Advanced Shoulder Post-Fracture Rehabilitation
A 22-week advanced program using dip stations, and barbells to aid in the recovery process.
Professional rehabilitation program designed for effective recovery and pain management.
Key facts at a glance
- Body part
- upper-limb · shoulder
- Injury type
- post-fracture
- Level
- advanced
- Duration
- 22
- Sessions/week
- 3
- Minutes/session
- 20
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview This is a 22-week, advanced-level rehabilitation guide for someone recovering from a shoulder fracture. It uses a dip station and barbell alongside other tools to rebuild strength, motion, and confidence. Sessions run about 20 minutes, three times per week. The plan moves through protective, mobility, strengthening, and power phases. Your clinician guides all decisions, especially about when to advance.
Who This Program Is For and Its Goal This program suits people with a healing shoulder fracture who have been cleared for advanced work and can follow detailed instructions. The goal is to restore shoulder motion, rotator cuff and scapular strength, and sport-specific power while protecting the healing bone and any surgical fixation. It is not a substitute for individualized medical care; your care team adapts it to your fracture type and healing status.
Before You Start Confirm with your clinician that your fracture is healing, any fixation is stable, and you are cleared for resistance and aquatic work. Do not start if you have a recent fracture, unstable fixation, severe muscle wasting, or severe pain. Stop and call your clinician if pain worsens sharply, you feel instability or a pop, numbness or tingling appears, or swelling increases.
Safety Notes and When to Stop Keep the spine neutral and avoid overloading the shoulder, especially early. Build resistance gradually and always cool down afterward. Stop immediately and contact your clinician if you have sudden severe pain, a feeling the shoulder is giving way, new numbness or weakness in the arm or hand, chest pain, or shortness of breath. These signals mean your shoulder needs reassessment, not more exercise.
Weekly Structure Plan for three sessions each week, roughly 20 minutes each, across 22 weeks. Early weeks focus on protected motion, often in water; middle weeks add band and cable strengthening; later weeks introduce barbell and dip-station work plus controlled power drills. Treat the timeline as a guide, not a deadline, and let your clinician adjust based on how your shoulder responds.
How the 22-Week Plan Is Organized The plan progresses through phases in plain terms: protect and move gently, then rebuild motion and strength, then add power and sport-specific work. Aquatic therapy supports early motion with less gravitational load. Blood flow restriction training and taping may support strength and scapular control when appropriate. Bands and cables build rotator cuff and scapular strength, and plyometric and dip-station work come later.
What a Typical Session Looks Like Expect a warm-up, a main block, and a cool-down. Warm up with gentle band or cable movements and scapular control drills. The main work uses your prescribed equipment for that phase, such as aquatic motion, band strengthening, or later barbell and dip-station exercises. Cool down with easy range-of-motion work and relaxed breathing to help the shoulder settle.
Warm-Up, Main Work, and Cool-Down Begin with light band or cable rotations and scapular setting to prepare the shoulder. Move into the main block using the equipment your clinician assigned for that phase, keeping the spine neutral and loads controlled. Finish with a cool-down of gentle stretching and calm breathing. Your clinician adjusts specific exercises, sets, and resistance; this guide intentionally avoids exact numbers.
Tracking Progress Track pain at rest and with activity, your range of motion, and how exercises feel session to session. Your clinician records outcome measures such as the ASES, Constant-Murley, UCLA, and Simple Shoulder Test scores, plus range-of-motion and strength testing. These give an objective picture of progress and help decide whether to hold, adjust, or advance your program.
How Progression Criteria Are Used Your clinician uses phase-specific criteria, such as low resting pain, tolerance of the sling and gentle motion, and stable joint signs, to decide when to move to the next phase. Outcome measures add context, showing whether motion, strength, and function are improving. Progression is a clinical judgment, not a fixed schedule, so expect adjustments along the way.
Recovery and Self-Care Rest between sessions and prioritize sleep and good nutrition to support healing. Use ice or heat only as your clinician advises, and follow any taping or bracing instructions. Keep the shoulder moving gently within allowed limits and avoid positions that strain it. Report changes in pain, swelling, or function promptly so your plan stays safe and effective.
Pain Management and Red Flags Follow your clinician's guidance on pain relief rather than self-prescribing. Mild soreness that settles with rest may be expected, but escalating pain, night pain, new weakness, numbness, or a sense of instability are red flags. Stop the activity and seek clinical review. Never push through sharp pain to "test" the shoulder, since this can slow healing.
Recovery phases
Pain at rest ≤2/10 on visual analog scale,Glenohumeral joint immobilized in neutral rotation with arm at side,No active or passive glenohumeral motion permitted,Digital sensation intact at fingers indicating no brachial plexus compromise,Rotator cuff tendon healing initiated with limited glenohumeral stress
→ Advance to: Phase 2
Pain at rest ≤2/10 on visual analog scale,Tolerates wearing shoulder sling as prescribed,No signs of complex regional pain syndrome in upper extremity,Passive elbow flexion and extension within pain tolerance,Scapular protraction and retraction exercises without glenohumeral motion
→ Advance to: Phase 2
Pain at rest ≤1/10 on visual analog scale,No rotator cuff tendon inflammation signs at subacromial space,Tolerates gentle scapular stabilization exercises,Wound healing complete if surgical approach used,Biceps tendon irritation minimal with elbow motion only
→ Advance to: Phase 2
Pain ≤1/10 at rest, ≤3/10 with gentle movement,AC joint stability maintained without displacement,Glenohumeral capsule healing on track per imaging if available,No labral irritation symptoms with scapular movements,Patient demonstrates understanding of movement restrictions
→ Advance to: Phase 2
Passive glenohumeral flexion to 90 degrees without pain,Passive external rotation to 30 degrees with arm in scapular plane,Active-assisted motion tolerated without exacerbating rotator cuff,Scapular upward rotation achieving 20 degrees passively,Biceps tendon sliding without catching or pain at bicipital groove
→ Advance to: Phase 3
Passive glenohumeral abduction to 90 degrees achieved,External rotation progressed to 45 degrees at 90 degrees abduction,Internal rotation to 70 degrees in scapular plane,Labral stability maintained with controlled glenohumeral translation,No AC joint pain with cross-body adduction movements
→ Advance to: Phase 3
Active-assisted flexion to 120 degrees achieved,External rotation 60 degrees at 90 degrees abduction,Patient demonstrates proper scapulohumeral rhythm without substitution,Rotator cuff activation without compensatory patterns,Serratus anterior activation during active-assisted flexion
→ Advance to: Phase 3
Full passive range of motion in flexion, abduction, external rotation,Active range of motion flexion to 110 degrees,No pain with glenohumeral translation tests for labral integrity,AC joint demonstrating stable articulation without superior migration,Biceps tendon resisting load without anterior shoulder pain
→ Advance to: Phase 3
Active flexion to 140 degrees with proper scapular kinematics,Active abduction to 120 degrees with glenohumeral dominance,Rotator cuff isometric contractions at neutral pain-free,Scapular protraction and retraction against gravity resistance,Lower trapezius activation during arm elevation
→ Advance to: Phase 4
Full active range of motion in all planes approaching pre-injury,External rotation strength 4/5 on manual muscle testing,Internal rotation strength 4/5 on manual muscle testing,Supraspinatus strength 3/5 testing empty can position,Serratus anterior strength 4/5 during scapular protraction
→ Advance to: Phase 4
Pain-free active range of motion in all functional directions,Biceps tendon can tolerate resisted elbow flexion without shoulder pain,External rotation strength 4+/5 at 90 degrees abduction,Rotator cuff kinetic chain integration during throwing motions,Scapular control maintained during loaded arm positions
→ Advance to: Phase 4
Full active range of motion equal to contralateral side,Abduction strength 4/5 on manual muscle testing,Flexion strength 4/5 on manual muscle testing,No labral pain with compression shift test,AC joint pain-free with functional overhead activities
→ Advance to: Phase 4
Rotator cuff strength 4+/5 all directions,Patient reports return to light activities of daily living,Scapular stabilizer strength 4/5 including serratus anterior and trapezius,Biceps tendon load tolerance to 50% body weight,Glenohumeral translation within normal limits
→ Advance to: Phase 4
Shoulder endurance allowing 3 sets of 10 repetitions at moderate load,No recurrence of pain 24 hours post-exercise,Proprioceptive retraining achieving joint position sense within 5 degrees,Functional reaching movements above shoulder height pain-free,Patient cleared for advanced strengthening progression
→ Advance to: Phase 5
Rotator cuff closed chain proprioception progressing to unstable surfaces,External rotation strength 5/5 at 90 degrees abduction,Internal rotation strength 5/5 at 90 degrees abduction,Scapular control during push-up plus exercise,Biceps tendon eccentric loading without anterior pain
→ Advance to: Phase 6
Supraspinatus closed chain strength 4+/5 in empty can position,Infraspinatus and teres minor endurance 3 sets of 15 repetitions,Subscapularis performance during internal rotation resistance,Serratus anterior achieving 3 sets of 12 at 60% body weight,Upper trapezius and lower trapezius balance during loaded elevation
→ Advance to: Phase 6
Rotator cuff external to internal rotation strength ratio 66-75%,Plyometric throwing progression beginning at 2 meters,Kinetic chain sequencing from lower body through scapula to glenohumeral,Labral stability maintained during acceleration phase of throwing,AC joint loaded without symptom reproduction
→ Advance to: Phase 6
Thrower's ten program completion without regression,Shoulder endurance index greater than 85% compared to contralateral,Proprioceptive accuracy within 3 degrees of contralateral side,Functional sport-specific movements at 75% intensity,Biceps tendon performance during high-velocity elbow flexion
→ Advance to: Phase 7
Rotator cuff strength symmetrical to contralateral side,Throw progression to 75% velocity without pain,Scapular dyskinesis corrected during dynamic activities,Labral integrity confirmed with functional tests,AC joint stability under load during contact sports
→ Advance to: Phase 7
Full sport-specific training at 85% intensity,No fatigue-related compensation in scapular positioning,Shoulder endurance matching demands of activity,Proprioceptive performance at pre-injury level,Patient reports confidence in shoulder function
→ Advance to: Phase 7
Return to full practice participation without restrictions,Shoulder performance metrics within 10% of pre-injury,Kinetic chain efficiency during high-intensity movements,Rotator cuff and scapular fatigue resistance adequate,Biceps tendon performance in sport-specific actions
→ Advance to: Phase 8
Full return to competitive play cleared by physician,All outcome measures at acceptable functional thresholds,Shoulder complaints none during high-demand activities,Patient education completed for maintenance program,Discharge criteria met with individualized home exercise program
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 6Patient demonstrates correct scapular setting during arm elevation
Light functional activities and conditioning
Week 9Wrist and finger range of motion full; no tenodesis limitation
Moderate activity and sport-specific conditioning
Week 13Patient demonstrates correct hand therapy exercise technique
Full return to sport, occupation, and recreation
Week 22Elbow flexion and extension range adequate for ADL completion
Precautions
- avoid-overloading
- maintain-neutral-spine
- cool-down-after
Contraindications
- recent-fracture
- unstable-fixation
- severe-muscle-atrophy
- severe-pain
Pain management
- Cryotherapy application 15-20 minutes post-exercise for inflammation control
- Non-steroidal anti-inflammatory medication as prescribed for tissue healing phases
- Glenohumeral joint mobilizations at grades I-II for pain modulation during acute phases
- Transcutaneous electrical nerve stimulation TENS for acute pain management
- Soft tissue mobilization to rotator cuff and scapular musculature for myofascial release
Equipment & modalities
Frequently asked questions
Can I skip the aquatic phase if I feel ready?
How hard should the barbell and dip-station work feel?
What if I miss sessions or have a flare-up?
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed October 6, 2026. · Read our editorial policy