Rotator cuff repair is notoriously challenging to recover from. Not only is it generally painful, but it also requires adherence to a very specific protocol. Progressing too slowly results in prolonged stiffness and pain, while progressing too quickly risks the rotator cuff repair failing to heal. I recommend the following 4 steps.
The first step begins at the time of surgery and ends 2 weeks after surgery. During this phase of rehabilitation I recommend minimizing any motion of your shoulder. Performing active finger, wrist, and elbow exercises is encouraged without limitation, but try to minimize any shoulder range of motion. Avoid any lifting, pushing, or pulling (even using only your hand) because it is really impossible to isolate your shoulder. You will be in an abduction sling, which allows the shoulder to rest, and takes tension off of the rotator cuff repair. To get dressed, and for hygiene, you will obviously have to temporarily remove the sling. Any motion of the shoulder during this stage must be passive only. The best way to accomplish this is via pendulum exercises.
Step 2 involves intentional passive range of motion exercises. During this stage you still need to avoid any active range of motion. This is often difficult for patients. Following along with me in the accompanying video will very helpful. Stretching needs to continue on a daily basis from this point until you have full, symmetric range of motion with your other shoulder.
Step 3 involves active range of motion. This is how we normally move around. Stretching should continue every day. No strengthening should occur yet.
As you enter the final stage of rotator cuff rehabilitation, you will now add strengthening exercises. Strengthening should be done 2-3 times per week only. It is not appropriate to perform resistance exercises on a daily basis. The exercise stimulates the muscle to grow, it then needs a few days to actually grow.
Most patients will continue to make progress with regard to range of motion, strength, endurance, and pain for an entire year following surgery. While the process is lengthy and unpleasant, careful adherence to this protocol will minimize the chance of ongoing stiffness and help prevent the rotator cuff from not healing. Many patients will need to continue stretching and strengthening for many months beyond what I have outlined above. This is normal, and anticipated. Continue stretching until you have achieved symmetry with your other shoulder. Continue strengthening until you are able to do all desired activities. most patients will report ongoing progress for an entire year following surgery.
6/26/2021 04:53:10 am
I had a TKR in Nov 2020. I am very grateful to come across your helpful information and videos especially during a time when I had no access to a physio due to covid.
6/28/2021 12:38:26 pm
At this stage, stretching alone is not likely to result in an optimal range of motion. I think you need to discuss this with your surgeon- consider arthroscopic lysis of adhesions with manipulation followed by much more consistent stretching afterward.
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Orthopedic Surgeon focused on the entire patient, not just a single joint.