Reverse Shoulder Replacement Recovery: Strengthening Exercises

The reverse shoulder replacement has a specific design that takes advantage of your large deltoid muscle.  So even if your rotator cuff is damaged, overhead movement is preserved. Strengthening exercises in physical therapy targets your deltoid muscle and the muscles attaching to your shoulder blade.  This articles shows you 5 of the most common strengthening exercises we prescribe to help with your reverse shoulder replacement recovery.

Shoulder Replacement Recovery: Returning to Sport

Many people pursue shoulder replacement surgery with expectations of returning to their favorite activities or sports.  A 2020 systematic review investigated the rate of return to sport in patients recovering from shoulder replacement surgery.  This paper included 12 different studies looking at patients after shoulder replacement surgery.   Overall, 82% of patients returned to playing their favorite sport.  Swimming showed the highest rate of return (84%), followed by fitness (77%), golf (77%), and tennis (69%).  Strengthening your shoulder is key to returning to these types of activities.

Reverse Shoulder Replacement Recovery: The Basics of Strength Training

For the best reverse shoulder replacement recovery you will need to be diligent with your strengthening exercises.  Light strengthening exercises begin 6 to 8 weeks after your surgery.  Again, the focus is on improving the strength of your deltoid muscle and the muscles that attach to your shoulder blade.  Strengthening exercise are performed once daily 3 to 5 times per week.  Initially, start with 15 repetitions per set.  Also, we recommend 2 to 3 sets of each exercise.  As you progress, increase the resistance as you lower the reps to 10 per set.

Band Forward Elevation in Supine

Lying on your back to exercise minimizes the effect of gravity.  This makes it ideal to begin exercising with light resistance while protecting your healing shoulder. To perform this exercise begin on your back holding a resistance band in your uninvolved side hand at waist level. Your involved side shoulder starts flexed 90° with your elbow straight holding the band in a thumb-up position. Place minimal tension on the band in this starting position.  Then, actively lift your arm into forward elevation to approximately 160°.  This will lengthen the band.  Pause 2 to 3 seconds at the top.  Finally, lower slowly back to the starting position.  Perform 10 to 15 repetitions for 2 to 3 sets each day.

Press-Up in Standing

Initially, perform this exercise without any weight.  As your strength improves, add 1 to 2 pounds.  Start in a standing position with your hand close to your body and elbow bent.  Perform an overhead pressing movement.  Straighten your elbow as your arm passes overhead.  Hold for 2 to 3 seconds before slowly lowering your arm back down to the starting position.  Perform 2 to 3 sets of 10 to 15 repetitions each day.   It is important to avoid “shrugging” your shoulder or arching your low back.

Prone Row

Begin lying on your stomach holding a dumbbell.  Start with your arm in an extended position.  Perform a row.  Your elbow stays close but not all the way against the side of your body.  Hold the top position for 1-2 seconds before slowly lowering the weight.  It is important to pull your shoulder blade back as you raise your elbow.  Avoid overextending and shrugging your shoulder.  Perform 2 to 3 sets of 10 to 15 repetitions each day.

Prone Horizontal Abduction

Lie face down with your arm over the side of a bed or bench.  With your thumb up and arm straight lift toward the ceiling at a 90-degree angle (the 9:00 and 3:00 positions of a clock).  This position is aligned with the muscle fibers of your middle trapezius.  Be careful to avoid shrugging your entire shoulder as you raise your arm.  Instead, think about tilting your shoulder blade backward as you raise your arm.  Pause at the top of the movement before returning to the start position in a controlled manner.  Perform 2 to 3 sets of 10 repetitions each day.

Serratus Wall Slide with Foam Roll

Begin with your forearms resting on a foam roll against the wall placed at shoulder height.  Protract the shoulder blades by pushing your upper back away from the wall.  This activates your serratus anterior muscle.  Next, “roll” your forearms up the wall in a controlled manner, making sure you don’t lose the protraction.  Return back to the starting point in a controlled manner.  Perform 2 to 3 sets of 10 repetitions each day.

Final Thoughts on Your Shoulder Replacement Recovery

Performing a gradual and progressive strength training program will optimize your reverse shoulder replacement recovery.   Everyone progresses at a different rate.  Your physical therapist will be your guide as you work towards your goals.  Most people return to their favorite sports or activities within 3 to 6 months.  This of course, assumes you have restored 85% to 90% of your shoulder strength.  If you would like help developing the best individually-tailored exercise program give us a call.

Reverse Shoulder Replacement and Early Rehabilitation

Reverse shoulder replacement is becoming an increasingly common surgery.  If you are plagued by painful shoulder arthritis along with rotator cuff disease this surgery is an option for you.  Also, some types of arm or shoulder fractures are best treated with a shoulder replacement.   After surgery, your outcome becomes largely dependent on your rehabilitation.  This article focuses on what is most important during the first month of your recovery.

Early Motion is Beneficial after Reverse Shoulder Replacement

There are two possible early complications following reverse shoulder replacement.  First, it is important to protect the shoulder from dislocating during the first month of your recovery.  Your shoulder is most at risk for dislocating when you attempt to reach behind your body.  You should avoid movements that involve reaching behind your back to dress or reaching into the backseat of your car.

Rehabilitation

The second common complication is a stiff shoulder.  Not moving your arm at all will result in shoulder stiffness.  This leads to a poor long-term outcome.  A recent study from the University of California showed excellent results when patients began range of motion exercise 1 week after surgery.  Both early exercisers and those who delayed exercise 6 weeks achieved excellent outcomes with very low complication rates.  This study suggests both immediate and delayed rehabilitation are safe and effective.

Exercises after Reverse Shoulder Replacement

This article describes 5 exercises we prescribe early after shoulder replacement.  We emphasize overhead range of motion.  For the first 6 weeks we refrain from performing exercises that involve reaching behind your back.  Some pain is acceptable during exercise.  However, pain should be minimal and dissipate soon after completing your exercises.  Most surgeons advise using a sling for the first few weeks.  You want to slowly wean yourself from using the sling to minimize your change of developing stiffness.

Table Slides

 Stand holding a towel with your hand resting on a table top or counter.  Relax your shoulder and neck muscles.  Slowly lean forwards and slightly out to the side (a 45 degree angle) while sliding your hand on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.

Waiter’s Bow

Begin standing with your hands resting on a table top or counter.  Relax the shoulder and neck muscles.  Slowly step backwards while keeping your hands on the table or counter.   When a mild stretch is felt, pause and hold the position for 5 to 10 seconds.  Perform 10 repetitions.  Avoid holding your breath, bouncing, or exercising through pain.

Washcloth Press Up

Lie on your back with your knees bent.  Hold a small towel with your hands close together.  Your other arm assists lifting your involved arm straight up to the ceiling.  Straighten your elbow fully.  Then pause and hold the position for 5 to 10 seconds.  Avoid exercising through pain.   Progress this exercise by performing it in a slightly reclined position.

Self-Assisted Shoulder Flexion

Begin lying on your back with your hips and knees bent.  With your other hand grasp the wrist of your involved side.  Next, passively lift your involved arm overhead.  Maintain a straight elbow.  Pause and hold the position for 5 to 10 seconds.  As your pain decreases, progress the exercise by increasing the duration of the stretch up to 30 seconds.

Wand-Assisted Shoulder Flexion

Begin on your back holding a cane or wand in each hand.  Space your hands slightly wider than shoulder-width.  The cane or wand is grasped between your thumb and index finger with a thumb-up position.  The thumb-up position will maximize movement at your shoulder joint.  With both elbows straight, lift your 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.  Perform 10 to 20 repetitions.

Final Thoughts on Rehabilitation after Reverse Shoulder Replacement

We have described 5 safe and effective exercises to begin soon after your reverse shoulder replacement surgery.  Start with the 2 or 3 exercises that are most comfortable for you.  Perform these exercises 2 to 3 times per day.  After a few weeks you want to be performing all 5 exercises several times per day.  After 6 to 8 weeks you will be ready to begin some gentle strengthening exercises.  Next week’s article will go into more detail about this phase of your rehabilitation.  Give us a call if you have questions or would like some help getting started.

Knee Replacement: Improve Your Balance and Walking

Knee replacement surgery is a proven way to decrease pain from knee arthritis.  This surgery also results in substantial improvements in your walking and overall mobility.  However, surgery alone cannot restore your muscle strength or balance.  For this reason many people who undergo knee replacement are plagued by poor balance and falls.  This article highlights several exercises you can perform to decrease your risk of falling after your knee replacement.

A 2019 review of more than 1 million patients undergoing knee replacement showed the following factors increase the risk of falling:

  1. Females
  2. Living alone
  3. Previous history of falls
  4. Previous history of joint replacement surgery
  5. Use of pain or psychiatric medications

Proven Exercises to Improve Your Balance after Knee Replacement

A 2018 review article in Sports Medicine looked at more than 700 people undergoing knee replacement surgery.  Greater improvements in walking and balance were observed following physical therapy programs placing a greater emphasis on balance training when compared to conventional methods of rehabilitation.  Balance training also improved function and knee range of motion to a greater extent than conventional methods of rehabilitation.

Balance training

Research from the University of Pittsburgh has identified specific exercises that improve your balance and walking after knee replacement surgery.  Five of these exercises are described in this article. They can be easily performed in your own home or under the guidance of your physical therapist. For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.  These exercises will only take you about 20 minutes to perform. For safety, perform each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Side Step Walking

Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.  Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.

Shuttle Walking

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.  Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.  Stand at the first cone and walk to the second cone.  Stop at the second cone and then walk backwards to the first cone.  Next, walk to the third cone.  Stop.  Walk backwards to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backwards to the first cone.  Complete this cycle 5 times.

Carioca Walking

Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Toe and Heel Walking

Stand on your tip toes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.   If this is not difficult for you, try walking backwards on your toes and backwards on your heels.

Tandem Walking

You may notice that your feet have become spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.  Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  It is okay to use one hand or finger on a counter for light support when first starting out.

Closing Thoughts on Improving Your Balance after Knee Replacement

The right rehabilitation is crucial to your outcome after knee replacement surgery.  Range of motion and strength require dedicated exercise to make improvements.  Balance training is often left out of physical therapy programs after knee replacement.  However, research shows high-intensity exercise combined with balance training is best.  The 5 exercises included in this article can get you started.  If you would like more help, give us a call.