Regaining shoulder motion after a fracture depends on a structured, gradual progression of range of motion exercises, starting with gravity-assisted movements and building toward active stretches and strengthening. The proximal humerus (the upper part of the arm bone near the shoulder joint) is the most commonly fractured area in this context, and research consistently shows that appropriate exercise reduces pain and improves shoulder function during recovery. Seven exercises form the backbone of most rehabilitation programs, though timing and technique matter as much as the exercises themselves.
Why Stiffness Sets In After a Shoulder Fracture
A shoulder fracture triggers a cascade of healing responses that, left unaddressed, work against your mobility. The joint capsule and surrounding soft tissues thicken and stiffen as the body lays down scar tissue. Research on patients who developed stiffness after surgically repaired proximal humerus fractures found increased deposits of extracellular matrix and disorganized collagen in the joint capsule, hallmarks of fibrosis that physically restricts how far the joint can move.1PubMed Central. Gene expression and histological assessment of capsular fibrosis in post-traumatic shoulder stiffness following plate fixation of proximal humeral fractures: an exploratory pilot study Immobilization during the healing phase, while necessary to protect the fracture, accelerates this process. The goal of range of motion exercises is to keep the capsule pliable, prevent adhesions from locking down the joint, and gradually coax the shoulder back to its full arc of movement.
Gentle Starting Exercises: Pendulums, Table Slides, and Wall Slides
The first three exercises in a typical program are designed to move the shoulder with minimal stress on the healing bone. They are usually introduced within the first few weeks, depending on your surgeon’s or physiotherapist’s guidance.
Pendulum swings are the classic starting point. You lean forward with your uninjured arm resting on a table or chair, and let the injured arm hang straight down. Then you gently sway your body so the arm swings in small circles or back and forth. Gravity does most of the work. Electromyography studies confirm that standard pendulum exercises produce very low muscle activation in the rotator cuff, keeping them below the threshold that could strain healing tissues.2PubMed Central. Electromyographic Evaluation of Early-Stage Shoulder Rehabilitation Exercises Following Rotator Cuff Repair This makes pendulums one of the safest early movements.
Table slides involve sitting at a table with your forearm resting flat on a towel or cloth. You slowly slide your arm forward along the table surface, letting the table support the weight of the arm while you work on increasing how far the shoulder can reach. The movement is gravity-minimized, meaning the table takes the load rather than your shoulder muscles.
Assisted wall slides work on a similar principle. You stand facing a wall and “walk” your fingers up the surface, using the wall for support as you gradually lift the arm higher. Early on, you stop well before any sharp pain. Over the weeks, your fingers climb a little higher as the shoulder loosens. Both table slides and wall slides generate low levels of rotator cuff activation, putting them in the same safe zone as pendulums for early rehabilitation.2PubMed Central. Electromyographic Evaluation of Early-Stage Shoulder Rehabilitation Exercises Following Rotator Cuff Repair
Why Pendulum Technique Matters More Than You Think
Pendulums look deceptively simple, and many people perform them incorrectly. The most common mistake is actively swinging the arm with your shoulder muscles instead of letting momentum and body sway do the work. Research measuring muscle activity during pendulum exercises found that large, incorrectly performed pendulums produced significantly higher activation in the supraspinatus (one of the key rotator cuff muscles) compared to correctly performed ones.3PubMed. Activation of the shoulder musculature during pendulum exercises and light activities Both correct and incorrect large pendulums also activated the rotator cuff muscles more than small ones.
The practical takeaway: keep your circles small at first, and focus on relaxing the shoulder rather than driving the arm through an arc. Your body should generate the swing, not your shoulder. If you notice your shoulder muscles tensing up, you are doing it wrong. Bigger arcs can come later, once your therapist or surgeon clears you for more aggressive movement. Getting this right early means the exercise does what it is supposed to do, gently mobilizing the joint rather than loading a healing fracture.
Building Up With Pulley-Assisted Overhead Reach
Once you have spent a few weeks with the gentler exercises and your fracture is showing good healing on follow-up imaging, the fourth exercise typically introduced is a pulley-assisted overhead reach. This uses a simple rope-and-pulley system (often hung over a door) where you pull down on one end with your healthy arm, which lifts the injured arm overhead. The healthy arm does the heavy lifting, and the injured side goes along for the ride, gradually stretching into flexion and sometimes abduction.
A randomized trial examining pulley exercises after shoulder surgery found that both the pulley group and a comparison group improved in flexion, abduction, and external rotation over time, with no difference in outcomes or complications between the two approaches.4PubMed. Are Pulley Exercises Initiated 6 Weeks After Rotator Cuff Repair a Safe and Effective Rehabilitative Treatment? A Randomized Controlled Trial That finding was from a rotator cuff repair population rather than a fracture population, but pulley exercises are a standard bridge between passive and active range of motion in most shoulder rehabilitation protocols. The key advantage is that you control the speed and range with your good arm, giving you a built-in safety valve if something feels wrong.
Posterior Stretches for Internal Rotation
As healing progresses, two stretches target the back of the shoulder, which tends to tighten up and restrict internal rotation (the motion of reaching behind your back).
The cross-body stretch is the fifth exercise. You bring your injured arm across your chest using your other hand to gently pull the elbow toward the opposite shoulder. A controlled trial comparing this stretch to a control group found that the cross-body stretch improved internal rotation by about 20 degrees over the study period, a statistically significant gain compared to the control group’s roughly 6 degrees.5Journal of Orthopaedic & Sports Physical Therapy. A randomized controlled comparison of stretching procedures for posterior shoulder tightness
The sleeper stretch is the sixth. You lie on your injured side with the arm at 90 degrees in front of you, elbow bent, and use the other hand to gently push the forearm down toward the bed, rotating the shoulder inward. Research using imaging to measure tissue stiffness found that the sleeper stretch reduced stiffness in both the upper and lower portions of the posterior shoulder capsule, while the cross-body stretch reduced stiffness only in the lower portion.6Journal of Biomechanics. Effects of sleeper and cross-body stretching on posterior shoulder capsule stiffness In practical terms, both stretches work, but they target the posterior capsule in slightly different ways, which is why most programs include both.
A four-week trial in athletes with posterior shoulder tightness confirmed that both the cross-body and sleeper stretches significantly increased internal rotation and horizontal adduction range of motion, and also decreased muscle stiffness in the posterior rotator cuff muscles.7Journal of Shoulder and Elbow Surgery. Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial While that study focused on athletes, posterior tightness after a fracture responds to the same stretching principles. Just be aware that these stretches are typically introduced later in recovery, once the fracture is well-healed and your therapist is confident the bone can handle rotational stress.
Scapular Stabilization Exercises
The seventh category is scapular-focused exercises, which target the muscles that control your shoulder blade rather than the shoulder joint directly. Scapular retraction (squeezing your shoulder blades together), scapular setting (gently pulling the shoulder blade down and back), and controlled shrugging all fall into this group. These movements address a problem that often gets overlooked: after a shoulder fracture, people unconsciously change how they move their shoulder blade to compensate for the injured joint. Over time, those compensatory patterns limit how much overhead motion you can regain.
A randomized controlled trial of patients who had undergone plate fixation for proximal humerus fractures found that adding scapular-focused exercises to a standard rehabilitation program produced significantly better shoulder function scores at both one and three months after surgery, along with less pain and better activity performance.8International Orthopaedics. Efficacy of scapular-focused rehabilitation protocol on shoulder function following Proximal Humeral Internal Locking System fixation for proximal humeral fractures: a randomized controlled trial The improvements were seen across multiple outcome measures, suggesting that scapular work has a broad positive effect on recovery rather than just fixing one specific deficit.
When to Start and How Quickly to Progress
The timing debate in shoulder fracture rehabilitation boils down to early mobilization (starting movement within the first one to two weeks) versus delayed mobilization (waiting three or more weeks, often in a sling). For non-surgically treated proximal humerus fractures, a systematic review and meta-analysis of randomized trials found a small but statistically significant advantage in function scores favoring early mobilization at three months.9PubMed Central. Early versus delayed mobilisation for non-surgically treated proximal humerus fractures: a systematic review and meta-analysis of randomised trials Importantly, early mobilization did not increase the rate of fracture displacement or total complications.
A separate meta-analysis reached a similar conclusion: early mobilization after proximal humerus fracture resulted in modestly better function on the Constant Shoulder Score, though the difference was not large enough to be considered clinically dramatic. It found no clear evidence that early movement improved range of motion or pain specifically, but it also did not lead to more complications.10PubMed Central. The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis A systematic review of upper limb fracture rehabilitation more broadly concluded that starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity.11Journal of Physiotherapy. Exercise reduces impairment and improves activity in people after some upper limb fractures: a systematic review
The message from the research is consistent: earlier movement is safe and offers a modest advantage, especially in the first few months. That said, “early” does not mean “immediately and aggressively.” The initial exercises should be the gravity-assisted kind described above, and your surgeon or physiotherapist should clear you based on your fracture pattern and stability.
Do You Actually Need Supervised Physical Therapy?
This is where the evidence might surprise you. For straightforward, non-surgically treated two-part proximal humerus fractures in older adults, supervised physiotherapy does not appear to produce better outcomes than a solid home exercise program. A multicenter randomized trial comparing supervised exercises to unsupervised home-based exercises found no clinically relevant difference in shoulder function scores at three or twelve months.12PubMed. Physiotherapist-supervised exercises versus unsupervised home-based exercises after nonsurgically treated proximal humerus fracture: a multicenter randomized controlled trial The researchers concluded that most older adults with this type of fracture can perform home exercises without a physiotherapist.
A second randomized trial compared a course of supervised rehabilitation to a single advice session and found virtually identical shoulder scores at six months, with no meaningful difference between the groups.13Journal of Shoulder and Elbow Surgery. Supervised rehabilitation comparable to single advice session after nonoperative treatment of displaced proximal humerus fracture: a randomized controlled trial These findings apply specifically to simpler fracture patterns treated without surgery. If you had surgery, have a complex fracture, or are struggling with pain or stiffness beyond what feels normal, supervised therapy is still valuable. The studies basically show that for the most common scenario, the exercises themselves matter more than who watches you do them, as long as you understand the movements and stick with the program.
What the Recovery Timeline Looks Like
Recovery from a proximal humerus fracture follows a predictable pattern, but it is slower than most people expect. Research tracking range of motion milestones found that functional elevation (raising the arm overhead), abduction (lifting it to the side), and extension (reaching behind you) were typically restored by weeks eight through twelve of rehabilitation.14Manual Therapy, Posturology & Rehabilitation Journal. Recovery of shoulder range of motion after proximal humerus fracture: A quantitative research on rehabilitation progression, gender differences and the prognostic value of initial mobility Internal and external rotation, the twisting motions that let you reach behind your back or throw a ball, recovered more slowly.
This timeline helps explain why those posterior stretches (the cross-body and sleeper stretches) tend to be introduced later and maintained longer than the forward-motion exercises. Rotational range of motion depends on capsular flexibility that takes more time to develop, especially after weeks of immobilization in a sling. Setting your expectations accordingly prevents the frustration of feeling “stuck” at a point where your overhead motion is good but you still cannot reach behind your back comfortably.
Fractures in Older Adults With Osteoporosis
Proximal humerus fractures disproportionately affect older adults with weakened bones, and rehabilitation in this group requires extra care. A review of management options for osteoporotic proximal humerus fractures emphasized that post-treatment rehabilitation is as critical as the treatment itself, but noted that no consensus exists on a single best protocol because the characteristics of both the patient and the fracture need to be considered together.15International Orthopaedics. Osteoporotic Fractures of the Proximal Humerus: an In-Depth Review of Current Management Options In practice, this means exercises may need to start more gently, progress more slowly, and be adjusted based on bone quality and any associated injuries.
Older adults also face a higher risk of developing compensatory movement patterns, where other muscles and joints take over for the injured shoulder. This is one reason scapular stabilization exercises are especially useful in this population: they prevent the shoulder blade from doing all the work while the glenohumeral joint stays locked up. If you are recovering from a fracture and also managing osteoporosis, a conversation with your treating team about adapting the pace and intensity of these exercises is worth having early.
When Something Feels Wrong
Most people progress through these exercises with gradually decreasing pain and increasing motion. But a small number develop complex regional pain syndrome (CRPS), a condition where pain becomes disproportionate to the injury, the shoulder swells, and the skin may change color or temperature. CRPS remains one of the most difficult pain conditions to treat, and early recognition is critical to getting adequate results from physical therapy.16PubMed Central. Physical therapy and rehabilitation of complex regional pain syndrome in shoulder prosthesis If your pain is getting worse rather than better after several weeks of consistent exercise, or if you notice unusual swelling, skin changes, or hypersensitivity in the affected arm, raise it with your doctor rather than pushing through.
Other red flags include a sudden loss of motion after a period of improvement, which could signal fracture displacement, and sharp, catching pain with specific movements, which could indicate a rotator cuff issue that the fracture may have masked. Range of motion exercises should produce mild discomfort, especially at the end of a stretch, but not sharp or worsening pain. The general rule of thumb is that any discomfort from a stretching session should settle within a couple of hours. If it lingers into the next day, you pushed too far.
Proprioceptive Training in Later Stages
Once your range of motion is largely restored, an often-neglected aspect of recovery is retraining the shoulder’s sense of position and coordination. After weeks of limited movement, the neuromuscular communication between your brain and shoulder joint degrades. You might have the physical ability to reach overhead but find that movements feel clumsy or imprecise. Research into rehabilitation programs for proximal humerus fractures has explored adding proprioceptive neuromuscular facilitation techniques and interactive technology-based therapies to classical physical therapy protocols, with the goal of restoring not just range but also the quality and control of movement.17Balneo and PRM Research Journal. New methodological aspects in rehabilitation after proximal humerus fracture Practically speaking, this stage might involve exercises with resistance bands at various angles, catching and throwing a light ball, or performing overhead tasks that require accuracy. This phase bridges the gap between a shoulder that can move and a shoulder you actually trust in daily life.