For those following my rehab journey, this entry will recap days 8-14 after surgery. At this point, I had been off pain meds for 4 days. However, I will admit I took one pain pill prior to my first PT session exactly one week out from surgery. For two decades I have listened to patients recount stories of their own or friends who report how painful therapy is after this surgery. Oddly enough, most of my patients over the years said it was not so bad. Perhaps, there is great variability in the intensity of the passive stretching among therapists.

Research Nuggets

The literature offers support and caution for early motion after rotator cuff repair. While ROM is generally better early on with early motion, there is some concern about higher re-tear rates. I am in the camp that gentle early passive range of motion (PROM) is okay given the proper regimen and patient compliance. Early active range of motion (AROM) or too vigorous PROM is likely to be more detrimental to the repair. Ultimately, these decisions are made based on the size of the tear, tear configuration, patient’s health and age, MD preference and whether or not this is a primary or revision repair.

The article abstract below is a great reference for activities and activation of the rotator cuff as measured by surface EMG to provide some insight for patients and clinicians regarding safe movement and exercise in the rehab process:

https://pubmed.ncbi.nlm.nih.gov/28704624/

In addition, here is another article that outlines post-op rehab (you can download the entire article for free)

https://pubmed.ncbi.nlm.nih.gov/29399735/

My First PT Visit

So, I would be lying if I said I was not nervous. I mean I was always the guy stretching the fresh post-op shoulders, and suddenly I am the one laying on the table a week out from surgery about to let someone move my stiff, sore shoulder. Fear of the unknown is probably the worst in that moment. My therapist is a colleague in my own clinic who actually reports to me. No pressure on him, right? LOL

He and I agreed to co-pilot my rehab and map everything out through constant dialogue and feedback. He has done a good job thus far. That first day the shoulder felt like a cement block to me. It seemed like super glue was preventing it from moving much. The focus was on gentle external rotation and flexion range of motion. Both hurt, but the flexion was by far the worst for me.

After doing pendulums and the PROM with him, my routine consisted of:

  • Seated passive external rotation using a cane on my own – 2 sets of 15
  • Scapular retraction (gentle squeezing of the shoulder blades together) – 2 sets of 15
  • Seated table slides with a towel – 2 sets of 15
  • Game Ready x 15 minutes with low compression

At the end of the session, I felt a sense of pride for getting through it. It was also enlightening being on the other side. Now I was the one receiving care. I was experiencing PT in a whole new way, with a new connection with other patients in the room. The power of community and watching and speaking to other patients is REAL. It was cool to actually experience the culture I was trying to create for our clinic and staff as a patient. It became very evident to me how important mentally and emotionally that physical therapy is for recovery. I was glad to pay my $50 co-pay for that experience.

I attended one additional PT session in week two. The only addition to my program was adding moist heat prior to stretching. I always do this for patients and highly recommend it. The shoulder just feels nice and more relaxed for the upcoming stretching which is not the most fun thing to be sure. Desensitizing the brain early on to to take it down from high alert is helpful in order to make small progressions in rehab. Ten minutes of heat sure seems like a great way to start.

As far as my pain during rehab, stretching into flexion at end range reached a 7/10, but I let Noah know and he backed off and we kept it to the 5/10 threshold the rest of the time. I was generally more sore later in the day, but found the following day the shoulder seemed to move and feel better. One other key note: I perform my home exercises 2x/day every day between PT sessions, usually once in the morning and once in the evening. I continue to use the Game Ready multiple times per day. My average pain level fluctuates between 3/10 and 5/10 most days.

My Early Takeaways

  1. This process is going to slow, tedious and uncomfortable journey especially early on
  2. Early PT within 1-2 weeks post-op will help with reducing stiffness and preventing a frozen shoulder
  3. Doing the home exercises is a must to maintain progress
  4. The sling keeps you from doing stupid things such as quickly moving the shoulder in a reflex manner
  5. Sleeping is still the hardest part
  6. You will have to depend on others for help with certain activities
  7. Anti-Inflammatory meds and ice are essential in keeping pain under control

That is a wrap for week two. I am learning a lot about myself in terms of my mental toughness, patience (or lack thereof) and my body’s own response to surgery. As I move forward, I will continue to share details about my MD follow-ups, exercise progressions and helpful tips for patients and clinicians alike.