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Exercises should be performed 3 x daily, 5 days per week
Phase 1- Protection Phase (0-6 weeks)
Weeks 0-2
Sling to be worn all times accept during showering
Keep wound covered and do not soak in water
Ice can be used post exercise
Exercise
- Pendular shoulder exercises
- No active shoulder exercise but gentle active assisted shoulder exercise can commence
- Scapular setting
- Assisted elbow, active wrist and hand exercise
Week 2-4
Range of Motion
- Continue pendular exercises
- Continue active assisted elbow, wrist and hand exercises
- Continue and progress active assisted shoulder flexion and begin gentle active external rotation
- Continue active assisted elbow and active wrist and hand range of motion
Strengthening
- Isometric scapular setting focusing on lower trapezius recruitment
- Hand grip strengthening with squash ball squeezes
Proprioceptive retraining
Push into a theraball against a wall with arm by side and elbow bent
Week 4-6
Range of Motion
- Continue pendular exercises.
- Continue gentle active assisted shoulder exercises.
- Supine (lying on your back gravity reduced cradling arm with other)
- Internal and external rotation (with arm in slight flexion)
Strengthening
Continue scapular setting exercises focusing on retraction and depression
Grip strengthening
Proprioception
Pushing a theraball into a wall and performing semicircles
Phase 2 - Range of Motion Phase (Week 6 to 12)
Week 6-8
Range of Motion
- Standing (Antigravity)
- Shoulder flexion with broomstick or other arm
- (Aim to achieve active flexion of 120 degrees by three months)
- Shoulder Internal and external rotation (to 30 degrees)
Strengthening
Continue scapular setting exercises and grip strengthening and commence isometric and through range of motion internal and external rotation strengthening. Repeat isometric exercises 15 repetitions with 5 second hold
Proprioception
Semicircles with a theraball in 70 degrees flexion
Week 8-12
Range of Motion
- Standing (Antigravity)
- Shoulder flexion with broomstick or other arm
- (Aim to achieve 150 degrees passive and 120 degrees active)
- Shoulder internal and external rotation (to 45 degrees)
- Supine Shoulder abduction
- Stretches
- Shoulder flexion -slide arm forward on a table -preacher stretches
Strengthening for Scapular Stability and Rotator cuff
Continue scapular setting exercises and grip strengthening.
15 repetitions with x 3 sets
- Internal rotation
- External rotation
- Shoulder flexion (bent elbow)
- Shoulder extension (bent elbow)
- Biceps and triceps strengthening
- Seated rows
- Bent over rows
Note: Avoid all over head strengthening push exercises
Proprioception
Semicircles with a theraball in 90 degrees abduction/flexion.
Phase 3 - Strengthening Phase (3 to 6 months)
Aim to progress active range of motion from 120 degrees shoulder elevation to full range and incorporate functional exercises and sport specific drills as indicated by your physiotherapist.
This may include
- Plyometric training
- Core stability training
- Proprioceptive retraining -plyometric type theraball work against a wall -body blade
- Use of mirrors for motor recruitment retraining
- Theraband strengthening in the scapular plane at increasing ranges of motion
- Gym type scapular strengthening including seated rows, latissimus pull downs
- Gentle biceps strengthening from 4 months
Note: Avoid all overhead push exercises
Phase 4 - Functional/Sport Specific Activity (4-6 mths +)
This phase should focus on maintaining full pain free movement, normalising strength power and endurance and the completion of sport specific testing if required.
Return to work/sport general guidelines
Please ask your surgeon and physiotherapist about your specific situation
Writing 2 weeks
Computer 2 weeks
Driving 6 weeks
Light duties 6 weeks
Moderate duties 3 months
Exercise bike 4 weeks
Running 8 weeks
Gym 12 weeks (light)
Golf 16 weeks/ 6 months (lead arm)
Swimming 3 months breaststroke / 6 months (freestyle)
Tennis 6-12 months
Surfing 6-12 months
Contact/high impact sport 9 -12 months