Your post-op rehabilitation can be more important in your recovery than the surgery itself.

This protocol is a guideline for your post-op rehab.  Remember, everybody is different and this often has to be individualized based on how it goes or things specific for your surgery.  If there are any problems or questions, look to Dr. Maffet for guidance.

GOALS:

1. Let inflammation settle down – that is a decrease in the pain, stiffness, and swelling.
2. Improve function – which is the rotator cuff and scapular rotator strength, shoulder range of motion, endurance and coordination.

First 7-10 days:

I don’t typically start any formal physical therapy before the first postoperative office visit.  During this time I want you working on decreasing the inflammation by icing the shoulder at least 3 times per day for 15 minutes.  You may have a cold therapy machine which makes this process easier.  I also want you backing off on your activity level as much as possible to help you’re your shoulder inflammation settle down.  If you start too much activity too soon,therapy or otherwise, you’re just going to make the shoulder angry and hurt more.

I will want you working on early passive range of motion of your shoulder.  This will initially be accomplished on your own with pendulum exercises several times a day advancing to walking up the wall as tolerated.  You will note shoulder muscles function is not required during these passive exercises.

Week 2-6:

Early physical therapy will sometimes be started depending on what exactly was done during the surgery.  Please check with me at this stage.  For most rotator cuff repairs and some SLAP and other labral repairs, I’ll continue passive only activities to allow our repair to heal.

1. Range of motion exercises
   1. Wand exercises in all planes
   2. Pulley exercises
   3. Posterior capsular stretching
   4. Towel internal rotation stretch
   5. Manual stretching and joint mobilization
2. Early strengthening exercises
   1. Scapular rotator stabilization and strengthening
   2. Early isometric rotator cuff strengthening to advance to active kinetic band or tubing as tolerated ( empty can, scaption, IR, ER)
   3. Rhythmic stabilization exercises
3. Anti-inflammatory modalities ( ice , electric stim )
4. Remember to learn to do these exercises as much as you can to do on the days you don’t have supervised physical therapy.

Shoulder Rehab Phase I        Photo demonstration of important exercises.

Week 6 – 3 months

1. Continue ROM exercises to reach full motion.
2. Active kinetic rotator cuff and scapular rotator strengthening program
3. Rotator cuff repair and some labral repair patients will start formal PT and strengthening at 6 weeks postop.
4. Advance as tolerated
   1. Push-up progressions (wall to table to floor), seated rows
   2. Plyoball work
   3. Rhythmic stabilizations
   4. ER at 90 degrees abduction on table or floor for teres minor

3 – 6 months

1. Initiate and progress sport specific and functional drills
2. Interval throwing program
3. Be completely comfortable with your home program and do a little every day.

Mark W. Maffet, M.D.