Shoulder Injury/Post Surgery Exercise Guide Dr. J. Shawn Leatherman

The rotator cuff is a frequent site of injury. Although the supraspinatus muscle and tendon is most commonly involved, it is important to rehab all four muscles of the cuff. Regular exercises to restore normal shoulder motion, flexibility and proper scar formation, promote a gradual return to everyday work and recreational activities which is important for your full recovery. Your orthopaedic surgeon, chiropractic physician or physical therapist may recommend that you exercise from 10 to 15 minutes 2 or 3 times a day during your early recovery period.

The below exercises are for the initial rehabilitation. This guide should help you better understand your exercise and activity program. All exercises should be performed with slow methodic movements, and they should be performed in a relatively pain free arc of motion.

• Pendulum, Circular - Bend forward 90 degrees at the waist, using a table for support. Rock body in a circular pattern to move arm clockwise 10 times, then counterclockwise 10 times.
  Do 3 sessions a day.
• Shoulder Flexion (Assistive) - Clasp hands together and lift arms above head. Can be done lying down (drawing A) or sitting (drawing B). Keep elbows as straight as possible.
  Repeat 10 to 20 times. Do 3 sessions a day.
• Supported Shoulder Rotation - Keep elbow in place and shoulder blades down and together. Slide forearm back and forth.
  Repeat 10 times. Do 3 sessions a day.
• Walk Up Exercise (Active) - With elbow straight, use fingers to "crawl" up wall or door frame as far as possible.
  Hold 10 seconds. Repeat 3 times. Do 3 sessions a day.
• Shoulder Internal Rotation (Active) - Bring hand behind back and across to opposite side. Do not force the movement.
  Repeat 10 times. Do 3 sessions a day.
• Shoulder Flexion (Active) - Raise arm to point to ceiling, keeping elbows straight.
  Hold 10 seconds, relax 2 seconds. Repeat 3 times. Do 3 sessions a day.
• Shoulder Abduction (Active) - Raise arm out to side, elbow straight and palm downward. Do not shrug shoulder or tilt trunk.
  Hold 10 seconds, relax 2 seconds. Repeat 3 times.Do 3 sessions a day.
• Shoulder Extension (Isometric) - Stand with your back against the wall and your arms straight at your sides. Keeping your elbows straight, push your arms back into the wall.
  Hold for 5 seconds, relax for 2 seconds. Repeat 10 times.
• Shoulder External Rotation (Isometric) - Stand with the involved side of your body against a wall. Bend your elbow 90 degrees. Push your arm into the wall.
  Hold for 5 seconds, relax 2 seconds. Repeat 10 times.
• Shoulder Internal Rotation (Isometric) - Stand at a corner of a wall or in a door frame. Place the involved arm against the wall around the corner, bending your elbow 90 degrees. Push your arm into the wall.
  Hold for 5 seconds, relax 2 seconds.Repeat 10 times.
• Shoulder Internal Rotation (Against gravity) - Keep elbow bent at 90 degrees. Holding light weight, raise hand toward stomach. Slowly return.
  Repeat 10 times.Do 3 sessions a day.
• Shoulder External Rotation (Against gravity) - Keep elbow bent at 90 degrees at side. Holding light weight, raise hand away from stomach. Slowly return.
  Repeat 10 times.Do 3 sessions a day.
• Shoulder Adduction (Isometric) - Press upper arm against a small pillow alongside your body.
  Hold 5 seconds. Repeat 10 times. Do 3 sessions a day.
• Shoulder Abduction (Isometric) - Resist upward motion to the side, push arm against back of chair.
  Hold 5 seconds. Repeat 10 times. Do 3 sessions a day.

After an exercise session has been completed, it is appropriate to ice the shoulder to decrease inflammation and reduce soreness. Ice should not be placed directly on the shoulder unless it is an ice-water solution. Re-freezable gel packs are a good option, with a thin layer of cloth between the ice pack and the skin. Application time is 20 minutes post exercise.

The initial recovery period can last from 4-8 weeks post injury or surgery, depending on the extent of the trauma, additional modalities such as ultrasound or interferential current, nutritional supplementation, and individual healing rate. After this period of time it is appropriate to add small weights and or resistance bands to the above exercise protocols for increases in functional strength. Normal weight training programs, sports interaction, and activities of daily living that require increased physical demand should not be initiated without re-examination and the approval of your doctor.