For the first 2 to 8 weeks after surgery, you will limit movement, wear a sling, and do passive stretching with PT. These exercises are designed to get your shoulder and rotator cuff muscles contracting enough to move your arm and shoulder through its full range motion. d. Crunches. Days 1-6. To protect your repaired tendons, you must continue to use the sling most of the time, even during sleep. Sleeping with the sling, in a recliner, and with a pillow under the arm. Active elbow/wrist/hand range of motion exercises. These exercises will help increase muscle strength and flexibility. . Lie down on a mat, support your head on a foam roller or rolled towel. Weeks 12 and beyond Start a more aggressive rotator cuff program as tolerated. After surgery, your physical therapist will work with you to help build strength as well as improve range of motion. c. Step up exercise. Range of motion (ROM) and visual analog scale (VAS) for pain were measured preoperatively and 3, 6, and 12 months postoperatively. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. The Rotator Cuff Surgery Recovery Timeline varies significantly and can take 6 months or more. Phase 2. Examples: a. Bridging exercise (arms folded across chest). Self-ranging motion using pulleys, especially in the scapular plane, was also consistently associated with greater recruitment of the shoulder muscles. Clasp hands together and lift arms above head. You will also begin range of motion exercises. Your physical therapy focuses on diminishing pain and inflammation. We then talked about nutrition, rest, icing, PT, and my focus on recovery. . The purpose of this study was to investigate the effect of the early initiation of passive and active range of motion exercises following arthroscopic . Detachment of the repaired cuff was identified in 12% of group 1 and 18% of group 2 (P =.429).Conclusion: Early passive motion exercise after arthroscopic cuff repair did not guarantee early gain of ROM or pain relief but also did not negatively affect cuff healing. Detachment of the repaired cuff was identified in 12% of group 1 and 18% of group 2 (P =.429).Conclusion: Early passive motion exercise after arthroscopic cuff repair did not guarantee early gain of ROM or pain relief but also did not negatively affect cuff healing. Rotator Cuff After Surgery | Physical Therapy | Rehab . In rotator cuff repair surgery one or more of these muscles are reattached to the bone Shoulder flexion and rotation are still the most commonly used exercises. Keep your hand pronated. Again, hold the position for 20 seconds and repeat 3 times. Rotator Cuff Repair WEEK EXERCISE GOAL 1-4 ROM Gradual Passive ROM in Scaption < 60 Pendulum exercises Elbow (flex/ext) range of motion Initiate rope/pulley week 5-6 post-op Initiate passive ER wand exercise week 3-4 not to exceed 30 of ER at 45 abduction Shoulder Passive Range of Motion Exercises These exercises are used to slowly regain your mobility, but not hurt any healing structures inside your shoulder. These exercises can be performed while protecting the surgically repaired site.5 Passive Range of Motion is indicated postoperatively for 2 to 6 weeks During the healing phase following surgery only passive range of motion Shoulder Surgery Exercise Guide - OrthoInfo - AAOS Wand ROM- flexion in supine 3. range of motion after rotator Phase 1 - Immediate Post Surgical Phase. Keep your back parallel to the floor when doing arm rows. Place one forearm against a fixed point (such as a doorway), with your elbow and shoulder at 90 degrees. Recent systematic reviews on the effect of rehabilitation after rotator cuff surgery confirms that early range of motion (ROM) exercises accelerate healing, reduce stiffness, do not increase the risk of re-tear and that immobilization does not increase tendon healing or the clinical outcome [ 21, 22, 23, 24 ]. By: Ken Chisholm . Criteria for Progression to Phase 3 Sucient passive and active range of motion without pain and compensation No shoulder hiking, scapular winging or trunk side flexion/extension Ability to perform 2 sets of 10 of flexion to at least AROM 90-110°, PROM 120-140° Effect of Two Rehabilitation Protocols on Range of Motion and Healing Rates After Arthroscopic Rotator Cuff Repair: Aggressive Versus Limited Early Passive Exercises. of manual passive range-of-motion exercises after repair of the rotator cuff.Thirty-one patients (thirty-two rotator cuffs) were randomly assigned to one of two types of postoperative management: continuous passive motion (seventeen patients) or manual passive range-of-motion exercises (fifteen patients). Active range of motion 3. Passive Motion (6-10 Weeks after Surgery) Passive range of motion is to begin 6 weeks after surgery. Electromyographic analysis of the rotator cuff . A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. d. Crunches. Stationary bike. Examples: a. Bridging exercise (arms folded across chest). During the next four to six weeks, while you continue a routine of passive ROM exercises, you will also limit the use of your shoulder and keep your arm in a sling most of the time to promote proper healing. These exercises can be performed while protecting the surgically repaired site.5 Passive Range of Motion is indicated postoperatively for 2 to 6 weeks During the healing phase following surgery only passive range of motion Shoulder Surgery Exercise Guide - OrthoInfo - AAOS Wand ROM- flexion in supine 3. range of motion after rotator Phase 1 - Immediate Post Surgical Phase. Arm position during passive exercise can also apply tension that is significant enough to result in a failure of the repair.14,31 A "Tension Free Zone" has been determined for passive range of motion exercises following rotator cuff repair.14,31 This zone consists of scapular elevation/abduction performed above 30° and external These exercises can be done daily. If you feel pain or weakness when trying to push back, that is a sign of rotator cuff injury. There are three main phases after a rotator cuff repair: 1. This surgery usually requires four stages of physical therapy as you recover. Passive range of motion exercises are better than pendulum exercises because they involve another person as the initiator of the motions, who can then gently add more range to the motions in a gentle and gradual fashion with better outcomes than the . Passive Motion (6-10 Weeks after Surgery) Passive range of motion is to begin 6 weeks after surgery. Published: 14 August, 2017 . Early results of continuous passive motion after rotator cuff repair: a prospective, randomized, blinded, controlled study. In the first two to eight weeks after surgery, you'll limit movement, wear a sling, and work with a PT on passive stretching. • Abduction brace/sling, remove sling only to bathe and to complete exercises. The only exceptions are while bathing or doing exercises recommended by your doctor or physical therapist. This program includes specially designed exercises to increase your shoulder strength, flexibility, and range of motion as it heals. approximately 2-3 weeks after surgery assuming that passive range of motion is progressing. Finally, you'll work on initial strengthening and eventually weight-bearing strengthening until you get back to normal levels of movement. They are perfect for the first 6 weeks after a shoulder injury or surgery. Phase 1: Recovery (Weeks 0-3) PRECAUTIONS Avoid weight bearing on operative upper extremity No shoulder active range of motion (AROM) Avoid pain during ROM exercises No shoulder external rotation (ER) past 0˚-30˚ depending on surgeon preference Avoid lying on operative side 2. These are my standard exercises after rotator cuff repair for the first 6 weeks. The goal for this stage of exercises is to recover to full range of . This begins 11 weeks after surgery and is done daily. He was shocked that 9 weeks after a rotator cuff and SLAP repair we were having this conversation. Examples: a. Bridging exercise (arms folded across chest). In the second stage, you'll work on active stretching. This exercise can be done either lying down (A) or sitting down (B). "Famous" Physical Therapists Bob Schrupp and Brad Heineck present: Pendulum Exercise & Passive Range of Motion- Shoulder (After Surgery/Injury)***Update*** T. b. Ankle band walks. Functional strengthening. . These exercises will help increase muscle strength and flexibility. Fifty-six patients were randomly allocated into group 1: early passive motion exercises were conducted 3 to 4 times per day during the abduction brace-wearing period. Repeat 5 times per day. Rotator cuff repair requires a rehabilitation process of 9 months up to 1 year for the repaired tendon to be completely integrated into the body. 45 DEGREE ACTIVE ASSISTED RANGE OF MOTION While propped on a pillow at 45 degrees and using a stick or cane, the normal arm will move the affected arm over the head. Phase 1:Passive motion: 1-6 weeks depending upon the size of tear and strength of the repair. Exercises (3 times each day): 1) pendulum exercises, 2) squeeze ball, 3) triceps muscles and biceps training with Theraband, 4) pulley passive flexion and scaption (scapular airplane) 0-60º, 5) isometric shoulder abduction, adduction, extension, and flexion with arm at side, 6) scapular pinches every hour, and 7) neck stretches for convenience Shoulder Adduction. Concentrate on keeping your shoulders back and down while wearing the sling. • A 6-week period of immobilization with a sling, and delayed start of PROM is recommended for large-sized tears. . Higher muscle activity was noted during patient self-assisted range of motion exercises as compared to mechanical CPM. Contrast bath therapy, also known as "hot/cold immersion therapy", is a form of treat The exercises should place no stress on the involved rotator cuff (Immobilizer on) 2. Finally, at just over 8 weeks from surgery, my range of motion was 98%! 3. Acta Orthop Traumatol Turc. 43 To this end, . A postoperative MRI scan was performed at a mean of 7.6 months . Several authors recommended early passive range of motion after rotator cuff repair to decrease the possibility of developing potential adhesion and stiffness [50,51,52]. Sometimes, patients use sticks or pulleys to assist the injured arm. Protection and active motion. Passive Motion (6-10 Weeks after Surgery) Passive range of motion is to begin 6 weeks after surgery. Pendulum exercises. 2 Level of evidence: 3. Remove the immobilization only for grooming and exercise. Phase 1 lasts for the first 10 days after your surgery. Phase One: Passive Motion After rotator cuff surgery, you will need to keep your arm immobilized in a sling for about six weeks. b. Ankle band walks. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . Slowly squeeze the pillow and try to lessen the gap between your elbow and the side of your chest. Early passive motion exercise after arthroscopic cuff repair . Place a small cushion in between the side of your chest and arm (a little bit below the armpit). The exercises should place no stress on the involved rotator cuff (Immobilizer on) 2. • A 6-week period of immobilization with a sling, and delayed start of PROM is recommended for large-sized tears. Continue for 30 seconds. Passive range of motion only- This is for the first 8 weeks after surgery. After your passive range is better, we'll begin active-assisted range of motion exercises where your uninvolved arm will help your involved arm move. Don't overthink if you initially find moving your arm a bit hard; your shoulder has been in a sling and as of late as undergone the trauma of surgery. 2. The main goals are to restore pain-free shoulder movement, stability, and strength. c. Step up exercise. Here are 5 rehabilitation exercises to help you fully recover! The first two weeks after a rotator cuff repair are all about trying to find a comfortable position for the shoulder in the sling during sleep and wakeful times. After-Surgery Torn Rotator Cuff Exercises. vi. Most people undergoing the surgery will follow-up with their surgeons for the first several months and go to . You should feel a gentle stretch in the front of the shoulder but not pain. Slowly release the pressure to relax your arms then do 10 more rounds. Shoulder Shrug and Roll; 2. Again, these should start on your back. Therefore, the early initiation of the pendulum exercises after a rotator cuff repair must be performed in the appropriate passive manner. Place a towel below your elbow for support. Full shoulder passive range of motion in all planes- flexion, abduction, external rotation and internal rotation Active range of motion full by week 12. c. Step up exercise. Effect of Two Rehabilitation Protocols on Range of Motion and Healing Rates After Arthroscopic Rotator Cuff Repair: Aggressive Versus Limited Early Passive Exercises . You'll gradually increase your passive range of motion to prevent muscular inhibition. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 28(1), . Stationary bike. In the second stage, you will perform active stretches. •No aggressive, painful passive range of motion or stretching that promotes muscle over-activity or spasm. Generally speaking, patients who undergo rotator cuff repair surgery will be limited to passive range of motion only, and forbidden to perform active motion such as lifting or reaching for the first 6 wks. After surgery, there is a tendency to hunch the shoulder blades up and forwards. (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). Passive range of motion exercises include flexion and extension of the shoulder, abduction, and external rotation. For the first 2 to 8 weeks after surgery, you will limit movement, wear a sling, and do passive stretching with PT. Shoulder Adduction. Purpose. Office visit two to three days post-op A 2010 study recognized that there are many different rehabilitation practices used after rotator cuff surgery. You will also begin range of motion exercises. approximately 2-3 weeks after surgery assuming that passive range of motion is progressing. Back of the shoulder stretch The only exception to this rule is an exercise called the "forward bow", which has been shown to have <10% activity of the rotator cuff. Start progressive resistance exercises with weights as tolerated. Once you start achieving full or near full passive ROM in your shoulder, your physical therapist may have you start active ROM exercises. Getting into bed The night after rotator cuff surgery is a difficult time. Rotator cuff repair requires a rehabilitation process of 9 months up to 1 year for the repaired tendon to be completely integrated into the body. The arm is moved in forward elevation, abduction, and external rotation. Aerobic conditioning: 1. 2. By six weeks after rotator cuff repair, the tendons are beginning to heal. I find that sling position is critical. With your doctor's approval, you move to active shoulder exercises . What to Expect From Your Doctor. I was given exercises to do after surgery. A shoulder immobilizer may be required for 4-6 weeks for maximal healing. Rotator Cuff After Surgery | Physical Therapy | Rehab . Passive . During this phase, your arm will be in a sling, and you will most likely need help to accomplish your everyday . Flex your elbow so that your upper arm is perpendicular to the forearm. Rotator cuff repair surgery involves repairing a torn or damaged tendon in the shoulder. Hold this position for 10 seconds. (all resisted rotator cuff exercises restricted until >12 weeks, see surgeon's instructions on page 2) . These exercises are designed to get your shoulder and rotator cuff muscles contracting enough to move your arm and shoulder through its full range motion. Active range of motion- This begins about 8 weeks after surgery. In conclusion, this study suggests that Thera-Band scapular retraction and shoulder pulley exercises can be added to early post-operative rehabilitation after more passive and active-assisted ROM exercises have been performed. Each day, increase the time until you can do 3 to 5 minutes. Phase 1 - Immediate Post Surgical Phase. Duzgun, I., et al. In the second stage, you will perform active stretches. They have enough strength to safely tolerate movements of the . Position you Some minor tears may be treated without surgery. This phase typically commences 4-8 weeks after surgery, . Abduction sling/brace. You will also begin range of motion exercises. Shoulder Adduction. START PASSIVE RANGE OF MOTION, OR ROM EXERCISES AT weeks FLEXION ROM: restrict to degrees until weeks . REFERENCE: Murphy CA, McDermott WJ, Petersen RK, Johnson SE, Baxter SA. 2. Stage 2. What's the Takeaway? Patients were instructed to wear an abduction brace for 4 to 5 weeks after surgery and to start active-assisted shoulder exercise after brace weaning. A Word From Verywell Excuse me. Exercises I like to use include: Passive ROM Golf club AAROM external rotation at 45 degrees Golf club AAROM external rotation at 90 degrees Golf club AAROM flexion Rope and pulleys—yes, I still use them and you should too! However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. Aerobic conditioning: 1. Several authors recommended early passive range of motion after rotator cuff repair to decrease the possibility of developing potential adhesion and stiffness [50,51,52]. Passive Range of Motion (ROM) Exercises: . Keep the circle small, less than 8 inches. In most cases, rotator cuff physical therapy begins with gentle passive exercises done while your therapist supports and moves your arm. You can also focus on one exercise at a time. Examples: a. Bridging exercise (arms folded across chest). Beginning about six weeks after surgery, new exercises will build your strength progressively and increase ROM even further. Range of motion exercises; Activity or sport-specific exercises Generally, physical therapy after rotator cuff surgery is divided into four phases: Maximal protection - This is when your shoulder is the greatest risk for re-injury. Most patients can do these on their own at home, which is critical in the first few weeks after surgery. Rotator cuff injuries often develop as a result of either a traumatic event or long-term overuse of the shoulder. And my strength was coming back! The goal of stage 1 is to protect the repair while maintaining as much range of motion as possible. Hold a 1-pound dumbbell with the hand of the affected shoulder. There were seventeen women and fourteen men, and the mean age was sixty-three years . Your goal for phase 1 is to protect your shoulder. You should only move the arm as far as it can go comfortably without pain. The Four Phases of Healing During Rehabilitation Following Rotator Cuff Surgery Phase 1: Immediate postoperative period (weeks 0-6) Goals Maintain/protect integrity of repair Gradually increase PROM Diminish pain and inflammation Prevent muscular inhibition Become independent with modified ADLs Precautions Lying Pendulum Exercises This exercise helps. vi. 2. Active range of motion exercise starts 6 weeks after the procedure. Figure 5: Safe and unsafe spaces for early passive range of motion. Passive range of motion 2. Cryotherapy. Strengthening- This begins 12 weeks after surgery. •Bracing generally for 6-8 weeks per physician approval •Protected PROM considered during the first 6-8 weeks •AROM initiated at 8 weeks within the range that shows good mechanics and no pain (weight of arm only). A rotator cuff tear can result from an injury such as a fall or heavy lifting, or from normal wear-and-tear and repetitive activities over many years. Passive external rotation (PER) with elbow 'near' the side of the body to 30 degrees. Recent systematic reviews on the effect of rehabilitation after rotator cuff surgery confirms that early range of motion (ROM) exercises accelerate healing, reduce stiffness, do not increase the risk of re-tear and that immobilization does not increase tendon healing or the clinical outcome [21-24]. Finally, you'll do initial reinforcements and final weight-bearing reinforcements until you've returned to your normal exercise level. There are four common phases. • Abduction brace/sling, remove sling only to bathe and to complete exercises. No overhead lifting. Shoulder Blade Pinch Weeks 3-6 Pendulum Hangs Progress scapula strengthening . Doing these with light weights before you . Phase 2: Active Motion: 6-12 weeks. But I think as we get older and we learn a little bit more, Kim AJSM 14 kind of said, "Immediate passive range of motion for small to medium tear had no failures. Keep your elbows as straight as possible. Slowly increase the elevation of your arms as the days progress, using pain as your guide. Pendulum exercises, passive range of motion by a physical therapist, and self-ranging motion with a dowel recruited the shoulder muscles to a lesser extent. Maintain the elevation for 10-20 seconds, then slowly lower your arms. Stage 2. 2014; 48 (6): 642-648. Repeat 3 times. May be adjusted base on location of the tear and intraoperatively determined 'safe zone' of ER. It is very difficult to completely relax while someone, or something else moves your shoulder. Try to imagine your shoulder is paralyzed. Active and manual scapula strengthening exercises: 1. Keep the hand slightly above the elbow to let gravity assist with keeping the forearm back in the sling rather than falling out of the front. Cervical spine stretches. c. Step up exercise. The main goals of rehabilitation are: 1. Gently turn your body away to stretch the front of the shoulder and chest. Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair. Rotator cuff repair requires a rehabilitation process of 9 months up to 1 year for the repaired tendon to be completely integrated into the body. No passive range of motion for six weeks with a large tear still had 33% failures." Mike Reinold: So I think what we're learning here is it's probably not physical therapy. 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Or physical therapist a pillow under the arm is perpendicular to the forearm pillow try. ; ll gradually increase your passive range of motion exercises following arthroscopic,.