The recovery process following shoulder surgery relies heavily on a carefully managed physical therapy (PT) program. PT is a sequence of controlled movements designed to restore function while protecting the surgical repair. The timeline for beginning rehabilitation depends entirely on the specific procedure performed and the nature of the tissues involved.
The Immediate Post-Surgical Phase
The period immediately after surgery focuses on protection and pain management, preceding the formal start of active physical therapy. The primary goal during the first days and weeks is to allow the biological healing of soft tissues, such as tendons and ligaments, to begin without disruption. Patients often wear a sling or immobilizer continuously to prevent movement that could strain the repair site.
Patients focus on controlling post-operative swelling and managing pain with medication and cryotherapy (cold packs or specialized icing units). While the shoulder joint is immobilized, patients perform gentle exercises for the elbow, wrist, and hand to maintain circulation and prevent stiffness in adjacent joints. This protective period creates a safe environment for the surgical site before significant movement is introduced.
Timelines Based on Surgical Procedure
The timeline for initiating formal physical therapy is dictated by the anatomical structure repaired, as different tissues require varying amounts of time to achieve initial strength. Procedures involving tendon-to-bone fixation, such as a rotator cuff repair, typically require the longest delay (often four to six weeks). This delay allows the tendon to securely integrate with the bone (tendon-to-bone healing) before any stress is applied. During this period, the patient is usually only cleared for passive motion exercises, where the therapist moves the arm entirely.
For labral and stabilization procedures (e.g., a Bankart repair), the timeline for starting movement is often shorter, sometimes beginning within the first week. These procedures impose strict limitations on specific movement planes, especially external rotation, which can stress the repaired labrum. The goal is to safely regain motion while avoiding positions that could cause dislocation or re-tearing. Formal physical therapy often begins around the two-to-four week mark, with careful monitoring of rotational limits.
In contrast, joint replacement procedures (arthroplasty) often have the shortest delay, with therapy sometimes beginning on the first or second day after surgery. For a standard total shoulder replacement, maximizing range of motion is a primary goal, and early passive motion helps prevent scar tissue formation. While a reverse shoulder replacement protocol may be more conservative initially, early motion is still prioritized to prevent stiffness. Strengthening exercises are typically delayed until around three months post-surgery for both types of replacements.
The Progressive Stages of Rehabilitation
Once physical therapy begins, the patient progresses through stages defined by the type of movement permitted, gradually introducing controlled stress to the healing structures. The first stage involves Passive Range of Motion (PROM), where the therapist or a machine moves the patient’s arm without any muscle contraction. This protects the surgical site by ensuring the patient’s muscles do not exert force, which is important in tendon repairs.
The next progression is Active-Assistive Range of Motion (AAROM), where the patient uses their own muscles to help move the arm, often assisted by the other hand, a cane, or a pulley system. This phase bridges the gap between passive movement and independent motion, allowing gentle engagement of the surrounding musculature. Following this, the patient advances to Active Range of Motion (AROM), moving the joint fully using only their muscle power.
The final stage shifts focus from mobility to Strengthening and Endurance, rebuilding muscle mass lost during immobilization. Exercises progress from gentle isometrics (muscle contracts without joint movement) to resistance exercises using bands or light weights. This phase aims to restore the functional capacity and stability of the shoulder, preparing the patient for a full return to daily activities and demanding physical tasks.
Individual Factors That Modify the Schedule
While surgical protocols provide a general framework, the actual progression through physical therapy is often modified by patient-specific variables. Patient age is a factor; younger patients often exhibit faster tissue healing, while older patients may require a more conservative timeline to ensure repair integrity. The overall health of the patient, including comorbidities like diabetes or a history of smoking, can significantly delay the biological processes required for tendon and bone healing.
The quality of the tissue repaired also influences the schedule; a large, complex tear requires a slower progression than a small, clean tear. Patient compliance with the home exercise program and therapy attendance is equally important, as inconsistency can lead to stiffness or slower recovery. Complications, such as an infection or the development of a frozen shoulder (adhesive capsulitis), will immediately alter the schedule, requiring a temporary shift in focus.