Shoulder Surgery and 1 Armed Workouts

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.

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.
rotator-cuff-repair2
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.
1 month
rotator-cuff-repair-labral-repair
2 months nonoperative side
rotator-cuff-repair2
3months
5 months
Skin the Cat…be careful!
You heard me… be very careful!

33 Comments

  1. Thanks, that is really comprehensive. I appreciate your perspective and will discuss these guidelines w/ MD. It’s such a bummer about the skin the cat, though! I’ve been doing that since I was a little kid… :-)

  2. Thanks for posting. Re skin the cat, I just repaired a distal biceps tear in a patient mid 40s excellent health, slap tear in another Mid 40 person. I just think there is a significant amount of stress on the joint. Again young people can and do get away with this exercise, but older folks who have never done it have to be extremely careful with it.

  3. Hey Dr. Rockett, Dan Pope and I interviewed you on our podcast a few months ago (Fitness Pain Free). I actually dislocated my shoulder yesterday doing snatches. I was hoping to get your thoughts on it since I am 12 years post-op for a bony bankart repair on the same shoulder. Hope all is well!

    Thanks!

    • Rob call my office 617 527-5040and give them your number so I can talk to you, Sean

  4. I have rotator cuff surgery coming up in September and I find the information here very helpful. I don’t like hearing that I can’t do a c/j for 5 months, but I don’t like them anyway. Would that be about the same for a regular clean. When you say light weight, what is light? Do you go by percentage of what we can lift or something you feel is light?

    • Zina, What you will be able to do afterwards will be determined by your surgeon. If you were my patient and I examined you and did the surgery then I could say, but I cannot tell you that over the internet unfortunately.

      • I do have one more question. When do you allow your patients do a sled pull? I see you have that listed as an exercise they can do. My doctor doesn’t know what a sled pull is and looked at me like I was crazy when I told him.

        Thanks for your time.

        • Sled pull for rotator cuff 2-3 months light to start

        • I must have done something wrong, because my comment yesterday did not post.

          I am almost six months postop. I was released from PT and my doctor. A bit disappointed that all I was told was to be careful. No real guidance on how to progress, but I guess that is commonsense. I guess since I have read so much on the percentages of failure for this type of surgery I am a bit uneasy.

          I have been sledding since three weeks after surgery. I just bought a waist harness. The sled has become my best friend. I joined a box where one of the coaches is very knowledgeable in helping people rehab. He wrote me many one-armed wods, so all has not been lost. I have done some group wods and just used the good arm.
          Now just starts the process of building strength in the arm and hoping for the best.

  5. Dr. R – thanks again for the surgery last week. This post is exactly what I’ve been looking for.

    Now that I’m 10 days out, I wanted to get back and moving. I biked and did some strength training with my unoperated arm. While my operated arm has no pain during any of these movements, I want to make sure to get your take on using pain as an indicator. Is pain a reliable sign of going too far? What other indicators should I be looking for when I want to keep moving my body (with my operated arm still in a sling and sticking to slow, controlled movements) but want to be careful about reinjuring my operated shoulder?

  6. Pain is a sign that you have gone too far. So the goal is to remain pain free with all these movements. I would rather have less done and feel safe than live on the edge and push the repair. SR

  7. Good, Informative Post, Thanks for this wonderful post and hoping to post more of this, so I’ll put this one on my bookmark list of http://www.manhattansportstherapy.com .

    Have Great Day.

  8. i dislocated my right shoulder on a 80 kg snatch………..got it reduced and after 40 days got operated for bankart(7 o’clock to 11 o’clock as per mri) and hill sachs(very small) lesion.the doctor has advised me to start weightlifting only after 6 months and i’m ready to wait…no hurry…….but even after 6 months can i do weightlifting again??you know snatches,clean and jerks,clean pulls,snatch pulls……….please advise………….:(

  9. I have to say in my practice I have gotten people back to weightlifting and crossfit but you have to talk to your doctor as I did not operate on you.

    • thankx for responding………i can’t travel outside india so had to be operated by the indian doctor….and he said that i can do weightlifting again but starting with a slow pace……i have read a lot of protocols on the net that tell you not to do some exercises like behind the neck presses with wide grip,bench with wide grip,pullies with wide grip????.i just want your opinion as you have operated on and worked with more sportspersons….so you can tell better……..take care…

  10. yes i have gotten people back to weightlifting with regular grip and wide grip activities. Grip width does not matter once it is healed. Dan Pope and I are working on a rehab protocol for people after shoulder surgery and after PT is done to help them get back to CrossFitting

    • thankxxx for responding……nd hopefully i’ll recover!!

  11. I would be very interested in your rehab protocol after shoulder surgery! When will this be available?

    Thanks!

  12. It is in the works.

  13. You gave me some really good advice about my hip last year, the replacement surgery went very well and following the Doctors orders i was able to return to Crossfit.

    Now I would like your thoughts on my shoulder. I dislocated my right shoulder in jui-jitsu 4 years ago. I put up with the pain for a couple of years. I eventually saw an Orthopedic Surgeon who felt it was a SLAP tear. I received a cortisone shot and did physical therapy and responded very well. Then my hip failed and my focus was on it. So now my shoulder is hurting again. An MRI shows an intermediate to high-grade partial thickness rim tear present to the distal supraspinatus tendon, distal infraspinatus tendon, and footplate. There is also a near circumferential tear of the glenoid labrum with intact associated scapular periosteum. A 1.5 cm paralabral cyst is present in the 4 o’clock position. the long head biceps tendon is intact.

    I am seeing the same Surgeon, but would like your opinion. I responded well to therapy before, but I really don’t want to keep going through this cycle. I have not dislocated the shoulder since, but I am losing strength. Overhead presses feel sloppy and I am recruiting other muscles to complete the motion, plus there is a lot of pain. Bench press or pushups cause pain and popping/clicking noises as well as catching. There are times when I’m extending my arm in front of me and turning my hand over, like opening a door or shaking someone’s hand, that I lose sensation in my hand and my grip strength weakens. I’ve dropped phones, pens, cups…

    Would you advise surgery over therapy at this point?

    Thanks,

    Paul

  14. Surgery if your symptoms are that dramatic would be best, good luck and happy to see you

  15. I can’t tell you how relieved I was to find this site and to read your posting! I am a competitive CrossFitter. I had continued working out with an injured shoulder for almost a year until I ended up with multiple dislocations and chronic instability. My surgeon told me that I required a total shoulder replacement, however I refused to have this done as I wouldn’t be able to continue with CrossFit/weightlifting competitively after. I had a labrum tear, damaged ligaments, extensive cartilage damage with significant cartilage loss, and the tendons that attach the biceps to the bone were completely torn off. I elected to have surgery to repair as much as could be instead (although the surgeon told me that there is only a 50% chance of it working, and if it does I will have at best 2-3 years before I will have to have the shoulder replacement). I had surgery 2 weeks ago for these repairs (obviously not much could be done about the cartilage other than cleaning it up) and also had a decompression (had 6 procedures done in total). My surgeon said that I could get back to CrossFit (but no overhead) in 3 months, and could do overhead 6-12 months. I know that you haven’t examined/assessed me, however given your knowledge/experience with the intensity required to be competitive with CrossFit, and given the issues that I have outlined above, do you think that it is possible that I will have the mobility/flexibility/strength in my shoulder to be competitive again? No matter what my chances may be, I intend on trying, because I have to. This is the only reason that I elected to try to repair my shoulder instead of having it replaced, but I would love to have your educated opinion on this. Regards, Tina.

    • I am sorry to hear about your shoulder. The only real way to answer all these questions that you have is to be patient and rehab appropriately. Hopefully you will feel good and be able to return.. Part of my lecture that i give is that the beauty of CrossFit is that you can modify anything and ramp up the exercises when you are in a better place. Don’t lose your wind and keep exercising within your restrictions. Good Luck

  16. Sean,
    I just came in to see you a few days ago regarding both of my shoulders and the potential for a slap tear. I have the MRI scheduled, but I wanted to clarify your thoughts on me working out. as I dont have pain in the majority or my range of motion, is it ok to continue to work out as long as I stay away from things that cause discomfort? I would be happy to just do normal push ups as a scale instead of an overhead press for example. Push ups dont seem to bother me, where as a OHP with load does bother me. strict pull ups don’t seem to bother me, where as Kipping can.

    I will be happy to consult with my coach and scale things appropriately, unless, you think that I should just completely back off on all things arms until we know for sure what is going on. Let me know what you think. ( i really could spend some time working on my double unders anyway)

    thanks again for your help….

    Brian

    • avoiding painful things is good. Check and see if it hurts more 1 or 2 days later and be vigilant.

    • Hey Brian, Avoid painful things and be careful with heavy anything

  17. I am currently in the process of rehabbing my shoulder to avoid surgery. I am about 4 months out doing one arm crossfit workouts and rehab on the injured shoulder. I have been told I have a torn labrum and a glenoid defect. I was cleared to start back with 2 arm workouts last week. I have started back very light with no over head stuff and no hanging stuff, and no kipping. After 2 workouts my shoulder pain is back to where it was when I stopped. So I think I am surgery bound. I feel I wasted 4 months of recover time. I am 41 the dr. is a shoulder and arm specialist and feels confident about the surgery. I can find lots of information about the labrum surgery, but for the glenoid defect he is wanting to do a microfracture surgery. I can find lots of info on microfracture on the knee, but not so much on the shoulder. What are your opinions on the microfracture surgery and what is the recover time on this type of surgery? I am hoping to be able to do crossfit again as I really enjoy it. Even if I can RX every workout that uses heavy weight. I am concerned that my strength is my motor and I don’t want to lose that while in recovery being a triathlete and obstacle course racer cardio is my strength.
    thanks
    DW
    Thanks

  18. Microfracture is an okay procedure for defects. It is the first step if needed. If it is a big defect microfracture not a great procedure.

  19. Thank you for the information.

    I am an avid road cyclist and runner. I can’t seem to locate much information about the appropriate time to resume running?

    Thanks

  20. Dr. Rockett do you offer any on-line consulation? i.e. review of existing MRI’s and discusss options? I’m near Washington, DC, am a 52 year old female CrossFitter (2.5 years in). Shoulder issue 18 months. I can give specifics but need another opinion. Recent doctor said “no human being should EVER lift anything heavy overhead”. I’m stuck. Thank you for your time.

  21. Yes you can talk to Denise in my office 617 527 5040

  22. Hi Dr. Rockett,

    Just wondering your thoughts on running. I see a lot of the protocols that hold off for 3-4 months before allowing running. I was told this is due to the jarring on the shoulder and how it might effect the repair? What are your thoughts on running and how does it fit into your protocol?

    Thanks,

    Kevin

  23. hello sean……i had an mri of my shoulder…operated for bankart lesion….the labrum is properly attached……the acromio-humeral distance is 8mm but subacromial distance is 6.78 i.e. less than 7mm…..the person who wrote my mri report says that it isn’t significant as it is not too less than the required distance..and asked me if i had pain during abduction which i don’t have………but when i back squat/front squat heavy….i have pain after the workout which extends below the elbow and sometimes upto the wrist and it keeps on moving from point to point….i don’t have any pain in rotations or any other shoulder exercises like presses,bench press,pushups etc…..can it be due to neck issues??or due to weaker trapezius as i haven’t been doing any trapezius strengthning…before injury i used to do lots of clean and snatch pulls….which after the injury haven’t been regular…also the pain goes away when i massage the neck+trapezius regularly and sometimes it goes into my head….please help…thanks in advance

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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