Rehabilitation exercises for rotator cuff injury are divided into four phases
Phase training I (0-3 weeks after surgery, maximum protection period)
During this phase, an external fixation brace is given to immobilize the shoulder joint. This is because tendon a bone healing generally takes 6-8 weeks and the postoperative shoulder is generally placed in an abduction rest position, generally 3O°-45° of abduction, for 6 weeks. The abduction position reduces the tension on the suture site, allowing for better healing. However, joint adhesions may occur if joint mobility exercises are not performed until 2 weeks postoperatively. Therefore, the main objective of this phase of rehabilitation is to protect the surgical repair site, reduce pain and inflammatory response, and gradually increase shoulder mobility. The content mainly includes active movement of the elbow and wrist joint, passive movement of the shoulder joint and scapular stability exercises.
1. After surgery, the affected shoulder should be braked. When sleeping at night, a pillow can be placed behind the upper arm to support the shoulder, so that the shoulder is in the most comfortable position. On the 1st postoperative day, take the initiative to move the wrist and elbow joints.
(1) Palmar flexion and dorsal extension: Slowly extend the wrist joint of the affected limb dorsally to the limit, then slowly flex it to the limit, one extension and one flexion is one stroke, 12-36 movements each time, 2-3 times a day.
(2) Left and right palm swinging: Straighten the five fingers of the affected limb and swing the palm back and forth to the ulnar and radial sides. One back and forth is 1 stroke, 12-36 strokes each time, 2-3 times a day.
(3) Elbow rotation: Support the upper arm of the affected limb with the healthy hand to brake the affected shoulder, and gradually rotate the elbow joint, one stroke for each 12-36 strokes, 3-5 times a day.
(4) Elbow flexion and extension: Support the upper arm of the affected limb with the healthy hand to brake the affected shoulder, and gradually extend and flex the elbow, one extension and one flexion is 1 stroke, 12-36 strokes each time, 3-5 times a day.
2.According to the individual condition, in the 2nd or 3rd week after surgery, remove the brace during training and practice passive shoulder joint and scapular stability exercises.
(1) Pendulum exercise: the patient’s body is bent forward (stooped), hands are down (or healthy hands are holding the table), do backward and forward swing and clockwise and counterclockwise circle, 5-10 times/day. Make sure the exercise is passive, initiated by the trunk and drive the shoulder joint in different planes to do small arc movements.
(2) Passive forward flexion exercise: supine position, with the affected upper limb in 30°-45° of abduction, the healthy hand grasps the affected forearm and passively elevates the affected limb with the assistance of the healthy upper limb, 3-5 times a day for mobility exercises, avoiding pain during training.
(3) Passive external rotation exercise: supine, the affected upper limb is in 30°-45° of abduction, with a towel roll under the upper arm to keep the humeral head in the scapular plane, and the healthy upper limb holds the treatment stick horizontally to assist the affected shoulder in external rotation activities.
(4) Freehand scapular resistance loosening: the patient is lying on his side with the healthy side facing downward, the physician assists the patient to perform forward extension, retraction, elevation and depression of the scapula, after training to a certain degree, gentle resistance is applied freehand to perform resistance scapular activities.
Caution.
1.Extra-training brace abduction rest position suspension brake
2.Prohibit active movement of the shoulder joint on the operated side
3. Avoid exceeding the range of motion prescribed by the surgeon.
Phase 2 (4-6 weeks after surgery, moderate protection period)
The main objective of this phase is to continue the exercises of the first stage, improve joint mobility, reduce postoperative pain and start gentle active activities of the rotator cuff muscles and deltoid. The activities are mainly anterior flexion and external rotation, avoiding active arm elevation.
1.Active forward flexion exercises: supine position, the affected upper limb is in abduction 30°-45°, active lifting of the affected limb, if the effort can be placed above a pulley, lifting the affected limb with the help of heavy objects or the healthy limb, 3-5 times a day, gradually increase the exercise activity, avoid pain during training.
2, wall climbing exercises: standing on the wall, the affected side of the hand holding the wall, fingers climbing upward, step by step. Each time 10-20 round trips, 3-5 times a day.
3.Isometric contraction of rotator cuff muscle group: The patient is supine, the shoulder joint is abducted 30°-45°, a pillow or a folded towel is placed under the distal end of the upper arm, a gentle resistance is applied to the forearm in all directions, so that the patient can perform rhythmic stability exercises against unarmed resistance to trigger a mild isometric contraction of the rotator cuff muscle group.
4. Deltoid isometric contraction exercises: in the standing position, a towel roll is placed under the inner elbow of the axilla, so that the arm has a gentle abduction (modified neutral position), the elbow is flexed at 90° and the lateral shoulder is leaned against the wall, and resistance to wall resistance isometric contraction of the deltoid and rotator cuff muscles is performed.
Phase 3 of training (7-12 weeks postoperatively, early functional exercise and muscle strength building period)
At this stage, the abduction brace of the affected limb is removed and full range of shoulder mobility is restored, but all training is kept below the plane of the shoulder joint, and the patient can perform the following exercises.
1. Elbow flexion and shoulder extension: With the upper arm as the axis of rotation, the forearm is inward and outward along the horizontal position as much as possible. One contraction and one extension is 1 stroke, 12-36 strokes each time, 3-5 times a day.
2. Inward shoulder exploration: flex the elbow of the affected limb, support the elbow of the affected limb with the healthy limb, make the affected limb inward, probe the healthy shoulder as far as possible with the affected hand, and gradually probe the healthy scapula backward, and repeat the above action after restoration. Repeat the above action after restoration. 12-36 times each time, 3-5 times a day.
3.Abductor pointing: straighten the affected limb and lift it forward to a horizontal position, then abduct it 90° and restore it, 12-36 times each time, 3-5 times a day.
4.Wall climbing exercise: stand facing the wall, the affected side hand holding the wall, fingers climbing upward, step by step. Each time 10-20 round trips, 3-5 times a day.
5.Passive abduction and external rotation: Lie on your back with the upper limb on the affected side at 90° of abduction, with a towel roll under the upper arm to keep the humeral head in the scapular plane (about 30° angle with the bed), and the upper limb on the healthy side holding the treatment stick horizontally to assist the affected shoulder in external rotation.
6.Inward shoulder exploration: supine position so that the scapula is fixed, the affected limb is placed in front of the chest to try to lap the healthy shoulder, while the healthy limb is assisted to pull medially.
Phase 4 (after 12 weeks postoperatively, late muscle strengthening period)
The rehabilitation goal of this stage is to solve the problem of residual mobility and to bring the muscle strength and flexibility to normal level, especially paying attention to the posterior joint capsule stretching exercise. Overhead exercises should be attempted only after the flexibility and stability of the joint capsule and ligaments have been restored. Resistance exercises can be performed as early as 12 weeks after surgery, and resistance and stretching exercises should be continued until 1 year after surgery to maximize muscle strength and obtain the best results. Combined movement exercises for shoulder joint mobility.
1.Continue the posterior joint capsule stretching: The patient lies on his side, the shoulder joint is flexed forward 90°, the healthy hand grasps and stabilizes the affected limb, and the posterior joint capsule stretching is performed by body gravity, the force gradually increases, so as not to induce serious pain.
2.Rowing action or swimming action: this action can be used to practice the movement of the shoulder joint by combining various actions, such as internal contraction, abduction, internal rotation, external rotation, forward flexion, back extension and supination. 3 times/d, 20 minutes/time.
3.Dumbbell exercise: Hold a 2-3kg dumbbell on the affected limb to perform shoulder abduction and supination exercises, you can exercise with the rhythm of music, 8 sessions as a group, 1 or 2 times a day.
Note: The rehabilitation program is individualized according to the patient’s occupation (athlete or non-athlete), injury, surgery, etc.