Shoulder Surgery Rehab - Does My Physio Know What He's Doing?

[meth0dz]

Hello,

I had arthroscopic surgery on October 29th, 2009 for a 9'o clock to 12'o clock posterior and anterior labral tear. It was repaired using 4 sutures.

My doctor recommended I stay in a sling for 6 weeks post op, and that I should be able to return to football at the 6 month point.

Now it's been 12 weeks. There have been a few times where I've moved it weird and was worried I hurt it, but I try to stay positive. I've been going to physio once a week and getting it stretched out which is really painful. I also noticed something weird where if I relax the muscles completely in the arm that had surgery, I can push on the outside of my deltoid and shift the muscle/make it crack. It would hurt very much to do this at the beginning but it's got better and doesn't hurt as much or happen as easily now.

The physio has had me doing 3 movements every day to assist in stretching the shoulder, they are: Putting my arm behind my back and pushing it up as far as I can go with my good arm and holding for 10 seconds, externally rotating as far as I can and holding it, and putting my arm on a table and learning over until I'm at 90 degrees or more and my arm is above my head.

Last Wednesday was the first time lifting weights with my shoulder. I went to the physio and he had me using light weights (3lb,5lb,8lb) lying on my good side and doing external rotations, side raises, and some other ones until failure. I was getting sharp pains while doing some of them but I am told this is just the scar tissue loosening. It was quite grueling but I trust that my physio knows what he is doing.

Yesterday was my first time doing upper body in the gym with assistance and supervision from the physio. Let me say, it was a very painful experience. It seems that he was pushing me rather hard, but again, I trust him. He is the head physio on my football team and also has worked with professional and Olympic athletes.

The ones he had me doing which caused lots of pain, which I hope was just loosening of the scar tissue, was hanging from a bar in a chin up position while attempting hang using all my weight and turn to the side. Another was push ups on a big exercise ball where you only go down a couple inches; ten times, and assisted chin ups. He basically said to just push through the sharp pain. He also had me doing some side and lateral raises with cables and some 15lb dumbbell presses. Does this seem like a little much for the first time?

When I got home from the gym, my shoulder ached like crazy and I didn't dare move it too much, so I just iced it, and its feeling a little better now. Another thing I am curious about is doing sprinting. When I saw my doctor last week, he said to wait another 6 weeks until sprinting as the surgery is still healing. When I asked my physio, he said I could start in the next week. Who should I listen to? Is my physiotherapist pushing me too hard and too fast? The physio is a very well respected professional in my city.

I would appreciate any thoughts or opinions.

Thank you

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[physiochile]

Hey methodz... my personal opinion and being a football player my self... the streching exercises are fine....my opinion is that before doing strengthing exercises you should always do isometric exercises for shoulder stability and once the shoulder is stable then go into strenth exercises ( concentric, excentric).....I think maybe you are pushing your self too hard ..if the pain is too much you should try and go slower... and to me seeing a physio once a week is not enough if your trying to get on the field soon.
hope this helps

[gaf1986]

Hi, sorry about the short reply, will try get back to you with more detail later but I need to get some sleep! My first thoughts are that your progressions should be a lot more gradual and totally agree with physiochile that stability of the rotator cuff and scapular stabiliser strengthening needs to be done ALOT before doing concentric exercises with weights. Coming up to 3 months post-op things should be pretty well healing up at that stage and I'd expect your sessions to become more agressive, but wouldnt ususally expect patients to have significant pain still. And at the end of the day the surgeon is the one thats been inside your arm so to speak and knows exactly what his done so I'd always suggest following their advice, most surgeons have their own post-op protocols they want the physio to follow to ensure the best outcomes. You can find examples of these protocols and guage where your at compared to what your currently doing if you search for SLAP lesion repair protocols. To be fair though, sounds like you have a well experienced physio and has prob handled loads of patients similar to yourself so I'd suggest he knows the right patients to push and those that need to take it easier!
Good luck anyways, hope this helps put your mind at ease!

[physiobob]

I would also say that this progression is way to much to soon. You should have good passive range of movement before beginning some gentle weighted exercise. You should not have to push into or through pain in any shoulder injury as I have usually found that completely counter productive. Hanging from the chin-up bar is a full body, end of range position on the GH joint and this would be a huge stress on the shoulder structures.

Basically I would listen in this case to your surgeon. They saw the damage, the did the sutures and it's there call. Make sure you get some good communication going with the PT and ask them for reasons for why they are prescribing each exercise. They may have a good justification, just I can't think of one right now?!

[vam44]

I would agree with Physio Dude. especially in relation to the chin ups and end range stretches. Your physio should work with the surgeons advice. Stability of the gleno humeral joint and the scapulothoracic should be the highest priority and this can be done most safely in unloaded positions such as prone with the arm dangling over the side of the bench. I you are up to free weights then you must be able to lower the weights down ( eccentric movements) without the muscles shaking and the movements should be smooth and controlled. The exercises on the ball sound great to me though as this encourages good muscle cocontractions around the G/H joint

As far as running is concerned I wouldnt be as concerned about gently running to restore general as dangling on your arm Its a lot to ask of a repaired labrum!

The last thing that you would want is a long standing shoulder problem so I would think that you should take rehab one step at a time and only progress when you have achieved really good strength

good luck

[meth0dz]

Thanks for the helpful replies everyone.

It's been a few weeks since I posted my initial question and my shoulder is undoubtedly improving.

I have asked my physio why he had me doing the aggressive work outs in the gym and he said it's because the joint healed really tight from being in a sling for 6 weeks and we need to break down the scar tissue. We have also moved on to Olympic lifts such as cleans and dead lifts.

Lately, I've been going to physio twice a week so he can stretch my shoulder out. To be fair, it is an excruciating experience. He has me put my hands behind and above my head and pushes them far past my pain threshold. Last week we literally heard a loud rip inside the joint while he was performing this maneuver, which caused me to let out a rather choice word in the clinic. He said the ripping is completely normal and something that we are actually striving to achieve. Apparently I am in for a few more good rips in the coming weeks - lucky me.

He also explained that if we weren't to stretch it out, the joint would heal tight permanently and I may never regain a full range of motion. It's basically a battle against the scar tissue.

As far as the sprinting, I have been doing it at about 80% and haven't noticed any significant pain.

I will keep this thread updated with my progress. I would be interested in hearing any further insight into this situation as I haven't found as much information as I would have expected about the scar tissue from a labral repair.

Thanks again