Undergoing shoulder surgery is a big deal. The whole process can take time- setting up pre-operative appointments, preparing for surgery, undergoing surgery, and surgical recovery are all major steps along the way. I often find that patient's get so wrapped up in the preparation phase pre-op that they fail to really consider the post-op recovery.
In my experience, surgeons tend to downplay the recovery time. This is especially the case when in comes to a timeline to return to a sport or recreational athletics. When I see patients for their first post-op visit, the majority of time is spent educating the patient on the timeline of recovery. Some patients are confused when I explain a timeline to them that is twice as long as what the surgeon said. As a physical therapist, there are many factors to consider when determining an appropriate timeline for recovery.
Factors Influencing Recovery Timeline
Age of the patient
General health and co-mordbities
Type of surgical procedure performed
The surgeons specific post-op protocol
Previous level of acitivity
Patient goals
General Timeline:
Phase 1: Initial Recovery (2-8 weeks)
Phase 2: Intermediate Recovery (4-8 weeks)
Phase 3: Dynamic Strengthening (4-8 weeks)
Phase 4: Return to Activity/Sport (4-8 weeks)
Total recovery time: 14-32 weeks (3.5-8 months)
The following is a general overview of the timeline for post-operative recovery. You should always consult with your MD and PT prior to initiating any rehab program.
Phase 1: Initial Recovery (2-8 weeks)
In the initial recovery stage, the patient is often immobilized in a sling. Depending on the surgical procedure and the doctors protocol, this phase usually lasts for the first 2-8 weeks after surgery.
Primary Complaints During Initial Phase of Recovery
Post-operative pain
Difficulty sleeping, disrupted sleep
Discomfort with wearing a sling
Lack of independence/ reliance on others
Rehab Focus During Initial Phase of Recovery
Pain management
Protect the surgical repair/surgical site
Decrease risk of infection
Gentle passive range of motion (depending on surgical procedure)
Education
Phase 2: Intermediate Recovery (4-8 weeks)
In the intermediate recovery phase, the patient will begin to perform progressions of basic exercises. These will most likely include passive range of motion, active range of motion, isometric contractions, and isotonic strengthening. These phase is critical because it sets the stage for the following phases.
Primary Complaints During Intermediate Phase of Recovery
Post-operative pain
Difficulty sleeping, disrupted sleep (link to shoulder sleeper pillow)
Stiffness- lack of range of motion
Weakness- difficulty moving the arm againt gravity
Rehab Focus During Intermediate Phase of Recovery
Pain management
Protect surgical repair
Progress range of motion
Initiate strengthening exercises
Phase 3: Dynamic Strengthening (4-8 weeks)
This is where the rehab progression starts to get more exciting and fun. Patients typically have minimal pain at this point and can start progressing to more challenging exercises. The major focus of this phase is to get your shoulder stronger. In most cases, this is the time where there is a transtion from "PT exercises" to more of a "gym program."
Primary Complaints During Dyanmic Strengthening Phase of Recovery
Stiffness- lack of range of motion
Weakness- difficulty lifting heavier weights
Rehab Focus During Dynamic Strengthening Phase of Recovery
Strengthening the rotator cuff and scapular muscles
Introduce plyometric (more explosive) exercises
Range of motion
Phase 4: Return to Activity/Sport (4-8 weeks)
Finally! Now is the time to make the exercises more specific to the patients sport. For example, this would be the time when a baseball player begins a throwing progression. The patient generally feels prepared for this next step because of the work put in the previous steps.
Primary Complaints During Return to Activity Phase of Recovery
Shoulder soreness following activity
Shoulder "feels different" performing the activity
Performance of the activity is not quite at pre-operative levels
Rehab Focus During Return to Activity Phase of Recovery
Gradually re-introduce the activity in a logical manner
Manage the workload of the specific activity- avoid doing too much too soon
Continue to work on strength and range of motion
I hope this article is a helpful guide to explain the post-operative recoery timeline. Keep in mind, each individual is different and may progress at a different rate. Stay patient and keep a positive mindset and it will most likely go well for you!