Better Surgical Outcomes
Some important facts to know before and after surgery - maximize your recovery with specialty MSK physiotherapy.
A guide to surgical recovery
Pre-operative planning
Managing your sling time
Protecting your surgery
Protecting your surgery
Managing your sling time
Protecting your surgery
Managing your sling time
Managing your sling time
Managing your sling time
Recovery of movement
Returning to work, exercise & sport
Recovery of movement
Recovery of strength
Returning to work, exercise & sport
Recovery of movement
Returning to work, exercise & sport
Returning to work, exercise & sport
Returning to work, exercise & sport
Pre-Operative Planning
If you are having elective surgery, it is important to have a sense of the required sling time as there are restrictions that will affect your transport and day to day activities.
A single session is normally sufficient to explain the surgery, ideal investigations, discuss and practice common exercise methods and plan out the post surgical process.
An examination of your current movement and strength, a discussion about any previous injury history and post surgical goals are important to review prior to surgery.
Learning and practicing your exercises 2-3 days before surgery is recommended.
Protect Your Surgery
After surgery, your surgeon will normally explain how to protect your incision and surgical site(s). Normally you'll have bandages for a couple of days and need to protect the incisions from water for five days to reduce any risk of infection.
Skin healing is often quick and typically at 5-7 days, the wounds are healing adequately. Bruising may occur in the arm and should resolve over time.
You may be advised of exercises to perform after surgery to maintain movement, reduce swelling and assist with pain relief. It is best to have these checked pre-surgically or within the first two weeks after surgery.
The bone and soft tissues can be sensitive for several days and instructions for pain management are important to follow. Adjustments for sleep may need to be made, typically with a more upright position. Pain medication is normally ceased after 3-7 days, but will depend on the extent and type of surgery.
Most shoulder surgeries require full time sling use to reduce activity at the surgical site and protect against any unwanted forces. Exceptions include prescribed exercises that have been given for your particular surgery.
Managing Your Sling Time
Wearing a sling can be quite tiring. Most patients are very happy to see the end of their sling use, and the exact timing should be determined by your surgeon or physiotherapist. This is normally removed after 4-6 weeks post surgery, depending on the type of surgery. Large cuff tears may require longer sling use.
Specific exercises are typically performed two - three times per day for movement and comfort, but will depend on your type of surgery. It can be an advantage to have more than one sling (for showering or during lower limb cardio exercises).
Exercises are prescribed to reduce the possibility of post surgical shoulder stiffness (joint scaring at ACJ, peri-subacromial scarring) during sling use, and should be directed by your physiotherapist.
Keeping forces low are paramount for healing tissue, and this may include restrictions on handling objects or range of movement at particular time periods after surgery.
Recovery of Movement
When you are advised to remove the sling, it may take a week to acclimatize to general movement depending on your pre-operative condition and the extent of your surgery.
Using pillows or cushions for support for the first week is reasonable if your arm is sensitive to the increased activity. Intermittent sling use is acceptable during this period. After removal of the sling, returning to normal activity typically involves light two handed activities and focusing on increasing motion.
The sling can create neck soreness and one or two physiotherapy treatments can be very helpful to settle any of these pains.
Depending on your surgery, you may have regained significant movement while still in sling or your shoulder may be quite stiff. Post surgical stiffness is common in the shoulder. Various methods are employed to reduce this reaction, mainly motion exercises within days post surgically.
It is commonly referred to as post surgical stiffness or post traumatic contracture (stiffness of the glenohumeral joint and / or acromioclavicular joint). Possible causes include swelling in the subacromial space, joint synovitis or capsule thickening / tightening or scarring.
During the healing phases, a variety of exercises, movements and manual therapy techniques are used to recover shoulder motion. Your physiotherapist will advise on the correct exercises to follow, and explain concepts of pressure, exercise frequency and how to interpret pain reactions.
It is common to spend 4-6 weeks after sling removal working on restoring your range of motion and working through any concerns. These time frames may be extended for cuff repairs and shoulder replacements.
Attendance to physiotherapy is normally on a weekly basis until flexibility is recovered. If your shoulder remains stiff for a prolonged period, strength work can be pursued prior to return of full movement.
Recovery of Strength
Strength loss can depend on your pre-surgical fitness and sling time, however some strength loss is unavoidable due to the activity restrictions while healing.
Recovery of strength will be guided by your physiotherapist and in some cases is vital to a strong repair - this is particularly the case for cuff repairs, biceps tendonesis and instability surgeries.
Contrary to popular belief:
- pain is not an effective guide to exercise intensity or selection
- full range of motion may be delayed and strength training can be appropriate prior to full movement
Pace of healing and tissue remodeling are considerations for your physiotherapist to determine with respect to the pace and level of strength training. Adhering to exercise selection, technique and load are important and will be guided by your physiotherapist based on key factors including the extent of your repair, surgical hardware strength and expected or demonstrated healing rates.
Some surgeries are quite robust at 3 months (capsulolabral, biceps and bony repairs), others may take up to 12 months to reach full strength (rotator cuff tears). Your physiotherapist will guide you through this process.
Attendance to physiotherapy is recommended every 1-2 weeks during the strengthening phases, but will depend on your independence and knowledge of recovery.
Return to low strength exercises typically begins at week 6-10 depending on the type of surgery, followed by moderate strength work at weeks 8-16. High strength work should be guided by your physiotherapist.
Returning to Work, Exercise & Sport
The demands of your occupation will determine your return to work date. Some patients can manage relatively sedentary work in sling, while others in active occupations may need two to three months of recovery. Patients requiring higher function or limited by repair strength (such as cuff repairs) may be three to six months. Examples of these high strength occupations could be marine occupations, emergency services and trade / construction work.
Return to exercise and sport are also demand dependent, including evaluating the risk of re-injury and any safety concerns. Body weight support, falling or collision sports require longer healing / restrengthening times before return to training and play.
Additional strengthening activities will vary depending on your exact needs. A return to training and competitive sport will be determined by your physiotherapist and in some cases may be assisted by a sports physiotherapist particular to that sport.
Your physiotherapist will guide you through these final steps.
Cameron is available for full coverage of treatment progressions and return to fitness for sport for all shoulder surgeries.
Returning to Sport & Exercise
