For the first 6 weeks, we recommend five stretching sessions a day lasting 12 minutes each (click on the links for each exercise). That equals one hour per day investment in a solid recovery. The standard program is shown below.
One minute warm up with Forward Elevation: Over Door Pulley
Three minutes of Forward Elevation: Forward Lean
Three minutes of Abduction stretching - the sideways lean
Three minutes of Forward Elevation: Supine
We note that some patients really do best with, and prefer, the over door pulley for the stretching, in addition to the ones with a problematic shoulder on the opposite side. Some patients decide to alternate between the 3 methods because they feel somewhat different kinds of stretching from each of them.
The key to these exercises is muscle relaxation. If the muscles are relaxed, the joint can be stretched effectively.
During the first 6 weeks we encourage daily safe aerobic exercises, such as walking, stair climber, stationary bike, elliptical, and treadmill. If you tend to sweat a lot, you should hold off on vigorous exercises until two weeks after surgery. The bandage needs to be kept clean and dry.
If a full range of motion is not achieved at 6 weeks, we consider a manipulation under anesthesia with complete muscle relaxation. This is an outpatient procedure which we perform in the recovery room. The patient is given a two-minute anesthetic during which the surgeon moves the shoulder through a complete range of motion to break up any adhesions that may be restricting motion. Immediately after that, that same day, the 5 sessions of stretching program is restarted. And patients find it much easier to move their shoulders further. There is some soreness from this, but the relief of being much easier to move most always supersedes it.
Second 6 weeks
Stretching exercises do continue on. If it’s been pretty easy to maintain the full motion you’ve gained since surgery, it’s OK to decrease from 5 to 4 sessions per day for a few days. If you find that you are still keeping that great motion with 4 sessions per day, then OK to try decreasing to 3 sessions per day, and so on. However, if when you decrease you find your shoulder feeling stiffer, it’s best to go back to the last higher number of times per day. Some shoulders just take longer to keep their flexibility with less stretching. Never quit stretching entirely – stretch at least once a day into each direction – just as a check to know that your full motion is still there. Your shoulder has been stiff for a LONG time, so takes some time to help it stay looser.
Assuming the patient has achieved a full range of passive motion, we start gentle progressive strengthening exercises at 6 weeks from the date of surgery.
The key to strengthening is slow, steady progression, making sure that any discomfort from the exercise disappears within 10 minutes after the exercise sessions. In general, any strengthening should not be painful, except for the kind of muscular soreness we have all felt after starting any other kind of strengthening exercise for another body part.
The strengthening exercises are done twice a day. During this time, it is important to do enough stretching exercises to maintain the full range of motion.
Each strengthening exercises should be done with a resistance that allows 20 comfortable repetitions. Once 20 reps are achieved at one level, a bit more resistance can be added.
The most important exercises is five minutes of Supine Press with Progressive Incline
This is a good time to add the Rowing Machine Exercise and the Pull Down Bar Exercise
Water exercises, such as moving the arm gently against the resistance of the water, kicking with the arms on a kick board, and breast stroke can be started at this time.
Keep in mind that while the joint itself is solid, the soft tissues, especially the rotator cuff, are at risk from sudden, heavy or jerky motions. This why gentle steady progression is the key. !A word of caution about exercises to avoid is shown here.
At this time, the patient can progress gradually into activities such as swimming, paddling, climbing, and gym workouts.
Gentle throwing can be started at this time.
Here are some additional rehab tips from ream and run superstars
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