Surgery forms one part of the treatment of your shoulder problem. Physiotherapy is as important as the surgery in your treatment and making the most of the surgery that you have undergone.
This is a guide to movements and exercises that you can do following your surgery, it is not a substitute for formal physiotherapy. Your physiotherapist will give you treatment specific to you, your condition and the operation you have received.
Pain relief
Pain is bad! Many people think that you have to ‘push through pain’ in order to get the best result. This is not the case in the shoulder and will often make things worse. Ensuring that you are taking enough pain relief, particularly in the early stages following surgery or just before a session of physiotherapy can be very helpful in your recovery. It will also aid your sleep which I consider essential for recovery.
Slings
Slings are there to support and protect you as well as warning other people that you have had an operation or injury. You will be given a timescale for how long you need to wear it by myself or the physiotherapist. Sometimes a strap will be fitted around your waist, this is to restrict certain movements and protect repaired structures.
Slings are generally worn for the majority of the time, including sleeping, but can be removed for periods during the day for eating, dressing, washing, physiotherapy and comfort.
You will be taught how to safely put on and remove your sling by the physio team on the day of your surgery, however a video is shown below on how to do this.
For some operations, a sling is only for comfort and can be taken off when you are comfortable.
Durations of slings are shown below for more common procedures.
- Subacromial decompression or AC joint excision: 2 weeks, but you can mobilise as pain allows.
- Rotator cuff repair: 4 weeks. May be longer in larger repairs, a body strap may be applied for some tears.
- Labral repair or stabilisation surgery (Soft tissue socket repair): 4 weeks, usually with a body strap around the waist in addition.
Weight restrictions
Generally for the first few weeks after surgery, a weight limit will be in place. If you have had a rotator cuff or labral (Soft tissue socket) repair, this is typically the weight of a cup of tea or similar. If no repairs have been performed, there are no restrictions, however I would advise a gradual build-up of weighted activity over the first 4-6 weeks with a maximum of 5 kilograms during this period.
Movement restrictions
This will depend on the operation that you have had.
As stated above, if nothing has been repaired, for example a subacromial decompression and AC joint excision then you can move as pain allows. This would also apply for a release of the joint capsule for a frozen shoulder.
If you have had a repair of the rotator cuff or labrum (Soft tissue socket), then there will be limitations on your range of movement to protect the repair.
Box of safety
If you are sat at a table with your elbows in at your sides and your forearms and hands in front of you (As if you were typing on a keyboard), this will create a ‘box of safety’, with your arms and tummy being the sides. Any movement inside the box is safe and anything outside is not unless you have been told otherwise by your physiotherapist or myself. These restrictions will be lifted gradually over a period of weeks to increase movement whilst protecting the repair and allowing the repaired structures to heal. Typically restrictions remain in situ for 12 weeks in repair surgery.
Elbow, wrist and hand movements
If it is just your shoulder that has been operated on, it is important to maintain the use of your elbow, wrist and hand below. The following video demonstrates the safe removal of the sling and basic exercises of the hand, wrist and elbow. This should be done 2 or 3 times per day.
Basic shoulder exercises
The following video shows basic shoulder exercises that can be done in the early stages following surgery. These can typically be started in the first few weeks after surgery.
Return to driving
You should not drive if you cannot fully control your vehicle on account of pain or restriction from your shoulder surgery and/or rehabilitation. Typically this is at least 4 weeks after repair surgery, sooner if no repairs have been performed.
Return to work
This of course will depend upon the nature of your job. This is only a guide to safely returning to work. You should consider discussing your return to work with your occupational health department or employer. A fit note or supporting information can be supplied on request. (More detailed reports may incur further charges)
Desk based work can be returned to as soon as you feel fit to do it. The ‘Box of safety’ still applies and it important to ensure you are comfortable during this. You may need to take more frequent short breaks and have reduced hours initially. Weight and movement restrictions as detailed above still apply.
For manual jobs or those requiring heavy lifting, you will be advised not to return to full duties for 12 weeks. You should discuss amended duties, hours or workplace modifications with your employer or occupational health department.
Return to sport/activities
Again this will depend on what you like to do. If no repairs have been performed, you can return to you sports and hobbies as pain allows, however I would always recommend a gradual return to activity over a period of a few weeks.
Cardiovascular activity such as using a spin bike can be done very soon after surgery but the restrictions with the sling and movement remain. Bearing weight through the arms to the handlebars should be avoided in the early stages following surgery, particularly if repairs have been performed.
Racquet sports or golf should be avoided for around 12 weeks if structures have been repaired.
Contact sports and those involving heavy weight are not to recommended to start until at least 12 weeks if structures have been repaired. Normally this would start with gentle training and then building up from there at 12 weeks. In reality return to playing may be between 4-6 months depending on progression with physiotherapy and range of movement.