This is part two of our blog series on physical rehabilitation after shoulder surgery. Read part 1 before proceeding.
Stiffness & Motion
After surgery the shoulder may be a bit stiff at the onset of care, but this will usually pass and the temptation to aggressively restore lost mobility is not in one’s best interest. This is especially true with the motions of elevation and its important precursor, external (backward) rotation. Passive and active assistive motion patterns are thus the focus of the early rehab process, and the physical therapist will classically guide the patient through the proper progression to ensure minimal encroachment against healing tissue and raw bone.
Bony pain inside the joint, secondary to the common “decompression” of the bony roof of the shoulder (to make more room for the rotator cuff) can be present for many months following the procedure. This will eventually resolve, but may be exacerbated with seemingly innocuous events such as sleeping on the shoulder many months following surgery.
From a strengthening standpoint, the restoration of scapular functional strength, with scapula positioned on a correctly postured torso is an early focus. Proper posturing of the trunk plays a crucial role in minimizing mechanical overuse to the ball and socket joint, as well as the rotator cuff. Most everyone is deficient in this regard and it is an important issue of which to be educated, particularly those returning to a seated work setting following their procedure.
Rotator Cuff Muscles
The four rotator cuff muscles function to maintain compression within the ball and socket and can be likened to lug nuts on the wheel of a car. They maintain the ball and socket in a congruent position and create the rolling as opposed to shearing of the ball on the socket. These are muscles of endurance and they support the muscles that produce power with daily activities such as the pectorals and deltoid.
Thus, when appropriate in the protocol progression, they need to be strengthened in a fashion that will emphasize endurance. One need’s to appreciate that low load (weight) and higher repetition exercise is most appropriate. As rotator cuff strength is restored, the transition to more aggressive exercise with the “power’ muscles of the shoulder girdle takes place.
An Ongoing Process
Functional strength and mobility gains are ongoing and it is important for the patient to be diligent with their home exercise long after formal physical therapy care has been discontinued. Improvement will often continue for a year or more via diligent effort with regard to one’s home exercise.
In summary, follow the guidance of the doctor and their team, the physical therapist, follow the protocol and minimize irritation due to overuse to ensure maximal outcome.
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