Intermediate Shoulder Post-Fracture Rehabilitation

Published: July 26, 2026Updated: October 6, 2026

A 20-week intermediate program using stationary bikes, resistance bands, and cable machines to aid in the recovery process.

Quick summary

Professional rehabilitation program designed for effective recovery and pain management.

Medically reviewed by WellAlly Editorial TeamLast reviewed October 6, 2026Editorial policy

Key facts at a glance

Body part: upper-limb · shoulder
Injury type: post-fracture
Level: intermediate
Duration: 20
Sessions/week: 2
Minutes/session: 30
Evidence level: moderate
ICD-10: S42
Cost tier: moderate

Program Overview This is a 20-week, intermediate-level rehabilitation guide for someone recovering from a shoulder fracture. It combines hands-on therapies with graded exercise using a stationary bike, resistance bands, and cable machine to restore movement, strength, and confidence in your shoulder.

Who This Program Is For and Its Goal This plan is for people past the earliest healing stage of a shoulder fracture who are ready to build mobility and strength under clinician guidance. The goal is to gradually regain shoulder motion and rotator cuff and scapular strength, reduce pain, and return to everyday activities safely over 20 weeks.

Before You Start Before beginning, have your clinician confirm this program fits your stage of healing. A short check of your motion, strength, and pain helps set your starting point. Ask questions about anything unclear, and make sure you understand how to use each piece of equipment before your first session.

Safety Notes and When to Stop This program is not for you during acute inflammation or severe pain. Always warm up first, avoid overloading the shoulder, and keep your spine in a neutral position during exercises. Stop and call your clinician if you develop sharp or worsening pain, new swelling, numbness, or a sudden loss of movement.

Weekly Structure Each week includes two sessions of about 30 minutes. The plan moves through phases that start with protecting the shoulder and controlling pain, then progress to early mobility and graded strengthening. Your clinician adjusts the pace based on how you respond, so faster is not better.

How the 20-Week Plan Is Organized The first weeks focus on calming pain, protecting healing tissue, and gentle activation. Middle weeks add mobility work and light resistance. Later weeks build strength and control with bands and the cable machine, and the bike supports general conditioning. Hands-on therapies such as ultrasound, laser, and electrical stimulation may support soft tissue healing alongside your exercises.

What a Typical Session Looks Like Sessions follow a warm-up, main work, and cool-down pattern. Your clinician guides the hands-on therapies, then you move into guided exercises and finish with gentle cool-down work to help your shoulder settle before you leave.

Warm-Up, Main Work, and Cool-Down Start with easy stationary-bike pedaling and gentle pendulum or range-of-motion movements to warm the shoulder. Main work includes scapular control drills, band and cable exercises for the rotator cuff and shoulder blade muscles, and mobility work. Cool down with light stretching and relaxed breathing.

Tracking Progress Your clinician records your pain, range of motion, and strength at intervals using measures like the ASES, Constant-Murley, and Simple Shoulder Test scores, a pain scale, goniometry, and handheld dynamometry. These snapshots show whether you are ready to advance and help catch problems early.

How Progression Criteria Are Used You move to the next phase only when you meet the listed checkpoints, such as comfortable motion, pain-free isometric strength, and good scapular control. These criteria, combined with your outcome measures, guide your clinician's decisions. Do not push ahead on your own if a checkpoint is not yet met.

Recovery and Self-Care Rest between sessions and keep up gentle daily movement as advised. Follow your clinician's guidance on pain relief and avoid positions that strain the healing shoulder. Good sleep, hydration, and pacing your activities support recovery and help you get the most from each session.

Pain Management and Red Flags Do not push through severe or sharp pain, and pause if the shoulder becomes swollen or highly irritated. Seek prompt medical advice for sudden severe pain, new deformity, fever, or numbness and weakness in the arm or hand. These may signal a problem needing urgent review.

Recovery phases

Week 1Phase 1: Protection and Pain Control

Pain at rest less than 3/10 on visual analog scale,Glenohumeral joint swelling minimal or resolved,Able to tolerate passive shoulder external rotation to 0 degrees without pain,Scapular stabilizer activation present during terminal humeral elevation,AC joint tenderness resolved or significantly reduced,Biceps tendon palpation reveals decreased tenderness

→ Advance to: Phase 2: Early Mobility

Week 4Phase 1: Protection and Pain Control

Passive glenohumeral flexion to 90 degrees achieved without compensation,Rotator cuff isometric contractions pain-free at grade 3/5,Scapular upward rotation during humeral elevation within 10 degrees of contralateral side,Labral repair protection protocols maintained (no combined flexion/abduction/external rotation),AC joint loading tolerated without pain reproduction,Biceps tendon resisted flexion without tendon subluxation pain

→ Advance to: Phase 2: Early Mobility

Week 5Phase 2: Early Mobility

Active glenohumeral flexion to 120 degrees achieved,Passive external rotation at 90 degrees abduction to 45 degrees,Passive internal rotation at 90 degrees abduction to 50 degrees,Rotator cuff external rotation against gravity tolerated without pain,Scapular rhythm maintained through 90 degrees of elevation,Glenohumeral translation less than 50% of humeral head diameter on anterior drawer

→ Advance to: Phase 3: Strengthening

Week 8Phase 2: Early Mobility

Active shoulder elevation to 150 degrees in scapular plane,Full passive glenohumeral range of motion achieved,Rotator cuff strength grade 4/5 in external rotation and internal rotation,Scapular protraction and retraction against resistance at 4/5,AC joint compression and distraction tests negative,Biceps tendon resisted tests grade 4/5 without crepitus

→ Advance to: Phase 3: Strengthening

Week 9Phase 3: Strengthening

Glenohumeral elevation strength 70% of contralateral side,External rotation strength at 90 degrees abduction 70% of contralateral,Internal rotation strength 70% of contralateral,Scapular stabilizer endurance test 30 seconds at 50% maximal voluntary contraction,Labral stability test (clunk test) negative for reproduction of symptoms,Biceps tendon speed test grade 5/5 without pain

→ Advance to: Phase 4: Advanced Strengthening

Week 12Phase 3: Strengthening

Rotator cuff strength 80% of contralateral side,Glenohumeral proprioception within 5 degrees of contralateral on repositioning test,Scapular upward rotation during full elevation within 5 degrees of contralateral,AC joint horizontal adduction test negative,Functional reach test score within 10% of contralateral,Biceps tendon load test negative for subluxation or pain

→ Advance to: Phase 4: Advanced Strengthening

Week 13Phase 4: Advanced Strengthening

External rotation at 90 degrees abduction at 80% contralateral strength,Internal rotation at 90 degrees abduction at 80% contralateral strength,Scapular control during loaded elevation patterns maintained,Glenohumeral joint position sense error less than 5 degrees,Labral shear test negative for pain or catching,Biceps tendon sling integrity maintained during loaded flexion

→ Advance to: Phase 5: Return to Function

Week 16Phase 4: Advanced Strengthening

Rotator cuff strength 90% of contralateral side,Closed kinetic chain shoulder stability test symmetric,Scapular acceleration and deceleration control during throwing progression,AC joint stress test negative at 90 degrees flexion,Proprioceptive accuracy within 3 degrees of contralateral,Biceps tendon engagement without compensation patterns

→ Advance to: Phase 5: Return to Function

Week 17Phase 5: Return to Function

Full strength symmetry (greater than 90%) in all rotator cuff planes,Scapular dyskinesis absent during dynamic loading tasks,Glenohumeral translation within normal limits on load and shift test,Functional outcome scores exceeding minimal clinically important difference,Biceps tendon stability confirmed through full range,AC joint stability confirmed through resisted overhead activities

→ Advance to: Maintenance/Discharge

Week 20Phase 5: Return to Function

Return to pre-injury activity level without restrictions,Shoulder Outcome Score (OSS) greater than 90 points,Glenohumeral range of motion within 5 degrees of contralateral,Rotator cuff strength 100% or matched contralateral,Scapular motion and timing normalized during functional tasks,No reproduction of symptoms with high-demand activities

→ Advance to: Maintenance/Discharge

Return to activity milestones

Pain-free basic activities of daily living

Week 6

Patient demonstrates correct hand therapy exercise technique

Light functional activities and conditioning

Week 9

Able to complete 5 minutes of light kitchen or desk activity

Moderate activity and sport-specific conditioning

Week 12

Patient reports ≥ 30% improvement in upper limb functional score

Full return to sport, occupation, and recreation

Week 20

Elbow valgus and varus stability intact under varus and valgus stress

Precautions

warm-up-before
avoid-overloading
maintain-neutral-spine

Contraindications

acute-inflammation
severe-pain

Pain management

Cryotherapy with compression (ice pack 15-20 minutes every 2-3 hours)
Non-steroidal anti-inflammatory medication as prescribed
Gentle soft tissue mobilization to trapezius and levator scapula
Positional relief using pillow support in slight elevation
Transcutaneous electrical nerve stimulation (TENS) for pain modulation

Equipment & modalities

Therapeutic ultrasound for soft tissue healingLow-level laser therapy for tissue repairElectrical stimulation for rotator cuff activationScapular stabilization proprioceptive trainingJoint mobilization (grades I-II) for glenohumeral capsular restrictionsstationary-bikeresistance-bandcable-machine

Frequently asked questions

Will I be sore after sessions?

Mild soreness that settles within a day or so is common as you build strength. Sharp or lasting pain is not expected, so tell your clinician if it happens.

Can I skip the warm-up if I am short on time?

No, warming up protects your shoulder and is part of the plan. Skipping it raises your risk of strain, so keep it short but do not skip it.

How do I know when I am ready to progress?

Your clinician uses the phase checkpoints and your outcome measures to decide together. Feeling ready is helpful, but meeting the criteria safely matters more than speed.

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Medical Disclaimer

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