Exercises after rotator cuff surgery

Why this is personal for us

Apex One exists because of a rotator cuff. Our founder tore his skiing and couldn't lift his arm past shoulder height for about a year. He first built the app to count reps accurately for rep competitions, and doing his own shoulder work at home is what turned it into a home rehab assistant. So we know how long this road feels.

He didn't have surgery, and everyone's shoulder is different. What follows is how rehab after a repair is commonly staged, so the protocol your surgeon gives you makes sense.

Your protocol decides the timing

After a repair, surgeons set rules about how long you wear a sling, what movement is allowed and when strengthening starts. They depend on the size of the tear, the tissue quality and the repair itself. Two people who had surgery the same week can be on very different timelines. Never move to the next stage because a website or a friend did. Move when your team clears you.

Stage 1: protection (sling phase)

The focus is letting the repair heal while keeping the rest of the arm and shoulder from stiffening. Typical exercises, if your team includes them:

1. Hand, wrist and elbow movement. Squeezing a soft ball, bending and straightening the elbow with the arm supported. Keeps the rest of the arm moving.
2. Pendulums. Lean on a table and let the arm hang loose. Rock your body so the arm swings in small circles. The arm muscles stay relaxed; the body does the work.
3. Shoulder blade setting. Gently draw the shoulder blades back and down, hold 5 seconds, relax. No arm lifting.
4. Passive range of motion. Your physio, or your other arm, moves the operated arm through an allowed range while its muscles stay relaxed. Only as directed.

Stage 2: active movement

Once you're cleared to use the shoulder muscles, you start moving the arm yourself, usually with help at first.

1. Table slides. Sitting at a table, slide your hand forward on a towel, letting the arm reach as the body leans. Slide back.
2. Assisted raises with a stick. Hold a broom handle with both hands and use the good arm to help lift the operated one forward and up, as far as allowed.
3. Wall walks. Facing a wall, walk the fingers up a little at a time, then slowly back down.
4. Lying arm raises. On your back, raise the arm towards the ceiling and overhead. Gravity helps more in this position than standing.

Stage 3: strengthening

Strength work typically starts with gentle holds and light bands, and only builds once range is back.

1. Isometric rotation. Elbow at your side, press the hand outwards and then inwards into a door frame without moving. Hold 5 to 10 seconds.
2. Band external and internal rotation. Elbow at 90 degrees by your side, rotate out and in against a light band. 2 sets of 10 to 15, slow.
3. Side-lying external rotation. Lying on your good side with a towel under the elbow, rotate the forearm up. Bodyweight first, then a very light weight.
4. Rows. Pull a band towards your ribs, squeezing the shoulder blades together. Builds the upper back that supports the shoulder.
5. Scaption raises. Thumbs up, raise the arms at a slight forward angle to shoulder height. Start with no weight.

Doing the reps well

• Slow beats heavy. Lift for about 2 seconds, lower for 3.
• Stop short of pain. A stretch or muscle burn is fine; a sharp or catching pain is a reason to stop.
• Keep the shoulder down. If your shoulder shrugs up towards your ear, the weight or range is too much for now.
• Do them often. Short sessions done most days usually beat one big weekly effort.
• Write it down. Telling your physio exactly what you did, and how it felt, helps them adjust the plan.

Call your surgical team if

• The wound is red, hot or leaking, or you have a fever
• You feel or hear a pop with sudden pain and loss of strength
• Pain that was settling suddenly gets much worse
• Numbness or tingling in the hand that doesn't go away

Everyday life during the sling phase

• Practise putting a shirt on the operated arm first and taking it off that arm last. Loose, front-opening tops make this much easier.
• Many people find sleeping semi-upright, propped on pillows or in a recliner, more comfortable at first.
• Keep the sling on as instructed, including at night if you were told to. The early weeks are when the repair is most vulnerable.
• Don't lift, push or pull with the operated arm until your team says so, even something as light as a full kettle.

Why the slow pace matters

It's tempting to push when the shoulder starts to feel better, especially if you're used to training hard. The tendon takes much longer to heal than the pain takes to settle, so feeling fine doesn't mean the repair is ready for load. That's why protocols hold back on strength work even when you feel ready for more.

What you can do is be very consistent with the exercises you are allowed. Doing the cleared exercises well, every day, is the part that's in your control.

Questions worth asking your team

• Which stage am I in, and what am I allowed to do with the arm right now?
• When can I take the sling off, and for which activities?
• When can I drive, work at a desk, or return to the gym?
• Which movements should I avoid completely for now?

Life in the sling

• Ask your surgical team exactly when and how to remove the sling for washing and exercises.
• A recliner or propped pillows often make sleeping easier in the first weeks.
• Loose, front-opening clothes are easier to put on.
• Keep your elbow, wrist and hand moving as instructed so they don't stiffen.

Does Apex One have a post-surgery program?

No. Apex One doesn't have a program for after rotator cuff surgery, so follow your surgeon's protocol and your physio. Its rotator cuff program is for a sore or pinchy shoulder without surgery. Don't use it after a repair unless your surgeon or physio says it suits your stage.

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