Rotator Cuff Strengthening Protocol
Rotator cuff strengthening protocol is a hugely important subject.
In the section headed rotator cuff protocol I talked in general about the need for a protocol for rotator cuff repairs and rotator cuff strengthening protocol.
In this section I want to be more specific about what you can expect after undergoing a rotator cuff surgical repair. What I want to share here is a fairly typical strengthening protocol.
This would be applied particularly to those undergoing a small rotator cuff surgical repair. This is a fairly generic example in that it can cover most people having this repair procedure. I would hope and anticipate that a more bespoke or targeted program would be produced if you had any complicating factors.
You will see that it includes all of the elements that I outlined in the rotator cuff protocol section. There is a definite timeline with built in goals. It includes advice on pain relief and ice treatment for swelling.
There is a detailed program of rotator cuff stretching exercises and a structured build up of both range of motion and load bearing exercises.
Please remember this is not a one size fits all rotator cuff strengthening protocol. I reproduce it here purely to give an indication of what you can expect from your own rotator cuff protocol. There will undoubtedly be differences so don't worry unduly about that.
Also do not worry too greatly about the terminology, some of it is medical speak or jargon. I have left it pretty much as is just to give an accurate picture of what to expect.
Everything should be gone through with you in detail, all of the terms explained and all of the rotator cuff stretching and exercises demonstrated.
Rotator cuff strengthening protocol
Day 1 post-operation to week 1
- Stay in Sling except for exercises
- Change dressings.
- Keep portal sites or incision clean and dry.
- Posterior shoulder rolls or scapular squeezes
- Cervical active range of motion
- Elbow active range of motion
- Hand squeezes
- Table slides into flexion, external rotation, and abduction (in scapular plane)
- Pendulum exercises
- Supine opposite arm assist flexion
- Supine Wand for ER at 45 degrees abduction
- Grade I-II Joint mobs to glenohumeral joint with emphasis on posterior and inferior directions.
- Passive range of motion into all ranges of patient tolerance - be particularly careful on internal rotation.
- Scapular manual resistive exercises (MRE)
- In side lying (contralateral side), resist scapular protraction and retraction with depression
- Ice every 2 hours for the first 3 days and then 3-4 times per day thereafter
- No putting weight through shoulder
- No active use of shoulder
- No reaching behind back
- Reduce pain and inflammation
- Remove sutures at 7-10 days post-op.
- Patient allowed to get area wet
- Protect the repair while gaining range of motion
- Maintain ROM and strength of distal and proximal joints
- Stay in sling when up and moving around. Patient can take it off when just sitting and when doing exercises
- Continue exercises as above
- Gentle submaximal isometrics at one week for flexion, external rotation, internal rotation, and extension with bent elbow
- Passive range of motion in all directions to patient tolerance.
- Patient brought up to 90 degrees abduction for exernal rotation
- Gentle submaximal isometrics at one week
- Gentle Rhythmic stabilization in balance point (100 degrees flexion, 10 degrees horizontal abduction) and neutral rotation with arm by side at 2 weeks
- Continue scapular MRE's
- Continue above precautions
- Do not overstress healing tissue
- Full passive ROM by end of week 4
- Start to regain dynamic stability
- Continue those above
- Side lying external rotation
- Blackburns 1 (Prone horizontal abduction in neutral) and 5 (Prone extension with external rotation)Supine active assist wand flexion
- Flexion wall crawl with opposite arm assist
- Standing wand extension
- Theraband internal rotation, external rotation, extension
- Continue same as above
- Full passive range of motion by 3-4 weeks post op
- MRE for IR/ER and extension
- Discharge Sling at physician's discretion
- Continue with those as above
- Standing wand flexion (start with bent elbow) progressing to active range of motion. Full Active range of motion by week 6
- Flexion wall crawl without help from other arm
- Horizontal adduction stretch at week 6
- Towel internal rotation stretch at week 6
- Continue with those above
- Progress with band color, reps and sets
- Theraband IR/ER at 90 degrees abduction at 8 weeks
- Full can at 8 weeks
- Blackburn 3 (Prone horizontal abduction with external rotation)
- Add weight to side lying external rotation and blackburn 5
- Continue as above
- Rhythmic stabilization performed in multiple body positions and ranges of motion
Weeks 12 to 18
- Progress with all above exercises
Hope you find this useful. If it removes some of the doubts or concerns you have pre op then it is worthwhile. I think it highlights how important having a rotator cuff strengthening protocol is.
It should help you realise how much work there will be for you after your rotator cuff surgical repair. Finally, note the emphasis, rightly given, to rotator cuff stretching and exercise.
I know how tough this is, like you I have been there. It will seem like an eternity but it isn't.
The first few weeks are by far the worst get through that and the problem becomes dedication and motivation.
This is not easy rehab but to be strong and pain free it has to be worth it.