Dr. Mullen believes in a team approach when it comes to treatment of orthopedic injuries, regardless of whether or not surgery has been performed. However, once a patient has surgery, it becomes imperative that the surgical repairs be adequately protected while reaching rehab goals.
There are three essential parts to successful outcomes in Orthopedic Surgery of the knee and shoulder and recovery from sports injuries.
PHYSICIAN
Accurate diagnosis is extremely necessary in order to provide effective treatment and appropriate treatment recommendations must be made in a timely fashion. If surgery is necessary, the surgeon’s skills must be meticulous, as surgery is as much an art form as it is intellectual. Experience is important.
PATIENT
Patients need to have a basic understanding of their problem and the treatment plan. The surgeon should provide information, supported by scientific literature, which allows the patient reasonable expectations for a successful outcome. In order to facilitate the best possible results, the patient must actively participate in their own care by following the treatment plan from start to finish.
PHYSICAL THERAPIST (PT)
Physical therapy cannot be overlooked as it can often mean the difference between an excellent outcome and a less than satisfactory one. This is especially true after any reconstructive procedure, and particularly those of the shoulders.
Insurance carriers have drastically cut the number of annual supervised physical therapy visits, regardless of the number or scope of problems a patient may have. As a result, it has become increasingly more important for physical therapy to be as efficient as possible. Dr. Mullen understands that while participating in proper rehab is critical, accessibility has become limited, as a result of many insurance carrier restrictions on annual visits allowed and the co‑pay cost of each visit.
A home program alone is a poor substitute for working with a skilled physical therapist, but the following guidelines outline a home program for those who simply cannot afford a supervised physical therapy program.
WARNING
In order to properly rehab a shoulder after an arthroscopic RCR, you must understand the current thinking of shoulder biology, biomechanics, repair techniques and timing of specific exercises during rehab of the rotator cuff. The knowledge and manual skills of a physical therapist will impact the outcome. Introducing the wrong exercises at the wrong time with the wrong technique may result in detrimental outcomes. It only takes one mishap during a critical phase to influence a poor outcome.
The series is designed to progress through a graduated program. Phase 1 involves range of motion exercises for post‑op patients and those with a stiff shoulder. Phase 2 introduces safe and proper strengthening exercises to address all of the muscles that are important in shoulder function. Phase 3 is advanced and challenges the shoulder muscles further in order to return to sports and higher levels of activity.
PHASE I: RANGE OF MOTION
These exercises are indicated for patients who have range of motion loss or tightness in their shoulder limiting motion. It is important to do these exercises slowly and several times per day to ensure that your shoulder gains the necessary range of motion needed for functional activities. Each exercise works a specific range of motion. Doing 5‑10 repetitions of each exercise several times per day will provide a training stimulus to increase your shoulder range of motion. Holding the end range of motion to impart a "stretch" is of utmost importance. Holding this end range position for 5 to as much as 15 seconds will provide a proper stretch to help improve your motion. Pain at the end range of motion can be encountered, and it is important to gain clarification as to whether a mild or moderate level of pain is acceptable for your condition from your doctor or therapist. With all exercises if significant pain is encountered consult your doctor or therapist for more information and evaluation.
Overhead Pulley facing the wall (easier)
Overhead Pully with your back to the wall (advanced)
Supine forward flexion
External Rotation at 45 degrees of Abduction
External Rotation at 90 degrees of Abduction
Internal Rotation up the back with a stick
Cross Arm Adduction Stretch
Sleeper Stretch
PHASE II: STRENGTHENING
The exercises listed in Phase II and III are recommended to improve strength and local muscular endurance of the shoulder and scapular (shoulder blade) region. It is important to perform the exercises slowly and with control using the proper resistance. Different color tubing or bands provide different resistance levels. It is important to use the resistance level and elongation level that allows you to do multiple sets of 15 repetitions of the exercise with proper form. A common error by many patients is to use too much resistance, thereby jeopardizing technique and overloading the shoulder structures. YOU SHOULD NOT HAVE PAIN DURING THE PERFORMANCE OF THESE EXERCISES. If any exercise causes pain, discontinue that exercise and consult your doctor or therapist. You should feel fatigue in the shoulder and upper back muscles during proper performance of these exercises. Perform these strengthening exercises one time per day, allowing the exercising muscles time to recover unless otherwise instructed by your therapist or doctor.
External Rotation Step Outs
Internal Rotation Step Outs
Standing External Rotation
Standing Internal Rotation
Standing Extension
Side Lying External Rotation
Side Lying Shoulder Flexion
External Rotation with Scapular Retraction
PHASE III: ADVANCED STRENGTHENING
The exercises listed in Phase II and III are recommended to improve strength and local muscular endurance of the shoulder and scapular (shoulder blade) region. It is important to perform the exercises slowly and with control using the proper resistance. Different color tubing or bands provide different resistance levels. It is important to use the resistance level and elongation level that allows you to do multiple sets of 15 repetitions of the exercise with proper form. A common error by many patients is to use too much resistance, thereby jeopardizing technique and overloading the shoulder structures. YOU SHOULD NOT HAVE PAIN DURING THE PERFORMANCE OF THESE EXERCISES. If any exercise causes pain, discontinue that exercise and consult your doctor or therapist. You should feel fatigue in the shoulder and upper back muscles during proper performance of these exercises. Perform these strengthening exercises one time per day, allowing the exercising muscles time to recover unless otherwise instructed by your therapist or doctor.
