Beginner Shoulder Post-Fracture Rehabilitation
A 13-week beginner program for post-fracture shoulder rehabilitation, focusing on the rotator cuff, labrum, AC joint, and biceps tendon, utilizing a rower and tennis ball for recovery.
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
- 2
- Minutes/session
- 30
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview Beginner Shoulder Post-Fracture Rehabilitation is a 13-week program designed to help you gently regain shoulder movement and strength after a shoulder fracture. It focuses on the rotator cuff, labrum, AC joint, and biceps tendon, using simple tools and a steady, gradual approach.
Who This Program Is For and Its Goal This program is for adults who are new to rehabilitation after a shoulder fracture and have been cleared by their clinician to begin guided exercise. The goal is to safely restore range of motion, reduce pain, and rebuild strength so you can return to everyday activities with confidence.
Before You Start Please review this guide with your physical therapist or doctor before beginning, and follow their individual guidance over any general suggestions here. This program is not appropriate if you have compartment syndrome, severe osteoporosis, or a wound that has opened, and your clinician should confirm these are not present.
Safety Notes and When to Stop Always warm up before exercising and keep your spine in a neutral, comfortable position. Stop and contact your clinician if you develop sharp or worsening pain, new swelling, numbness, tingling, weakness, or any wound opening. Slight soreness that settles with rest is common, but severe or lasting symptoms need prompt medical review.
Weekly Structure Plan for two sessions per week, about 30 minutes each, across 13 weeks. Sessions build gradually from gentle protection-focused movement toward more active mobility and light strengthening. Keep the pace comfortable, and use rest days between sessions to let your shoulder settle.
How the Plan Is Organized The 13 weeks move through phases in plain terms: early weeks protect the healing shoulder and control pain, middle weeks add gentle assisted movement, and later weeks introduce light strengthening and everyday use. You will use a rower for supported warm-up and light conditioning and a tennis ball for soft-tissue and scapular work, all adjusted to your comfort.
What a Typical Session Looks Like Each session follows a simple pattern: a warm-up, main exercises, and a cool-down. Warm-up may include gentle arm movements and light, comfortable rowing; main work focuses on the mobility and strengthening exercises your therapist assigns; cool-down includes easy stretching, soft-tissue work with the tennis ball, and ice if recommended.
Warm-Up, Main Work, and Cool-Down Begin with easy shoulder circles, scapular squeezes, and a short, gentle rower warm-up at low effort. The main portion includes your assigned range-of-motion, scapular, and light strengthening exercises, using the tennis ball for soft-tissue release as directed. Finish with slow stretching and a cool-down, applying an ice pack if your therapist advises it for comfort.
Tracking Progress Keep a simple log of each session noting your pain level before and after, which exercises you did, and how your shoulder felt. Share this with your clinician, who will also use standard shoulder scores, pain ratings, range-of-motion measurements, and strength tests to track your recovery over time.
How Progression Works Your clinician uses the phase criteria and your outcome measures to decide when you are ready to advance. Moving forward depends on keeping pain controlled and meeting movement and strength goals, not simply on the calendar. Outcome measures help confirm that progress is real and safe before adding new challenges.
Recovery and Self-Care Rest is part of rehabilitation. Sleep comfortably with support under the affected arm if advised, stay generally active, and avoid heavy lifting or overhead reaching until cleared. Ice, as recommended, can help manage soreness, and gentle movement between sessions supports healing.
Pain Management Cautions and Red Flags Do not push through sharp pain, and never adjust medications without your clinician. Seek urgent advice for sudden severe pain, marked swelling, fever, numbness, chest pain, or a wound that reopens. These signs may indicate a problem that needs medical attention rather than more exercise.
Recovery phases
Passive forward flexion to 45 degrees with glenohumeral joint protection,External rotation limited to neutral (0 degrees) to protect rotator cuff interval,Active scapular retraction with proper scapular plane positioning,Pain level maintained below 3/10 during all exercises,Full elbow, wrist, and hand range of motion preserved,Sleeping in slight elevation with pillow under affected arm for AC joint comfort
→ Advance to: Phase 2: Early Protected Mobility
Passive forward flexion increased to 60 degrees within pain limits,Glenohumeral joint distraction with grade I-II mobilization for joint capsule flexibility,Isometric rotator cuff contractions (supraspinatus, infraspinatus, subscapularis) at submaximal effort,Scapular protraction and retraction in neutral with proper scapular kinematics,Continued AC joint protection avoiding overhead positions,Pain-free pendulums (Codman) for glenohumeral circulation
→ Advance to: Phase 2: Early Protected Mobility
Passive forward flexion to 75 degrees with scapular stabilization,Active-assisted external rotation to 15 degrees protecting labral attachment,Isometric biceps brachii contraction with elbow flexed at 90 degrees for biceps tendon activation,Scapular elevation and depression with proper upper trapezius and lower trapezius recruitment,Pain-free active range of motion for elbow flexion and extension,Tolerance of prone lying with arm supported for glenohumeral positioning
→ Advance to: Phase 2: Early Protected Mobility
Passive forward flexion to 90 degrees with scapular plane at 30-40 degrees,Active-assisted external rotation to 30 degrees protecting anterior labrum,AAROM with wand: flexion, abduction, and external rotation within tolerance,Scapular stabilization exercises in side-lying: scapular punch for serratus anterior activation,Isotonic rotator cuff strengthening with light resistance (1-2 lbs) for supraspinatus and infraspinatus,Pain-free functional use of affected arm at waist level
→ Advance to: Phase 3: Intermediate Strengthening
Passive forward flexion to 110 degrees with glenohumeral joint mobs,External rotation increased to 45 degrees at 90 degrees abduction protecting posterior capsule,Active forward flexion to 70 degrees against gravity with proper scapulohumeral rhythm,Sidelying external rotation with 1-2 lbs for rotator cuff (infraspinatus, teres minor) strengthening,Scapular rows with resistance band for middle trapezius and rhomboid activation,No AC joint tenderness with palpation or functional movements
→ Advance to: Phase 3: Intermediate Strengthening
Forward flexion to 120 degrees with combined glenohumeral and scapular motion,External rotation to 55 degrees at 90 degrees abduction in functional range,Active abduction to 90 degrees with proper rotator cuff centering in glenoid fossa,Sidelying internal rotation with light resistance for subscapularis strengthening,Prone scapular stabilization: I, T, Y, W patterns for lower trapezius recruitment,Tolerance of activities above shoulder level without pain flare
→ Advance to: Phase 3: Intermediate Strengthening
Forward flexion to 140 degrees approaching functional range,External rotation at 90 degrees abduction to 70 degrees with labral protection,Active range of motion: full forward flexion, abduction to 120 degrees, external rotation to functional levels,Rotator cuff strengthening: external rotation and internal rotation with 3-5 lbs resistance,Biceps curl progression: resistance band or light dumbbell (2-4 lbs) for biceps tendon loading,Scapular protraction with push-up plus against wall for serratus anterior endurance
→ Advance to: Phase 4: Advanced Strengthening
Full forward flexion range with normalized scapulohumeral rhythm (2:1 ratio),External rotation strength at 90 degrees abduction at 75% of contralateral side,Internal rotation and external rotation strength ratios approaching 3:2 for glenohumeral stability,Proprioceptive exercises: wall pushes with weight bearing through affected upper extremity,Push-up progression: wall to counter with proper scapular retraction and protraction,Functional reach patterns in all directions without compensation
→ Advance to: Phase 4: Advanced Strengthening
Full range of motion in all planes: flexion, abduction, external rotation, internal rotation,Rotator cuff strength: external rotation at 5/5 on manual muscle testing,Biceps tendon resistance testing: negative Speed test for proximal biceps pathology,Scapular stabilization: prone Y-T holds for 30 seconds each without fatigue,Closed kinetic chain exercises: table pushes, counter pushes for glenohumeral proprioception,Tolerance for 30-minute session without pain escalation
→ Advance to: Phase 4: Advanced Strengthening
External rotation at 90 degrees abduction at 80% of contralateral side strength,Resistance training: Theraband or cable column at functional resistance levels,Plyometric progression: two-hand chest pass, wall dribble for power development,Overhead athlete progression if applicable: throwing program initiation at 50% effort,Endurance training: repeated scapular stabilization through functional patterns,Return to light functional activities with affected upper extremity
→ Advance to: Phase 5: Return to Function
Internal rotation and external rotation strength at 85% of contralateral side,Advanced rotator cuff exercises: external rotation with resistance in functional positions,Biceps tendon loading: resisted elbow flexion in multiple angles for tendinous adaptation,Scapular control during overhead activities with proper upward/downward rotation,Proprioceptive training: unstable surface pushes, weight shifting on affected arm,Progressive return to activities of daily living involving overhead reaching
→ Advance to: Phase 5: Return to Function
Full strength comparison: rotator cuff and biceps at 90% of contralateral side,Sport-specific or occupation-specific movement patterns introduced,Endurance testing: ability to perform 3 sets of 15 repetitions at moderate resistance,Shoulder complex endurance: scapular stabilization through full range,Functional testing: reaching, lifting, carrying objects of varying weights,Confidence in affected shoulder for functional activities
→ Advance to: Phase 6: Maintenance and Discharge
Range of motion within 10 degrees of contralateral shoulder in all planes,Strength at 95% or greater of contralateral side for rotator cuff and biceps,Positive outcome on empty can test, external rotation resistance test,Scapular dyskinesis corrected: symmetric scapular motion during arm elevation,Patient education completed: home exercise program for maintenance,Discharge criteria met: return to pre-injury functional level
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 3Able to tolerate light resisted flexion and extension without flare
Light functional activities and conditioning
Week 5Pain ≤ 3/10 during functional reaching and lifting activities
Moderate activity and sport-specific conditioning
Week 7No increase in pain at 48-hour follow-up after exercise progression
Full return to sport, occupation, and recreation
Week 13Able to perform light overhead reaching for objects at eye level
Precautions
- warm-up-before
- maintain-neutral-spine
Contraindications
- compartment-syndrome
- severe-osteoporosis
- wound dehiscence
Pain management
- Cryotherapy: ice pack application for 15-20 minutes post-session to manage inflammation
- Non-steroidal anti-inflammatory medications as prescribed for pain and inflammation control
- Gentle glenohumeral joint mobilization within pain-free range for joint capsule mobility
- Rest and activity modification: avoiding overhead activities and heavy lifting during early phases
- Modalities: electrical stimulation (TENS) for pain modulation during acute phase
Equipment & modalities
Frequently asked questions
Can I exercise if my shoulder is sore?
How do I use the rower safely?
What if I miss a week?
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