ASES Foundation

Patient Exercise Programs

Tips to keep your shoulder in the best condition and out of the Surgeons office!

  • Maintain a healthy lifestyle by keeping a healthy weight, performing regular exercise, and avoiding an excess of unhealthy foods. Good & proper posture, especially of your head/neck and scapula helps to keep your shoulder healthy & pain free. Obesity can be related to arthritis of the shoulder and makes it more difficult to manage. Diabetes, which is related to obesity, can contribute to rotator cuff tears and a joint stiffness called frozen shoulder. High cholesterol, which is also related to obesity, can contribute to rotator cuff tears.
  • In the COVID-19 era and with more of us working from home or driving long commutes, our postural mechanics suffer. We tend as both athletes and working adults to develop a progressive imbalance with greater strength in our pectoral muscles (the front) than the shoulder blade stabilizers (the back).  When you add hours of work, Zoom calls, computer meetings, and daily life this puts our shoulders in a difficult position for optimal function.  By balancing our upper body strength and focusing on our shoulder blade stabilizer muscles (rhomboids, trapezius and serratus), we can minimize shoulder pain, enhance rotator cuff and shoulder function, and reduce neck strain and fatigue. A good general rule is stretch the anterior shoulder muscles (pectoralis major & minor) and strengthen the posterior shoulder muscles.
  • Be careful when lifting heavy objects or walking on uneven terrain. Many shoulder and elbow injuries are related to falls or to a sudden and uncontrolled shift in weight for a heavy object. These same traumas are some of the main causes of failure after shoulder surgery as well. Make sure you have help lifting heavy or uneven objects and that you are steady on your feet. Always lift with your legs from a stable base. Examine your home for trip hazards such as cords and loose rugs. If you live in a location with snow and ice, work to make sure your walkways are cleared, salted, and that you are using shoes with adequate tread.
  • Be sure to perform warm up exercises before starting any moderate or high intensity exercise at home or in the gym. Try to warm up your legs, back, and arms with body weight movements such as squats and arm circles. A proper warm up will help your muscles improve their ability to tolerate more intense exercise.
  • When weight-lifting at the gym consider a lower-weight and higher-repetition exercise regimen. Generally, exercises that involve lifting overhead, i.e. Olympic style-lifts, such as squat press, overhead press, and jerk-type exercises, are harder on your shoulders than below-shoulder lifts. Over time, the overhead lifts strain your shoulder cartilage and tendons without giving you substantial improvements in strength and function to make the additional shoulder stress worth the load. Make sure you have strengthened the small stabilizing muscles, such as the rotator cuff muscles and scapular stabilizers, before strengthening the larger muscles such as the deltoid, trapezius, and pectoralis.

Home Exercise Program:  To keep your shoulder healthy and allowing you to stay active:

Below is a list of the best exercises, that can be done 1-2 times per week, as an addition to any exercise routine, to keep you shoulder strong and pain-free. Each exercise should be done 10-15 times and 1 -2 sets should be completed. Stop any exercise that causes pain and focus only on those that do not cause pain during or afterwards. Some light muscle soreness lasting no more than 1 day is acceptable. These exercises generally require you to obtain a set of TheraBand’s (resistance bands), which are large rubber bands of varying resistances, or a set of light weights. If you do not have weights, soup cans or water bottles can work just as well.

  • External rotation – With your elbow bent and your arm at your side, rolled up towel under your arm & side of your body, rotate your arm outward against the resistance of a TheraBand. Slowly return to the start position and repeat. Keep your elbow at your side and your shoulders square. “Squeeze” your shoulder blades together while you rotate out. If you do not have a band, you can also perform this exercise by laying on your side as shown and rotating your arm up so the
Patient Exercise Programs
  • Internal rotation – With your elbow bent and your arm at your side, with a towel roll between your arm and your side, rotate your arm across your body against the resistance of a TheraBand. Slowly return to the start position and repeat. Keep your elbow at your side.
Patient Exercise Programs
  • Shoulder Blade Rows- Stand facing a door with the TheraBand attached to the doorknob. Start with your elbows bent and your upper arms at your side. Keep your upper arm close to your side and pull back until your hand is level with your body. Then slowly return to the start position. “Squeeze” your shoulder blades together when your arms are extended back and as you pull.
Patient Exercise Programs
  • Shoulder Extensions – Tie a knot in the end of your TheraBand then put it over the top of a door and close it. While keeping your elbows straight, pull the bands from chest height to the side seams of your pants. Slowly return to start position.
Patient Exercise Programs
  • Shoulder Blade Retraction – During these exercises, focus upon pulling the shoulder blades together. Start by squeezing the shoulder blades together to get used to the muscles that contract to bring your shoulder into this position. Recreate this sensation during the exercise. Lie on your stomach with your arm hanging towards the floor. Raise your arm to your side until it is parallel to the floor. You can also perform this exercise on an exercise ball to work your core. Repeat with the arms in a “W” position, and in a “T” position.
Patient Exercise Programs
  • Corner Stretch – Start with your hand on a door frame and slowly walk forward. You should feel a stretch across the front of your chest.
Patient Exercise Programs
  • Wall Slides – start with your back on the wall, trying to keep your low back flat. Keep your arms positions on the wall as best as you can. Slide your arms up and over your head as high as possible without causing pain. If you are not able to keep the entire arm on the wall, try starting with just your fists on the wall
Patient Exercise Programs

General Elbow Care:

Tips to keep your elbow in the best condition and out of the Surgeons office!

(this can apply to those who have had surgery and those who have not and want to avoid ever needing it!)

  • Incorporate strength training, range of motion/flexibility and cardio workouts into your workout routine. To keep yourself in the best shape possible and to maintain a healthy elbow, try to vary the types of workouts you do each day. Performing the same routine each day can lead to overuse injuries. Furthermore, if weightlifting is irritating your elbow, try to lift with your palms up rather than down to decrease stress on the outside of the elbow.
  • Be mindful of your daily activities (work, recreational, etc.). Some of us, especially now that many are working from home, spend a lot of time performing repetitive activities, especially those involving the computer, video games, etc. It is important to take breaks and stretch out your wrist, hand fingers and elbow throughout the day.
  • Proper ergonomics are crucial to avoid overuse injuries of the elbow. An adjustable desk that can convert from standing to sitting will help take stress off the elbow as you work throughout the day. Similarly, a foam wrist cushion can help place the hand and wrist into a less stressful position to mitigate the risk of sustaining an overuse injury such as epicondylitis (tennis elbow). If you frequently use a computer mouse, a mouse with a trackball can sometimes help protect your elbow.
  • For those athletes among us, be sure to maintain flexibility at the shoulder, neck, trunk, and hips and core to decrease stress on the elbow during athletic activities.
  • Weak hips and/or legs may contribute to elbow injuries in the overhead athlete because of altered biomechanics and compensations.

Home Exercise Program:  To keep your elbow healthy and allowing you to stay active:

Below is a list of the best exercises, that can be done 1-2 times per week (or as needed), as an addition to any exercise routine, to keep you elbow strong and pain-free. 

  • Wrist flexion and extension stretch – with the elbow extended, palm facing down and the shoulder at 90 degrees of elevation, extend your wrist as far as you can. Then use your opposite hand to extend the wrist even further. You should feel a stretch in your forearm. Once completed, flex your wrist. Use the opposite hand to stretch the wrist into flexion. Again, you will feel a stretch in your forearm.
  • Gripping exercises are excellent to help the elbow. This can be done with a ball, a handheld gripper, or any other device that provides resistance while you attempt to make a fist. This will help strengthen the muscles of the forearm and will keep the elbow health. Be careful not to do this exercise if you are experiencing tennis elbow.
  • Forearm rotation exercises – with a 1- or 2-pound weight held in your hand (or more if needed), elbow bent, simply turn your palm up and down, keeping the shoulder and elbow immobile. Perform this exercise with your elbow flexed to create forearm supination/pronation. This should be done in a very controlled manner to avoid any excess stress on the elbow. This can be done for 3 sets of 10.
  • Wrist curls (flexion)- using a small hand weight in your hand, straighten your elbow, rest your forearm on the edge of the table or arm rest, palm up. Start with your wrist extended (palm should be facing away from you now), then curl the weight up (palm facing you). Perform in a controlled manner and perform 3 sets of 10.

Start:

Finish:

  • Wrist curl (extension)- using a small hand weight in your hand, straighten your elbow, rest your forearm on the edge of the table or arm rest, palm down. Start with wrist flexed (fingers down), then curl the weight up (back of your hand should be facing you). Perform in a controlled manner and perform 3 sets of 10.

If you have had elbow surgery:

After an elbow surgery, most patients have reached their maximum improvement when they are one year out from their surgery.  Many have questions about what they can do and what they should avoid for the long term, to keep their elbow healthy.

1) What activities/sports are allowed after an elbow replacement?

  1. General activities of daily living such as cooking, cleaning, etc. can be performed after an elbow replacement
  2. Craft activities such as knitting and crocheting
  3. Board games, cards, etc.

2) What activities and sports are best avoided after an elbow replacement?

  1. Racket sports or throwing activities should be avoided after an elbow replacement
  2. Contact sports should be avoided after an elbow replacement
  3. Sports with a major risk of falling (horseback riding, climbing, etc.) should be avoided after an elbow replacement

3) Is there a weight limit on what I can do for the long term after a replacement?

  1. Generally you should avoid lifting objects more than 15lbs.

4) What about after Tommy John Surgery, what sports/activities are allowed?

  1. Once you have completely recovered from Tommy John surgery, there are no restrictions placed on your elbow. You can perform all activities of daily living and compete in all sports.

5) What activities are best avoided?

  1. There are no activities that need to be avoided after the person has completed rehabilitation from Tommy John surgery (which can take 12 to 15 months for a full recovery and return to full pitching/throwing activities). Activities that stress the surgery include throwing a baseball, throwing a javelin, and weightbearing activities on the elbow such as gymnastics
  2. Is there a weight limit? – no, there is no weight limit for lifting set on the elbow after full recovery from Tommy John surgery

6) What are some tips to keeping my elbow healthy and pain-free?

  1. Following elbow surgery, it is important to maintain your elbow motion as best as possible. Take a few minutes each day to completely bend and straighten your elbow to avoid any loss of motion.
  2. After elbow surgery your elbow may flare up on you from time to time. This is normal. When this happens, ice the elbow and take some anti-inflammatory medications if you can tolerate these and do not have any contraindication to taking them.

7) When to be worried:

  1. If you have had prior surgery on your elbow such as a tendon or ligament repair and feel a “pop” while preforming a strenuous activity, or numbness into your hand, please contact your doctor immediately
  2. If the elbow begins to swell up, especially if this swelling is accompanied by a significant increase in pain, fevers, chills, or night sweats, contact your doctor immediately

Click here for a printable version of  the General Elbow Care information

Shoulder Care after Rotator cuff Surgery:  Do’s and Don’ts for the long term and exercises to stay healthy:

After a shoulder surgery (rotator cuff, biceps surgery, bone spurs) many patients have reached their maximum improvement when they are one year out from their surgery, but it is possible to continue improving up to 24 months. Many have questions about what they can do and what they should avoid for the long term, in an effort to keep their shoulder healthy.

1) What activities/sports are allowed after a rotator cuff repair?

a. Following rotator cuff repair, your surgeon will have a rehabilitation protocol that lets you gradually regain shoulder function while protecting the repair so that the rotator cuff tendon heals back to the humerus bone. This generally involves a sling for 4-6 weeks with supervised physical therapy to regain motion. Strengthening begins several months after repair, return to activities 5-6 months from surgery, and while the majority of improvement is obtained by the one-year mark, many continue to improve beyond that. It is important to follow your surgeon’s protocol for the best outcome.
b. After recovering from rotator cuff repair, patients may generally resume all activities and sports as tolerated, unless directed otherwise by their surgeon.

2) What activities and sports are best avoided?
a. After recovering from rotator cuff repair, patients can return to all activities and sports as tolerated, unless directed otherwise by their surgeon.

3) Is there a weight limit on what I can do for the long term after a rotator cuff repair?
a. No. Patients can generally return to lifting weights, however, consult with MD regarding safe weight to resume . No heavy lifting for 9 months

4) Are there any activities I should absolutely avoid?
a. Please consult with your physician and physical therapist regarding activities you should avoid. Activities such as heavy overhead lifting and rock-climbing can be difficult on the repair.
b. Activities that involve sudden quick movements, sudden jerking or hanging should be avoided for 6-7 months following surgery. Activities such as weightlifting cleans, overhead pressing, pull ups, chin ups, hanging, and throwing a ball should be delayed until full strength has returned & full healing has occurred.

5) What are some tips to keeping my shoulder healthy and pain-free?
a. When weightlifting, patients may consider lower-weight and higher-repetition exercises. Generally, exercises that involve lifting overhead, i..e Olympic style-lifts, such as squat press, overhead press, and jerk-type exercises, are harder on your shoulders than below-shoulder lifts. Make sure you focus on the small stabilizing muscles, such as the rotator cuff muscles and scapular stabilizers.

b. Restoring full motion is important to pain free full shoulder function. Continue to perform your shoulder range of motion exercises. These can be done with a stick, or golf club. Perform shoulder flexion, external & internal rotation motions.

c. Maintaining good posture is essential to pain- free shoulder function and cuff healing. Maintain anterior shoulder flexibility and strengthen the scapular muscles. Perform exercises such as the corner stretch to stretch pectoralis minor and then strengthen the scapular muscles with rowing, standing T’s & I’s.
d. Maintain a healthy lifestyle, including maintaining a healthy weight and avoiding problems that can arise from lack of exercise and an excess of unhealthy foods. Obesity is related to arthritis of the shoulder. Diabetes, which is related to obesity, can contribute to a frozen shoulder and to rotator cuff tears. Thus, maintaining a healthy weight can also prevent shoulder problems.

5) WHAT’s Good to DO for the Shoulder:
a. Staying active and using your shoulder
b. Improving your posture.
c. Doing good shoulder functional activities such as cuff strengthening exercises, golf, full body exercise
d. Maintaining a stretching program

6) When to be worried:
a. Let your doctor know if you develop new pain or weakness of the shoulder, as this could be a sign of rotator cuff problems after repair. This is particularly true if you have a specific injury with new onset pain or weakness, as this could represent a re-tear of the repair.

7) What is a good shoulder exercise regimen to keep my rotator cuff repair functioning well?
a. You should ask your Physical Therapist for a HEP (home exercise program) at your last visit, however, below is a list of the range of motion and strengthening exercises, that can be done 1-3 times per week, as an addition to any exercise routine, to keep you shoulder flexible, strong and pain-free. These exercises generally require you to obtain a set of TheraBands, which are large rubber bands of varying resistances, or light weights. We all want to be strong as possible but keep the resistance light so that you use proper form, this will make your shoulder stronger and more stable.

Click here for a printable version of  the General Shoulder Care information

Shoulder Care after Shoulder Arthroplasty: Do’s and Don’ts for the long term and exercises to stay healthy.

After a shoulder replacement, most patients have reached a peak in their improvement at one year from surgery. However, continuing with a healthy exercise program for the muscles around the shoulder and carefully selecting activities will help optimize shoulder function and reduce risk of the prosthesis loosening and shoulder irritability.  Many have questions about what they can do and what they should avoid for the long term, in an effort to keep their shoulder healthy.

What activities/sports are allowed after a shoulder replacement?

a) Following shoulder replacement, your surgeon will have a rehabilitation protocol that lets you gradually regain shoulder function while protecting the replacement so that the shoulder heals appropriately, in particular the front rotator cuff called the subscapularis that has to be re-attached after replacement. This generally involves a sling for 6 weeks with supervised physical therapy to regain motion. Strengthening begins several months after replacement, a progressive return to activities 4-6 months from surgery, and improvement at a year from surgery. It is important to follow your surgeon’s protocol for the best outcome.

b) After recovering from shoulder replacement, patients may generally resume most  activities and sports as tolerated, unless directed otherwise by their surgeon.

What activities and sports are best avoided?

a) Some surgeons recommend avoiding activities that place higher stress on the shoulder replacement in order to potentially reduce the risk of the replacement loosening. This would include pushups, bench press, and overhead. Many would also advise against heavy manual labor and extreme power tools such as a jackhammer.

Is there a weight limit on what I can do for the long term after a replacement?

a) Reverse: discuss limits with your surgeon, there are different opinions ranging from activity as tolerated to a 20 lb weight limit, especially with overhead lifting.

b) Anatomic: there is generally no weight limit, although some surgeons recommend avoiding activities that place higher stress on the shoulder replacement in order to potentially reduce the risk of the replacement loosening. This would include pushups, bench press, and overhead weightlifting.

Are there any activities I should absolutely avoid?

a) Discuss with your surgeon based on your type of replacement. It may be worthwhile to avoid pushups, bench press, and heavier overhead lifting, particularly following a reverse shoulder replacement.

What are some tips to keeping my shoulder healthy and pain-free?

a) When weightlifting, patients may consider lower-weight and higher-repetition exercises. Generally, exercises that involve lifting overhead, i..e Olympic style-lifts, such as squat press, overhead press, and jerk-type exercises, are harder on your shoulders and may be best to avoid after shoulder replacement, particularly reverse replacement. Make sure you have strengthened the small stabilizing muscles, such as the rotator cuff muscles and scapular stabilizers, before strengthening the larger muscles such as the deltoid, trapezius, and pectoralis. Seated row exercises with a band are important to balance the shoulder help the rotator cuff function.

b) Maintain a healthy lifestyle, including maintaining a healthy weight and avoiding problems that can arise from lack of exercise and an excess of unhealthy foods.

When to be worried:

    1. Let your doctor know if you develop new pain or weakness of the shoulder, as this could be a sign of problems with the replacement. This is particularly true if you have a specific injury with new onset pain or weakness, but also if pain or weakness begins more gradually.
    2. Also notify your doctor if you develop signs of infection (redness, swelling, warmth), or symptoms of instability of the replacement.

What is a good shoulder exercise regimen to keep my shoulder replacement functioning well?

Below is a list of exercises, that can be done 2-3 times per week, as an addition to any exercise routine, to keep you shoulder flexible, strong, and pain-free. These exercises generally require you to obtain a set of therabands, which are large rubber bands of varying resistance, or light weights.  Keep the tension/weight of the band light to avoid straining the shoulder.

RANGE OF MOTION / STRETCHING

Flexion

 

Abduction

External rotation

Internal rotation

Corner stretch

STRENGTHENING

External rotation – With your elbow bent and your arm at your side, rotate your arm outward against the resistance of a TheraBand. Slowly return to the start position and repeat. Keep your elbow at your side and your shoulders square. “Squeeze” your shoulder blades together while you rotate out. If you do not have a band, you can also perform this exercise with a partner or with a wall or post pressing against the outside of the wrist.

External rotation at 0 degrees of abduction

External rotation at 90 degrees of abduction

Internal rotation – With your elbow bent and your arm at your side, rotate your arm across your body against the resistance of a TheraBand. Slowly return to the start position and repeat. Keep your elbow at your side.

Internal rotation at 0 degrees of abduction

Internal rotation at 90 degrees of abduction

LRow Exercise – Stand facing a door with the TheraBand attached to the doorknob. Start with your elbows bent and your upper arms at your side. Keep your upper arm close to your side and begin by engaging your shoulder blades first so they are centered on your back. Next, pull back until your hand is level with your body as you concentrate on pulling your shoulder blades back and down towards the center of your lower back. Concentrate on your posture so that your spine is in a straight line and your head and neck are centered over the back of your pelvis. Then slowly return to the start position. “Squeeze” your shoulder blades together as you pull. You can repeat with the elbows straight, pulling down.

Scapular Strengthening Exercises – During these exercises, focus upon pulling the shoulder blades together. Start by squeezing the shoulder blades together to get used to the muscles that contract to bring your shoulder into this position. Recreate this sensation during the exercise. Lie on your stomach with your arm hanging towards the floor. Raise your arm to your side until it is parallel to the floor. You can also perform this exercise on an exercise ball to work your core or using TheraBand. Repeat with the arms in a “T”, “Y” and “I” position. Use the weight of your arm or a 4-6 oz. can of tuna fish or tomato soup for three sets of 10-12.

I position

 

T position

Y position

Acknowledgements

A special thanks to those surgeons and physical therapists who assisted with the creation of this content.

Julie Bishop, MD
Peter Chalmers, MD
Greg Cvetanovich, MD
Brandon Erickson, MD
Haim Hechtman, DPT
Holly Kreisle, DPT
Jonas J.R. Rudzki, MD
Mitch Salsbery, DPT
Kevin Wilk, DPT, FAPTA

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ASESF Mission

Promoting research & education for care of the Shoulder & Elbow

  • Addressing critical research needs and furthering the study of shoulder and elbow injuries and repair
  • Supporting the entry of young physicians into the field of musculoskeletal health
  • Promoting and funding strategic educational initiatives in shoulder and elbow with the ultimate goal of delivering enhanced value-based care through better patient outcomes and lower costs
  • Educating the clinical and academic community, and the public, about care, surgical treatment options and prevention of injuries to shoulder and elbow
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