Rehabilitation After Shoulder Surgery or Injury


Shoulder rehabilitation, or rehab, is a process of restoring full function to the shoulder using exercises specifically for an injury or surgery to the shoulder. Rehab includes learning proper posture and body mechanics along with exercises appropriate for the injured area. Exercises include stretching, which restores muscle and joint flexibility, and strengthening, which improves muscle strength and motor control. A complete rehab program can also include balance exercises activities.

The progression of shoulder rehab exercises is to:
1. relieve pain, swelling and irritation
2. restore range of motion
3. strengthen the joint

A major component of rehab is for you to learn what you can and cannot do—that is, your limitations.

A shoulder injury or surgery (which your body treats as an injury) results in weakness of the structures of the shoulder joint, incoordination of your muscles, and loss of joint function (range of motion). The first exercises you do during recovery must be gentle and safe so that you don’t make the injury worse or reinjure the joint. Progressing through the rehab program properly helps ensure the most effective recovery and increases your chances of returning to full function—in some cases, better function than before your surgery. Because it’s so important that you do the exercises correctly as well as build up your strength gradually, your doctor may recommend that you see a physical therapist to guide you through your rehabilitation. Also, physical therapy is often paid for by insurance programs.

The Purpose of These Exercises

The following exercises can help you in rehabilitation of your shoulder joint after an injury or surgery. These exercises are listed in order from easy to more difficult. You should begin with the exercises to restore range of motion (ROM). This will provide a gentle warm-up as you increase your muscle and joint mobility. Do the exercises slowly and pay attention to any pain you have. As you complete each exercise, do to the next range of motion and then start the strengthening exercises. Do not do any of these exercises without approval from your doctor.

Keep in mind these exercises are meant for rehabilitation and reconditioning following surgery or injury. They are not meant to be used as a regular exercise routine for sports or conditioning. Rehabilitation is meant only to help you gain full flexibility, strength, endurance and balance and to regain normal function of the joint.

Before and After You Do the Exercises

It might be helpful to review shoulder anatomy and function and the bones and joints in the arm.

Before you start the exercises, warm up your shoulder joint for about 10 minutes with the range of motion exercises. Also, a warm heating pad or warm compresses can help warm up. Warm up helps prevent new injury to the area from doing the exercises.

When you finish the exercises, apply ice to your shoulder for about 20-30 minutes to reduce swelling and speed healing. Don’t place the ice directly on your skin. Before applying the ice, place a towel or cloth on the skin to be iced. To make an ice pack, put ice chips or ice cubes in a plastic bag or wrap them in a thin towel. Place the ice pack over the covered skin at the injury. The pack may sit directly on the injured area.

Muscles and Muscle Groups Affected by the Exercises

Each exercise lists the tissues affected—individual muscles or muscle groups. Some muscle groups have specific names, such as the rotator cuff. Other muscle or muscle groups are defined by their function—bending or straightening.

Extension straightening a limb or joint.
Flexion bending a limb at a joint.
Abduction moving a limb away from the midline of the body (the midline is represented by the spine).
Adduction moving a limb toward the midline of the body (the midline is represented by the spine).

Range of Motion Exercises for the Shoulder

1. Pendulum Exercise

• Tissues Affected: Shoulder muscles and shoulder capsule.
• Starting Position: Stand and bend forward with the uninvolved arm supporting the upper body on a table or the back of a chair. Holding a 1-pound weight (such as a can of soup) in the involved hand, allow the arm to hang toward the floor.
• Exercise: With the arm hanging freely toward the floor, shift your body weight from one foot to the other, allowing the involved arm to swing gradually like a pendulum.
• Repetitions: Perform the exercise for 1 to 2 minutes as needed and before and after shoulder strengthening exercises.

2. Cane Exercise

• Tissues Affected: Shoulder muscles and shoulder capsule.
• Starting Position: Lie on the floor on your back with your knees bent and both arms straight up toward the ceiling holding a cane, long stick or broom handle.
• Exercise: (1) Keeping your arms straight, slowly lower the cane over your head toward the floor. Return to starting position. (2) Keeping your arms straight, slowly lower the cane to one side and then the other.
• Repetitions: Hold each stretch as tolerated, and repeat 10 to 15 times.

3. Kneeling Reach Stretch

• Tissues Affected: Shoulder muscles and shoulder capsule.
• Starting Position: Begin on the floor on your hands and knees with your hands directly under your shoulders.
• Exercise: Keeping your hands stationary, slowly sit back onto your heels. To increase the stretch, begin with your hands farther from your knees (out in front of your shoulders), and slowly sit back onto your heels.
• Repetitions: Hold each stretch for 15 to 20 seconds, and repeat 5 to 10 times.

4. Internal and External Rotation

• Tissues Affected: Pectoralis muscles and shoulder capsule.
• Starting Position: Standing, holding a towel behind your back with one hand behind your neck and the other hand behind your waist.
• Exercise: Gently move the towel up and down, as if you were drying off your back,
• Repetitions: Repeat 8-10 times, pause, then do the same thing, reversing your hand positions.

5. Corner Stretch (more advanced)

• Tissues Affected: Pectoralis muscles and shoulder capsule.
• Starting Position: Stand close to a corner in a room facing the corner. Hold your arms out straight to the sides, then bend them up at the elbows to make 90-degree angles (your upper arms will be parallel to the floor, your lower arms reaching straight up) and place your upper arms on the wall. Put one foot and knee into the corner.
• Exercise: Keeping your foot and knee in the corner and your arms against the walls, push your chest into the corner. Keep your chin tucked in and breathe deeply. Return to starting position.
• Repetitions: Hold for 30 seconds, and repeat 3-5 times.

Strengthening Exercises for the Shoulder

1. Superman Squeeze (scapular retraction)

• Muscles Used: Shoulder retractors (the trapezius and the rhomboid, which underlies the trapezius), posterior deltoid and external rotator.
• Starting Position: Lie on the floor face down with your arms at your sides or standing with good posture.
• Exercise: Squeeze your shoulder blades together, and reach toward your feet with your hands. Increase the difficulty by lifting your hands off the ground, palms facing downward. If you don’t have neck problems, raise your head off the floor (continue to look at the floor).
• Repetitions: Hold for a count of five, and repeat 10 times, which completes one set. Progress to 3 sets of 10.

2. Wall Push-ups

• Muscles Used: Shoulder protractors (pectoralis muscles and serratus).
• Starting Position: Stand, facing the wall with feet about two feet from the wall.
• Exercise: Place both hands flat on the wall, with your arms straight, shoulder-width apart at shoulder height. Bend your elbows and lower body toward the wall until your chest is a few inches from the wall. Squeeze chest muscles as you push back to starting position. It helps to focus on your chest muscles as you push back.
• Repetitions: Repeat 10 times, which completes one set. Progress to 3 sets of 10.

3. Flexion and Abduction

• Muscles Used: Rotator cuff and deltoid.
• Starting Position: Stand with the arm of the affected shoulder at your side holding little to no weight, letting pain be your guide.
• Exercise: (1) Slowly raise the arm in front of you to 90 degrees, then slowly return. (2) Slowly raise the arm out to your side to 90 degrees, then slowly return. With both movements, keep the shoulder blade from rising up toward your ear. You can perform this exercise with both arms at the same time.
• Repetitions: Repeat 8 to 10 times, which completes one set. Progress to 3 sets of 10.

ROTATOR CUFF EXERCISES

The rotator cuff is a group of four muscles that provide the shoulder with dynamic stability and keep the shoulder girdle (bony arch formed by the collarbones and shoulder blades) depressed. Rotator cuff strengthening is critical to rehabilitation of any shoulder injury and will help prevent reinjury.

STRENGTH

1. SCAPTION (Scaption is the plane of motion that the scapula moves in.)

• Muscles Used: Supraspinatus.
• Starting Position: Stand with no weight or a 1-pound weight in the hand of each arm.
• Exercise: Slowly raise the arms 45 degrees from the front. Keep your shoulder blade depressed, and raise the arm no higher than 90 degrees. Keep your thumbs pointed downward, leading with pinky fingers.
• Repetitions: Repeat 10 times, which completes one set. Begin with one set, progressing to 3 sets, with brief pauses between each set.

2. EXTERNAL ROTATOR

• Muscles Used: Infraspinatus and teres minor.
• Starting Position: Lie on the floor on your unaffected side with a towel between the involved elbow and your body. Your elbow should be bent to 90 degrees.
• Exercise: Holding no weight or a 1- to 2-pound weight, slowly raise your hand toward the ceiling while keeping your elbow at your side on the towel. Slowly return to starting position.
• Repetitions: Repeat 10 times, which completes one set. Begin with one set, progressing to 3 sets, with brief pauses between each set.

3. INTERNAL ROTATION

• Muscles Used: Subscapularis.
• Starting Position: Lie on the floor on your back with the involved elbow bent to 90 degrees. Place a towel between your elbow and body to keep the shoulder in proper position.
• Exercise: Holding no weight or a 1- to 2-pound weight, keep your elbow bent. Slowly lower your hand toward the floor, then bring hand in toward stomach.
• Repetitions: Repeat 10 times, which completes one set. Begin with one set, progressing to 3 sets, with brief pauses between each set.

  • rob

    A sock full off dried rice, heated in a microwave makes for an excellent flexible heat pack. can be used repeatedly.

  • VENKAT

    had shoulder replacement (affected due to a fall at home) about 2 years back. in spite of physiotherapy cannot raise hand(right hand) above head level. there is persistent muscular pain at the shoulder area. exercises increase pain temporarily. As I am too old (88) I do not want another surgery nor any vigorous exercise. Because of fall, confidence reduced and I am walking slowly with a walking stick. . I do NOT mind living with this. any suggestions.

  • Jessica Lopez

    hello my name is jessica and i was wondering what kind of exercises i can do after having right shoulder surgery at home to help the recovery process go quicker i had my tendon cut and re- tacked lower and some bone spurs shaved down and cleaned up i am on pain meds and would like to get off of them as quick as possible so if there is any thing i can do at home to help this along that would be great. Thank you and hope to hear from you so.

  • Annie

    Hello, I am a massage therapist and have a question in regards to muscles removed or reattached after a reverse shoulder replacement.

  • Media Partners

    First and foremost, follow what your surgeon tells you to do. If he has referred you to a physical therapist PT, then follow what the PT says. We have educational information about R.I.C.E. treatment. Usually, ice is applied immediately after doing rehab exercises to help keep the swelling down. Be sure not to place the ice directly on your skin. So if you are doing exercises 3-4 times a day, then ice 3-4 times a day after each exercise session.

  • Ray

    how often one should ice the shoulder during rehab and after shoulder arthroplasty?

  • Media Partners

    Thanks for the tip Ralph! Heating pads are flat but most are flexible enough to fold over the top of the shoulder. A curved one would certainly be more handy.

  • Ralph

    As far as using a heating PAD on the shoulder – they are alll FLAT, but there is a curved one, the Heating Pouch. Google it.

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