Rotator Cuff Surgery: Phase 2 Exercises

Rotator cuff surgery rehabilitation is a marathon, not a sprint.  You must remain patient throughout the process in order to achieve the best long-term outcome.  Rotator cuff repairs involve stitching tendon back to tendon or tendon back to the bone.  This requires caution for the first 3 to 6 months after surgery while the repair is vulnerable to re-tearing.  Overly aggressive stretching or lifting of the arm can damage the repaired tendon.   The exercises included in this article are a progression of the early phase range of motion exercises done during the first 2 to 6 weeks after surgery.

This second phase of rehabilitation typically begins 6 weeks after surgery.  However, these exercises may be delayed for an additional 2 to 4 weeks for larger tears which require greater protection.  Phase 2 exercises utilize less external assistance than those performed in phase 1.  Also, these exercises are progressed by being done against gravity.  These factors contribute to slightly greater activation of the rotator cuff muscles but do so in a protected fashion.  The goals of phase 2 are to restore range of motion and prepare the shoulder muscles for gentle strengthening exercises during phase 3.

Incline Table Slides

This exercise is a progression of the table slide exercise performed in the early phases of rehabilitation.  Begin standing, holding a towel with the hand of the involved arm resting on a surface inclined 45 degrees.  Relax the shoulder and neck muscles.  Actively, slide the hand up the incline.   At the top, hold the position for 2 to 3 seconds.  Typically, 10 to 15 repetitions are performed for 2 to 3 sets.

Wall Slides

This exercise is a progression of the incline table slide.  The goal is to transition towards raising the arm overhead against gravity without assistance.  Begin standing, holding a towel with the elbow bent.  Relax the shoulder and neck muscles.  Actively, slide the hand up the wall.  At the top, hold the position for 2 to 3 seconds.  Lower the arm under control by slowly sliding back down the wall.  Initially, the uninvolved hand can be used to assist the movement.  As pain decreases and strength improves, perform the exercise unassisted.

Active Press-Up in Supine

Lie on your back with the knees bent.  The involved arm begins at the side with the elbow bent.  Actively lift the arm straight up to the ceiling.  When the elbow reaches full extension, pause and hold the position for 2 to 3 seconds.  Typically, 10 to 15 repetitions are performed for 2 to 3 sets.  This exercise can be safely progressed by performing it in a slightly reclined position and eventually in standing.

Wand-Assisted Flexion in Supine

Begin on the back holding a cane, wand, or similar straight object in each hand.  The hands are spaced slightly wider than shoulder-width.  The cane or wand is grasped between the thumb and index finger assuming a thumb-up position.  The thumb-up position will maximize movement at the shoulder joint.  With both elbows straight, lift the arms overhead until a mild to moderate stretch is felt.  Hold this position for 5 to 10 seconds.  Then slowly lower back to the start position.  Typically 10 to 20 repetitions are performed.

Resistance Band Elevation in Supine

Performing exercises lying on the back minimizes the effect of gravity.  This makes it ideal to begin exercising with light resistance while protecting the healing rotator cuff repair.  To perform band elevation in supine, begin on the back holding a resistance band in the hand of the uninvolved side at waist level. The involved side shoulder starts flexed 90° with the elbow straight holding the band in a thumb-up position. Minimal tension is placed on the band in this starting position.  Actively lift the arm into forward elevation to approximately 160°, thereby lengthening the band.   Pause 2 to 3 seconds at the top, then lower slowly back to the starting position.  Typically, 10 to 15 repetitions are performed for 2 to 3 sets.

Closing Thoughts on Rotator Cuff Surgery

From the 6 to 12-week point after rotator cuff surgery, most patients feel much less pain.  This can provide a false sense of security.  The repaired tendon is still at only approximately 25% to 50% normal strength during this time period.   Exercise must still be applied cautiously during this phase of rehabilitation.  Your physical therapist and surgeon will communicate with each other to determine the optimal rate of progression for you.  Those patients who remain patient and consistent with their exercises usually achieve the best long-term outcomes.

 


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