- Hi, and welcome to Phase 2
of your rehabilitation following surgery.
I'm Marty Kelly with Penn Rehab
and I'm going to show you exercises
that you would start six weeks after your surgery.
You want to do these exercises only after six weeks
because they're a little bit more progressive.
So if you're not at six weeks,
go back to your Phase 1 exercises.
The next exercise I'm going to show you
is called shoulder extension.
This typically starts six weeks postoperatively,
but in some cases, it can start somewhere up to 12 weeks postop.
So just contact your physician or he will tell you about that.
The way we're going to do this exercise
is you're going to hold onto your stick,
cane, golf club, whatever you're using.
Your hands are about shoulder-width apart.
The elbows are relatively straight,
the palms facing back.
You're going to turn and face me.
And now I'm going to have you lift back.
Your nonsurgical arm will help the surgical arm.
You'll take it to the point where you feel some stretch.
Don't force the motion.
You're going to hold that for about 10 to 15 seconds.
You're going to do that 10 times.
When you come out of the position,
you'll rest for a few seconds
and then move back into it again.
The next exercise I'm going to show you
is shoulder internal rotation.
This exercise is done six weeks postoperatively
but sometimes you may not start that up to 12 weeks.
Talk to your physician about that.
So the way we're gonna do this is,
we're gonna have the hands
kind of, slide toward each other,
but if you cannot get your hands together
then you want to try to separate them to comfort, all right.
So you separate them to the point
where you feel a little bit of discomfort.
If you can get your hands to touch, perfect.
From wherever your hands are where you're comfortable,
you then want to slide the hands up the back
to the point where you feel that increase in stretch.
Again, don't force this stretch.
It's just to the point you feel an increase in pain.
You're going to hold that for 10 to 15 seconds
and then you'll slide it back down.
Give it a few seconds' break and repeat the process.
You're going to do that 10 times,
doing that 3 times a day.
The next exercise I'm going to show you
is horizontal adduction or cross-body stretch.
This is typically done six weeks postoperatively
although in some surgical procedures,
it may not start for 10 to 12 weeks.
Talk to your physician about that.
To do the exercise,
you're going to reach across with your nonsurgical arm,
and you're going to hold behind your elbow.
So you're really trying to relax the surgical arm.
You can bring this across the chest
typically in a lower position is better to begin
because the higher you go,
you'll actually be compressing the rotator cuff
and/or the surgical area of most surgeries performed.
So start low on the chest.
You're going to pull across and into you.
You'll stop at the point
where you feel the beginning of discomfort.
You're going to hold that for 10 to 15 seconds.
You'll come out of the position a few seconds.
Give it a break and then repeat that process again,
holding 10 to 15 seconds.
You're going to do that 10 times.
Do that 3 times a day.
Your therapist may talk about doing this one
a little bit more through the day,
maybe up to 5 times.
We're going to start exercises
that are designed to lift the weight of your arm.
Now you've got to realize that your arm has weight to it.
You don't need to put an extra weight in it when you move.
But the weight of the extremity changes
based upon where you are to gravity.
For instance, if I were to place Bryson's arm in this position,
it hardly weighs anything relative to gravity,
but if he were standing and his arm were out
in the same position,
this is where his arm weighs the most.
So early on when we begin rehabilitation,
we're going to just use the weight of the extremity
and change your body relative to gravity.
One of the initial exercises we're going to use
the other arm to help raise his surgical arm.
So we're going to start with the elbows bent.
Now here's another little physics issue.
If the elbow is bent versus the elbow straight,
the arm weighs less with the elbow bent.
So we're going to start with the elbow bent,
a little less stress on the surgical site,
and I'm going to ask Bryson using his nonsurgical arm
and his surgical arm to lift the stick/cane/golf club
up to shoulder level and then continue
as far as he can over the head
and then hold that for 10 to 15 seconds.
He's going to hold it there.
He stops at the point where there's discomfort.
It's not going to really create significant pain.
Bring the arm back down, elbows are bent,
return to the initial start position.
So again, this is activating muscles,
still protecting the surgical repair.
These exercises are done after six weeks.
Let me have you do it again. Bring it on up.
The right arm is assisting.
Over time you can assist less with your nonsurgical arm.
In between reps, you wait 3 to 5 seconds,
give a little break.
Now to progress this, bring it on down.
You would then start with the elbow straight.
The arm weighs more.
Bring the arms up and if you'll notice,
it will feel significantly different
because there's much more weight to your arm,
more tension on the surgical repair site
or the surgical site itself.
And again, same thing, 10 to 15 seconds.
Talk to your physical therapist about when to progress
from elbow bent to elbow straight.
Okay, you're at a point now where you no longer
need assistance of the nonsurgical arm.
So I'm going to have Bryson go ahead,
bring the arm in this position.
Elbow is bent. It weighs less.
He's going to go ahead
and reach on up over the head and continue on up.
Gets that stretch.
He's going to hold that for 10 to 15 seconds.
After 10 to 15 seconds, bring the arm down,
bend the elbow.
Again, I would recommend doing it
with a doubled-up pillow underneath your arm.
When that becomes easy to do,
then you straighten the elbow out.
The arm weighs more. Bring the arm up.
It's like putting a weight in your hand
just by straightening your elbow;
10- to 15-second stretch.
Again, talk to your physical therapist
about when to progress from elbow bent to arm straight.
You will repeat that 10 times, doing that 3 times a day.
This next exercise is a table slide.
This is again to activate muscles of the shoulder
but still have some support of the extremity
by the table.
So go ahead and lean forward.
As he leans forward, he's using his muscles
to slide that arm forward.
He's going down as far as he can.
That's increasing his elevation range of motion.
So again active-assistive exercise.
You're going to hold that 10 seconds,
bring it back on up, doing that 10 times.
This next exercise is a ball roll exercise.
It can be done sitting. It can be done standing.
We're going to show the sitting exercise.
Now you may not have a ball this big,
but you can use a basketball, soccer ball.
You're going to place your hand on the ball
and then you're just going to reach forward.
The ball is supporting the weight of the extremity
but muscles are being used.
So if you're using a soccer ball or a basketball,
your arm may not go as high.
Bring it on back.
But you're still getting activity and support
from the ball.
Go ahead forward again.
Now this one you don't need to hold this.
This is just a movement back and forth.
I really want you to concentrate on moving the arm
and not shrugging the shoulder.
Let me have you kind of shrug the shoulders.
We don't want to do that. Bring it back down.
Relax.
Do it again. Kind of shrug as you do it.
We're trying to really just get arm motion.
Bring it on back down.
So relax your shoulder, reach forward,
and back and forth just holding for a couple seconds,
doing that 10 to 20 times
and you can do that 3 times a day.
So we showed you doing the exercise
where you're doing a single-arm raise
with the elbow bent and straight
and you can progress that
and talk to your physical therapist about this.
If you begin to incline yourself,
so if you have a recliner,
set that recliner back so you're inclined somewhat
and then you repeat the same exercise.
Elbow is bent.
You're going to reach over the head,
but because you're at an angle, your arm weighs more
because now you're becoming more vertical,
and that's adding resistance.
So you can use your recliner to do that.
You can use a beach chair or a chair that you use outside
if you're in the summer months that will be angled up
and you progress that exercise
based upon how much you angle it.
So the more vertical you are, the straighter your arm is.
Discuss that with your therapist.
You would raise the arm, hold for 10 seconds,
bring the arm back down.
Start with the elbow bent
and then progress with the elbow straight.
If you stick to a consistent program
and do these exercises properly,
you'll be ready to move on to the final stages of your rehab.
And really, most importantly you'll be ready to go back
to doing those activities that you did before surgery.