises yet.
At this point, you should be able to give up your sling. You’ll use continue to use heat before you exercise. Your therapist also introduces active assistive range of motion (AAROM) work. Using equipment or their hands, your therapist calibrates the force to your specific needs and addresses difficulties with certain movements. You begin an active assisted exercise program including:
- Side-lying external rotations
- Side-lying internal rotations
- Prone rowing
- Prone horizontal abduction
- Bicep curls
- Upper body ergometer below 90 ̊ elevation
You still need to take precautions to protect your shoulder. Outside of the passive movements you do in physical therapy, you shouldn’t lift anything. You need to limit behind the back movements and you must not support your body weight with your hands or make any sudden movements.
Phase 3 – Immediate Range of Motion
During phase 3, your goals are to regain your full active range of motion (AROM). You’ll work on dynamic shoulder stability and gradually restore your shoulder and power so you can return to your daily functional activities.
During week 7 you and your physical therapist work on introducing more AROM exercises. If you lift your arm without hiking up your shoulder or shoulder blade, you’ll work on exercises, including:
- Should abduction
- Supine internal and external rotations
- Prone rowing
- Prone horizontal abduction
- Prone extension
- Elbow flexion
- Elbow extension
If you can’t lift your arm without hitching up your shoulder, you’ll continue to work on the previous exercises until you can smoothly lift your arm. You will also continue to work on stretching and stability drills to maintain your newly restored range of motion.
You continue to work on these exercises and incorporate side-lying external rotations.
In these weeks, you add lateral raise and functional activities, if the provider gives you the all-clear.
Finally, in week 14 you and your therapist start to work on fundamental shoulder exercises like standing forward punches, shoulder shrugs, and bicep curls.
Phase 4 – Advance strengthening
Your goal in this final phase of recovery is to maintain your full, pain-free range of motion and improve your muscular strength and power while you return to functional activities.
You continue stretching and range of motion exercises and you add more shoulder strengthening exercises. If you’re an athlete, you incorporate sport-specific training.
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 rotator cuff repair.