Physical therapy is an essential component of recovery following subacromial decompression surgery. It helps patients restore strength, flexibility, and functionality in the shoulder while preventing stiffness and future injury. This article explores the role of physical therapy, the phases of rehabilitation, key milestones, and common exercises used to support recovery.

The Role of Physical Therapy

Subacromial decompression surgery relieves impingement by increasing space in the shoulder joint. However, the surgery itself may cause temporary stiffness, weakness, and limited range of motion. Physical therapy is designed to:

  • Prevent Stiffness: Gentle stretching and passive movement maintain joint mobility.
  • Rebuild Strength: Gradual strengthening of the rotator cuff and surrounding muscles ensures shoulder stability.
  • Improve Range of Motion (ROM): Therapy helps restore the ability to lift, rotate, and move the arm without restriction.
  • Promote Healing: Controlled movement encourages blood flow to the surgical site, aiding in tissue repair.
  • Prevent Compensatory Movements: Proper exercises prevent overuse of surrounding muscles and ensure balanced shoulder mechanics.

Phases of Physical Therapy

Recovery through physical therapy occurs in distinct phases, each with specific goals and milestones.

Phase 1: Immediate Post-Surgical Recovery (Weeks 1-3)

Goals: Minimize pain, reduce swelling, and prevent stiffness.

  • Passive Motion: A physical therapist moves the shoulder gently to maintain joint mobility without stressing healing tissues.
  • Pendulum Exercises: Simple movements where the arm dangles and swings in small circles to promote gentle motion.
  • Cold Therapy: Ice is often applied after therapy sessions to manage swelling and pain.
  • Avoidance of Active Movement: During this phase, patients should avoid lifting or actively moving the arm.

Milestones:

  • Pain is well-controlled.
  • Early shoulder motion within a comfortable range.

Phase 2: Early Rehabilitation (Weeks 4-6)

Goals: Begin light active movements and improve shoulder flexibility.

  • Active-Assisted Exercises: Patients use their non-operated arm or a tool (e.g., a stick) to assist in shoulder movements.
  • Wall Crawls: Gently walking the fingers up a wall to increase shoulder elevation.
  • Isometric Exercises: Static exercises that contract the shoulder muscles without moving the joint, such as pressing against a stationary object.

Milestones:

  • Achieving pain-free passive range of motion.
  • Improved ability to perform light daily activities like grooming or dressing.

Phase 3: Intermediate Rehabilitation (Weeks 7-12)

Goals: Restore active range of motion and rebuild shoulder strength.

  • Active Range of Motion (AROM): Exercises to lift and rotate the arm without assistance.
  • Resistance Band Exercises: Using light resistance bands to strengthen the rotator cuff and scapular muscles.
  • Scapular Stabilization: Focused exercises to improve the coordination of the shoulder blade during movement.

Milestones:

  • Active motion close to pre-surgery levels.
  • Reduced stiffness and increased endurance in the shoulder.

Phase 4: Advanced Strengthening and Functional Recovery (Months 3-6)

Goals: Full recovery of strength, endurance, and range of motion.

  • Weighted Exercises: Gradual incorporation of light dumbbells to build strength in the shoulder and arm muscles.
  • Plyometric Training: For athletes or active individuals, advanced exercises like ball throws may be introduced to mimic sport-specific movements.
  • Endurance Exercises: Longer sessions with resistance bands or weight machines improve stamina for repetitive tasks.

Milestones:

  • Full, pain-free range of motion.
  • Strength and function restored for most daily activities and recreational pursuits.

Key Exercises to Support Recovery

Here are some commonly recommended exercises in each phase of physical therapy:

Phase 1: Passive Motion and Gentle Mobility

  • Pendulum Swings: Lean forward and let the arm hang freely, moving it in small circles or back-and-forth motions.
  • Supine External Rotation: Lie on your back and use the non-surgical arm to gently rotate the operated arm outward.

Phase 2: Assisted and Light Active Movements

  • Wall Crawls: Walk your fingers up the wall, reaching higher over time as mobility improves.
  • Stick-Assisted Shoulder Flexion: Use a dowel or stick to assist in lifting your arm forward.

Phase 3: Active and Strengthening Movements

  • Resistance Band Rows: Anchor a resistance band and pull it back toward your body to strengthen the upper back and shoulders.
  • Scapular Retractions: Squeeze your shoulder blades together while keeping your arms by your sides.

Phase 4: Advanced Strength and Functional Training

  • Overhead Dumbbell Presses: Lift light weights overhead to build endurance and strength.
  • Ball Tosses: Throw a lightweight ball against a wall to simulate sports or functional activities.

Milestones for Successful Recovery

  • 6 Weeks: Improved mobility and light activity without significant pain.
  • 12 Weeks: Full active range of motion with minimal discomfort.
  • 6 Months: Restoration of shoulder strength and return to normal activities, including sports.

Common Challenges and Tips for Success

Challenges

  • Pain or Stiffness: Normal during the initial phases, but severe or persistent pain should be reported to your therapist.
  • Plateaus in Progress: Recovery may slow down at certain stages, requiring patience and continued adherence to therapy.

Tips for Success

  • Stay Consistent: Regular therapy sessions and home exercises are crucial.
  • Listen to Your Body: Avoid pushing through sharp pain to prevent re-injury.
  • Communicate with Your Therapist: Share concerns and progress to adjust your therapy plan as needed.

FAQs

  1. How soon can I start physical therapy after subacromial decompression?
    Physical therapy usually begins within the first week after surgery to maintain mobility and prevent stiffness.
  2. Can I do therapy exercises on my own?
    Home exercises are an essential part of recovery, but it’s important to follow your physical therapist’s guidance to avoid overexertion or improper techniques.
  3. How long does physical therapy last?
    Most patients participate in therapy for 3-6 months, with some continuing advanced exercises for up to a year, depending on their goals.
  4. Will physical therapy be painful?
    Some discomfort is normal, especially during stretching or strengthening. However, therapy should not cause sharp or severe pain.
  5. Can physical therapy fully restore my shoulder?
    With consistent effort, most patients regain full range of motion and strength. Advanced recovery depends on individual goals and adherence to the rehabilitation plan.

Physical therapy after subacromial decompression is a critical step in achieving a full, functional recovery. By progressing through structured phases of rehabilitation, adhering to exercises, and collaborating with your therapist, you can regain pain-free mobility and return to your daily activities and favorite pursuits.