Shoulder surgery does not mean you have to lose everything you have worked so hard for. Some people are rightly concerned about injuring their repaired shoulders after surgery. These people make a surgeon feel better. Some people think the repair is healed right from day one and want to test it; these people frighten me despite my efforts at counseling. I think there is a compromise that can be achieved without losing your all important wind and without hurting yourself. Some patients are concerned about becoming imbalanced and don’t want to work one side of their body. It is my belief that you shouldn’t let it waste away waiting for the other one to heal. I promised I would write about this topic so here it is.
Shoulder Surgery and 1 Armed Workouts
First let me state that these are my opinions about post operative workouts and what can and cannot be done. If you have had surgery as always you need to consult your surgeon and not take this as verbatim. Hopefully you have gone to someone who is familiar with the terms Clean and Jerk and Snatches so your appointment does not take 3 times as long as it should be. Also if you are considering surgery get this stuff outlined ahead of time so you don’t get surprised when your shoulder surgeon says you are not to workout for 19 months and then you can only do big toe raises. I have had people come to me for second opinions just to get things straight about what they can and cannot do after surgery. So here goes:
The first 6 weeks after surgery are critical to the healing of a repair, for argument’s sake let’s say the person has a rotator cuff repair (on left) or a labral repair (on right).
The tendon has to heal to the bone and in order to do this needs a relatively quiet environment almost like a fracture healing needs a cast or splint. So the problem with all this is that if we casted your shoulder joint and immobilized it for 6 weeks, things would heal alright…BUT you would have a lot of trouble moving your joint because the ligament and capsule of the joint would shrink and tighten preventing motion around your joint. So I am a firm believer in passive motion in the first 6 weeks to prevent tightness, gain motion and then when things are ready to be strengthened, you don’t have to worry about flexibility. This physical therapy dance that we do is predicated on maintaining flexibility without stressing the repair; it is a fine line and one that we would rather err on the cautious side of. Hell hath no fury like a retear of a shoulder repair. I tell patients I would rather have them healed and tight than loose and retorn! In this initial postop period after the skin has healed in about 7-10 days, stationary bike is fine to maintain cardiovascular activity. Stairclimbers and treadmills are notorious for people losing their balance and falling especially if you are wearing a sling. A cuff or labral repair patient is allowed to move their hand and elbow to prevent hand and elbow stiffness and we encourage this. I do not want the patient reaching or carrying anything in that hand for 6 weeks to prevent bad things from happening. I want people to sleep with the sling on. I have received many a phone call about an alarm that startled the patient, they moved their operative shoulder to shut it off and then proceeded to wake everyone else in the house up with their own scream alarm.
For the first 2-6 weeks I have allowed patients to 1 arm aerodyne, 1 arm light kettlebell swing, air squat, step up and down boxes, 1 arm dumbbell squat, 1 arm rowing, lunges, 1 arm farmer’s carry, careful situps and back extensions, sled drags. The key to all of this is the THE WEIGHT ON THE OTHER SIDE HAS TO BE SMALL ENOUGH THAT THE REPAIRED SIDE REMAINS QUIET AND UNAFFECTED. THERE SHOULD BE NO MOTION OF THE OPERATIVE SIDE AND NO STRAINING THAT PUTS TORQUE OR STRESS ON THAT SIDE. VERY IMPORTANT POINT HERE.
The next 6 weeks are a very dangerous time because you may discontinue the sling but again it is not able to be stressed or risk rupture of the repair. I have seen one armed burpees where a person bends over holding body with good hand planted on floor and chest is off ground like a football lineman. Legs then go back into a 1 arm plank position and then come forward again. Again operative arm is at side and not getting stressed. After 6 weeks things have healed partially and usually enough to begin gentle strengthening of the cuff. By 3 months the repair has a mature scar and can withstand more stress. Dumbbells and bands on the operative side are allowed and can begin to increase strength. I still don’t allow explosive activities until 5 months. I had a patient who went golfing at 4 months because he felt so good. Unfortunately his golf game was not as good as his arm and he hit the ground with the club ripping the repair.
Below is a protocol that I use for cuff repairs. again for my patients and check with your surgeon for specifics.