Intermediate Shoulder Post-Fracture Rehabilitation
A 15-week intermediate program using ankle weights, therapy putty, and ankle braces 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
- intermediate
- Duration
- 15
- Sessions/week
- 5
- Minutes/session
- 30
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Intermediate Shoulder Post-Fracture Rehabilitation — Program Overview
This program is for people recovering from a shoulder fracture who have completed initial protection and immobilization under clinician guidance, and are ready for an intermediate- level rebuilding plan. The goal is to gradually restore shoulder movement, rebuild rotator cuff and shoulder-blade muscle strength, reduce pain, and return you to everyday function over 15 weeks. It is not a substitute for hands-on direction from your physical therapist, who should confirm you are ready for this stage and review your progress along the way.
Before You Start
Check with your clinician before beginning and keep all appointments for reassessment. Stop and contact your clinician if you have severe or worsening pain, sudden swelling, numbness or tingling, new weakness, a feeling of the joint giving way, or any sign of a new injury — and do not push through sharp pain. Your clinician may hold or delay certain exercises if pain is high, if the fracture is still healing, or if you have pressure or swelling concerns, so follow their specific instructions over this general guide.
Weekly Structure
The plan runs 15 weeks at five sessions per week, about 30 minutes each, using ankle weights, therapy putty, and a supportive brace your clinician may recommend. Early weeks focus on protection and gentle assisted motion; middle weeks build active movement and light strengthening; later weeks add progressive resistance and functional patterns. Your therapist will decide when each phase begins based on your pain, movement, and strength rather than the calendar alone. Warm up before every session and keep the spine in a neutral, comfortable position throughout.
What a Typical Session Looks Like
Begin with a gentle warm-up such as shoulder-blade squeezes, pendulum swings, and easy putty squeezes to increase blood flow. The main work combines range-of-motion exercises, shoulder-blade stabilization drills, rotator cuff isometrics, and progressive strengthening using ankle weights and putty with controlled, pain-free effort. Finish with a short cool-down of gentle stretching, relaxed breathing, and any cold therapy your clinician recommends. Keep movements slow and controlled, and never use the weights in a way that overloads the shoulder.
Tracking Progress
Your therapist uses specific mileposts — such as pain levels, how far you can move your arm passively and actively, and shoulder-blade control — to decide when to advance a phase. These are checked during reassessment visits, not self-judged. Outcome measures like the SPADI, ASES, goniometric motion, manual muscle testing, pain scales, and thrower-specific tools help track change over time and guide adjustments. If you have not met the criteria, it simply means your shoulder needs more time, not that you are failing.
Recovery and Self-Care
Manage pain with the guidance of your clinician, including cold therapy and any prescribed modalities; do not change medications on your own. Rest the shoulder between sessions and avoid overloading it with heavy lifting or repetitive overhead work. Red flags to report right away include severe pain, rapid swelling, numbness, weakness, or a joint that feels unstable. Keep follow-up appointments, and remember that steady, supervised progress is safer than rushing ahead.
Recovery phases
Pain level ≤ 3/10 at rest with proper glenohumeral immobilization,Passive forward flexion to 45° within tolerance avoiding stress on AC joint,Passive external rotation at 0° abduction to 15° protecting labral repair,No active ROM of glenohumeral joint to protect fracture site,scapular stabilization exercises in supine with minimal shoulder elevation,Edema management around acromioclavicular region
→ Advance to: Phase 2: Early Motion
Pain level ≤ 2/10 at rest,Passive forward flexion to 60° within tolerance,Passive external rotation at 0° abduction to 20°,Active-assisted elbow/wrist/hand exercises with shoulder protected,scapular depression and retraction exercises in neutral,Tolerable pain with gentle pendulum exercises for glenohumeral circulation
→ Advance to: Phase 2: Early Motion
Pain ≤ 2/10 with passive ROM exercises,Passive forward flexion to 90°,Passive external rotation at 0° abduction to 30°,Active-assisted forward flexion to 75° with good scapular control,Rotator cuff isometrics at 0° abduction (supraspinatus, infraspinatus, subscapularis),scapular kinematics demonstrating proper upward rotation during flexion
→ Advance to: Phase 2b: Continued Motion
Pain ≤ 1/10 with passive ROM,Passive forward flexion to 110°,Passive external rotation at 0° abduction to 40°,Active-assisted external rotation at 90° abduction to 30°,Passive abduction to 90° protecting AC joint,Begin active-assisted ROM in scapular plane
→ Advance to: Phase 2b: Continued Motion
Full passive forward flexion to 150°,Passive external rotation at 90° abduction to 45°,Passive internal rotation to T8 level,Active forward flexion to 120° with proper scapulohumeral rhythm,Active external rotation at 0° abduction to 45°,scapular strengthening: rows, scapular punches with resistance bands
→ Advance to: Phase 3: Strengthening
Full passive ROM in all planes,Active forward flexion to 145° with minimal scapular compensation,Active external rotation at 90° abduction to 50°,Active internal rotation at 90° abduction to 60°,biceps tendon isometrics in neutral with elbow flexion,No pain with active-assisted glenohumeral ROM
→ Advance to: Phase 3: Strengthening
Full passive ROM maintained,Rotator cuff strengthening: external rotation at 0° abduction with resistance band (2 lb),Rotator cuff strengthening: internal rotation at 0° abduction with resistance band (2 lb),Subscapularis strengthening: forward punch with light resistance,scapular strengthening: prone Y-T-W exercises at 30° elevation,Pain-free with all strengthening exercises
→ Advance to: Phase 3: Advanced Strengthening
External rotation at 90° abduction initiated (infraspinatus/teres minor),Full can exercise at 0° abduction (supraspinatus),scapular strengthening: wall push-ups with proper scapular motion,biceps tendon strengthening: elbow flexion with 2-3 lb,Upper extremity endurance training initiated,Strength ≥ 4/5 on manual muscle testing for external rotators
→ Advance to: Phase 3: Advanced Strengthening
External rotation at 135° abduction progressing resistance,Internal rotation at 90° abduction with resistance,PNF diagonal patterns for glenohumeral stabilization,scapular stabilization: loaded scapular drills with resistance,biceps tendon strengthening: resisted elbow flexion/supination,Active ROM equal to contralateral side within 10°
→ Advance to: Phase 4: Return to Function
Rotator cuff progressive resistance ≥ 70% contralateral side,External rotation strength at 90° abduction ≥ 70% contralateral,scapular control during loaded overhead activities,biceps tendon progressive resistance ≥ 70% contralateral,Shoulder endurance: 3 sets of 15 repetitions all exercises,No compensation patterns during functional movements
→ Advance to: Phase 4: Return to Function
Full pain-free active ROM in all planes,Rotator cuff strength ≥ 80% contralateral side,External rotation at 90° abduction strength ≥ 80% contralateral,scapular stability during pushing/pulling activities,Begin light sport/work-specific activities at 50% intensity,Proprioceptive training: wall dribbles, unstable surface exercises
→ Advance to: Phase 4: Sport/Work-Specific
External rotation at 90° abduction ≥ 85% contralateral,Internal rotation at 90° abduction ≥ 85% contralateral,scapular strength ≥ 85% contralateral on push-up plus,biceps tendon strength ≥ 85% contralateral,Functional movement screen shoulder mobility passing,Begin overhead throwing progression if applicable
→ Advance to: Phase 4: Sport/Work-Specific
Full strength equal to contralateral side (≥90%),Endurance testing: 25 repetitions at testing weight without fatigue,Sport-specific drills at 75% intensity,AC joint loading without pain (cross-body adduction negative),Glenohumeral stability confirmed on apprehensive test negative,Return to modified work duties if applicable
→ Advance to: Phase 4: Final Progression
Sport-specific activities at 90% intensity,Advanced proprioceptive exercises: perturbation training,Overhead athlete: throwing program at 75% velocity,scapular control under fatigue conditions,Final strength testing ≥ 90% contralateral all planes,Patient education for maintenance program
→ Advance to: Phase 4: Discharge/Return to Activity
Full pain-free ROM equal to contralateral side,Rotator cuff strength ≥ 95% contralateral side,scapular strength and endurance equal to contralateral side,biceps tendon strength and function equal to contralateral side,AC joint stability confirmed - no pain with resisted cross-body adduction,Functional testing: Return to sport/work test battery passed
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 4Pain ≤ 3/10 during functional reaching and lifting activities
Light functional activities and conditioning
Week 6No increase in pain at 48-hour follow-up after exercise progression
Moderate activity and sport-specific conditioning
Week 9Elbow flexion and extension range adequate for ADL completion
Full return to sport, occupation, and recreation
Week 15Grip strength ≥ 50% of unaffected side on dynamometry
Precautions
- maintain-neutral-spine
- avoid-overloading
- warm-up-before
Contraindications
- severe-pain
- recent-fracture
- compartment-syndrome
- limited-range-before-assessment
Pain management
- Cryotherapy: ice pack application 15-20 minutes post-session for inflammation control
- Non-steroidal anti-inflammatory modalities: electrical stimulation (high volt galvanic)
- Pharmacological consultation for appropriate NSAID use as needed
- Gentle soft tissue mobilization to trapezius, levator scapulae to reduce referred pain
- Positioning and ergonomic education to avoid impingement positions in early phases
Equipment & modalities
Frequently asked questions
Will using ankle weights on my shoulder be safe?
What should I do if a session makes my pain worse?
Can I skip ahead to harder exercises if I feel ready?
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