Beginner Shoulder Rehabilitation Post-Fracture
A 13-week beginner program focused on recovery from shoulder fractures, using ankle braces and Bosu balls to gradually reintroduce movement and strength to the rotator cuff and surrounding structures.
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
- beginner
- Duration
- 13
- Sessions/week
- 3
- Minutes/session
- 20
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview This is a beginner, 13-week shoulder rehabilitation guide for recovery after a shoulder fracture. It is designed to be done three times per week, about 20 minutes per session, and gradually reintroduces movement and strength to the shoulder, rotator cuff, and surrounding structures in a safe, step-by-step way.
Who This Program Is For and Its Goal This program suits people early in recovery from a shoulder fracture who have orthopedic clearance to begin gentle rehabilitation under clinician guidance. The goal is to control pain and protect healing tissue first, then restore passive motion, build active movement with good shoulder-blade control, and finally strengthen the shoulder for everyday use.
Before You Start Check with your doctor or physical therapist before beginning, and make sure your fracture has been cleared for movement. Do a warm-up before every session. Keep your spine in a neutral, comfortable position. Stop if pain increases or if you feel new warmth, swelling, or catching in the shoulder.
Safety Notes and When to Stop Do not exercise if the shoulder is in an acute inflammation flare—meaning it is hot, significantly swollen, or very painful at rest. Stop and contact your clinician if pain rises during a session, if you notice clicking, catching, or a worsening deformity at the collarbone joint, or if you develop numbness, weakness, or pain that does not settle with rest.
Weekly Structure Plan for three sessions each week, roughly 20 minutes each, across 13 weeks. Progress is organized in phases—protection and pain control, early passive motion, active assisted motion, and active motion—so you build skills in order rather than rushing ahead. The ankle brace, Bosu ball, and tennis ball are used as supportive tools for balance, controlled loading, and gentle proprioceptive work.
How the 13-Week Plan Is Organized The plan starts gently and advances only when you meet simple, observable goals. Early weeks focus on calming pain and protecting the shoulder; middle weeks add assisted and then active movement; later weeks build strength and control. Your clinician may add therapeutic ultrasound, manual stretching, scapular stabilization with a band, aquatic therapy, and weight-bearing proprioceptive training as appropriate for your stage.
What a Typical Session Looks Like Each session follows a warm-up, main work, and cool-down pattern. The warm-up uses light, pain-free shoulder and shoulder-blade movements. The main work includes the exercises your clinician has cleared for your current phase. The cool-down uses gentle stretching and relaxed breathing, and you finish by noting how the shoulder feels.
Warm-Up, Main Work, and Cool-Down Warm up with slow, small arm and shoulder-blade motions, keeping your spine neutral. During main work, use the tennis ball for light controlled rolling or grip work, the Bosu ball for gentle supported balance and weight-bearing through the arm only when cleared, and the ankle brace only if your clinician has prescribed it for your lower-limb support. Cool down with gentle posterior-capsule stretching and rest.
Tracking Progress Keep a simple log of your pain before and after each session, what you did, and how the shoulder felt the next day. Your clinician will also track outcome measures such as the SPADI and ASES questionnaires, a pain scale, active range of motion by goniometry, manual muscle testing of the rotator cuff and biceps, and the Single Arm Put-Out Test for functional strength.
How Progression Criteria Are Used You move to the next phase only when the goals for your current phase are met—for example, pain staying low at rest, no signs of active inflammation, and movement within the range your orthopedic team allows. Your clinician uses these criteria plus the outcome measures to decide when it is safe to advance, so progress is guided by your body, not the calendar.
Recovery and Self-Care Rest the shoulder between sessions and avoid heavy lifting or overhead reaching until cleared. Use ice or heat only as your clinician advises. Keep up gentle movement on non-session days if it feels comfortable. Sleep and general activity support healing, so pace yourself and avoid sudden increases in load.
Pain Management Cautions and Red Flags Do not push through sharp or rising pain, and avoid exercising a hot, swollen shoulder. Contact your clinician for severe or worsening pain, new swelling or warmth, a visible change at the collarbone joint, numbness or weakness in the arm or hand, or pain that keeps you awake at night. Do not change any medication without your doctor's advice.
Recovery phases
Pain at rest ≤2/10 on visual analog scale,Glenohumeral joint demonstrates no signs of active inflammation (warmth, significant swelling),Passive range of motion within fracture tolerance as per orthopedic clearance,Scapular mobility intact with no compensatory patterns observed,Rotator cuff musculature shows ability to engage in submaximal isometrics without exacerbating pain,AC joint demonstrates stability with no step-off deformity worsening
→ Advance to: Early Passive Motion
Passive forward flexion to 90 degrees achieved without pain increase,Passive external rotation at 0 degrees abduction achieves 30 degrees with tolerance,Scapular stabilization exercises demonstrate ability to control scapular position during upper extremity movement,Glenohumeral joint capsule shows no restrictions limiting physiologic motion,Rotator cuff isometrics in neutral rotation maintained for 5 seconds without pain,Biceps tendon tolerance to passive elbow flexion with shoulder positioned appropriately
→ Advance to: Active Assisted Motion
Active assisted forward flexion achieves 110 degrees with good scapular control,Active assisted external rotation at 45 degrees abduction achieves 45 degrees,Patient demonstrates ability to actively elevate scapula without compensatory trunk extension,Labrum integrity maintained during shoulder movements (no clicking, catching, or painful internal impingement),Rotator cuff activation visible during manual muscle testing grades 3/5 in plane of scapula,Biceps tendon demonstrates pain-free resistance at elbow flexion with shoulder in neutral
→ Advance to: Active Motion Phase
Active forward flexion achieves 130 degrees with minimal scapular substitution,Active external rotation at 90 degrees abduction achieves 60 degrees,Glenohumeral rhythm demonstrates less than 30 percent scapular contribution during elevation,Rotator cuff muscle strength achieves 3+/5 on Oxford scale for supraspinatus, infraspinatus, subscapularis,AC joint remains stable through active range of motion without pain provocation,Patient demonstrates independent shoulder girdle control during functional activities
→ Advance to: Early Strengthening
Active forward flexion achieves 150 degrees with normal scapulohumeral rhythm,External rotation at 90 degrees abduction achieves 70 degrees with good strength,Rotator cuff manual muscle testing demonstrates 4-/5 for external and internal rotators,Scapular stabilization achieves full hold time of 30 seconds in prone extension exercises,Biceps muscle strength achieves 4/5 on resisted elbow flexion with shoulder in neutral,Glenohumeral joint demonstrates no posterior capsule restriction
→ Advance to: Middle Strengthening
Full active range of motion in all planes achieved (flexion 170, abduction 170, external rotation 90, internal rotation 70),Rotator cuff strength achieves 4/5 for all cuff musculature,Scapular control demonstrates proficiency during loaded upper extremity exercises,Biceps tendon tolerance to resisted supination and elbow flexion without anterior shoulder pain,Patient demonstrates ability to lift arm above shoulder level without fatigue limiting function,AC joint demonstrates pain-free tolerance to overhead activities
→ Advance to: Advanced Strengthening
Rotator cuff strength achieves 4+/5 with resistance matching functional demands,External rotation strength at 90 degrees abduction achieves 70 percent of contralateral side,Scapular stabilization demonstrates ability to maintain position during push-up plus progression,Glenohumeral proprioception demonstrates ability to reposition arm accurately with eyes closed,Biceps strength achieves 80 percent of contralateral side on isokinetic testing,Patient reports return to light activities of daily living without pain limitation
→ Advance to: Dynamic Strengthening
Rotator cuff endurance demonstrates ability to complete 3 sets of 15 repetitions without fatigue,External rotation at 90 degrees abduction achieves 80 percent of contralateral side strength,Scapular control maintained during overhead throwing progression activities,Internal rotation flexibility demonstrates no deficit compared to contralateral side,Patient demonstrates ability to reach behind back to T12 level without pain,AC joint demonstrates tolerance to loaded elevation in multiple planes
→ Advance to: Sport-Specific Progression
Rotator cuff strength at 85 percent of contralateral side on handheld dynamometry,Patient completes functional reaching tasks at shoulder height without compensations,Scapulohumeral rhythm remains normal during high-velocity upper extremity movements,Biceps tendon demonstrates no provocation during eccentric loading exercises,Patient reports less than 10 percent difference in visual analog scale during activity versus rest,Glenohumeral joint passes instability tests without positive findings
→ Advance to: Return to Activity Preparation
Rotator cuff strength achieves 90 percent of contralateral side in all planes,Full range of motion with strength maintained throughout arc,Scapular stabilization demonstrates ability to control scapula during pushing and pulling activities,Patient completes simulated work or sport activities without pain exacerbation,Biceps tendon demonstrates pain-free performance during power generation activities,Patient reports confidence in shoulder function during loading tasks
→ Advance to: Conditioning Phase
Patient completes 3 sets of 10 repetitions at 70 percent predicted one-repetition maximum,External rotation to internal rotation strength ratio achieves 66 percent at 90 degrees abduction,Scapular control maintained during plyometric upper extremity exercises,Patient demonstrates ability to sustain shoulder function over multiple repeated efforts,Glenohumeral proprioception scores within 10 percent of contralateral side,Patient returns to modified work or recreational activities
→ Advance to: Final Conditioning
Rotator cuff strength achieves 95 percent of contralateral side on isokinetic testing,Patient completes full training session without post-exercise pain increase,Scapular stabilization demonstrates proficiency during sport-specific movements,Biceps muscle endurance matches contralateral side during repeated functional tasks,Patient demonstrates ability to generate power through shoulder complex without hesitation,AC joint demonstrates full tolerance to contact and loading activities
→ Advance to: Return to Full Activity
Rotator cuff strength achieves 100 percent of contralateral side or meets functional demands,Full, pain-free range of motion in all planes achieved and maintained,Scapular control demonstrates automatic recruitment during all upper extremity activities,Patient reports return to pre-injury functional level without modifications,Biceps tendon demonstrates no residual deficits during strength testing,Patient cleared for full unrestricted activity based on objective and subjective criteria
→ Advance to: Maintenance
Return to activity milestones
Pain-free basic activities of daily living
Week 3Rotator cuff strength: supraspinatus grade ≥ 4 out of 5 on make test
Light functional activities and conditioning
Week 5Able to sustain light load ≤ 2kg in functional reach position
Moderate activity and sport-specific conditioning
Week 7No sign of shoulder impingement with resisted empty can test
Full return to sport, occupation, and recreation
Week 13Pain does not radiate during upper limb tension test at Stage 2
Precautions
- warm-up-before
- stop-if-pain-increases
- maintain-neutral-spine
Contraindications
- acute-inflammation
Pain management
- Cryotherapy application for 15-20 minutes post-exercise to reduce inflammation
- Non-steroidal anti-inflammatory medication as prescribed by physician
- Gentle soft tissue mobilization to trapezius and pectoralis musculature
- Positional relief using pillow support during sleep to reduce glenohumeral stress
- Electrical stimulation for pain modulation targeting suprascapular nerve
Equipment & modalities
Frequently asked questions
Do I need supervision for this program?
What if a session makes my pain worse?
How do I know when to move to the next phase?
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