Beginner Shoulder Tendon Repair Rehabilitation
A 14-week beginner program using ankle weights, and balance boards 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
- tendon-repair
- Level
- beginner
- Duration
- 14
- Sessions/week
- 2
- Minutes/session
- 20
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview This is a beginner-level shoulder rehabilitation guide for people recovering from a shoulder tendon repair. It runs 14 weeks at two sessions per week, about 20 minutes each, using ankle weights and a balance board as tools. The plan moves through gentle protection, early motion, and gradual strengthening under clinician supervision. Because recovery from tendon repair varies, your therapist will adjust the pace to your body and surgical instructions.
Who This Program Is For and Its Goal This program suits adults starting rehabilitation after a shoulder tendon repair who have been cleared by their surgeon or therapist to begin guided exercise. The goal is to protect the repair while gently restoring movement, then build shoulder and shoulder-blade control and strength over time. It is not for people with unstable fixation or compartment syndrome. Progress is measured by comfort, motion, and function, not speed.
Before You Start Please review this plan with your surgeon and physical therapist before beginning. Your therapy team should confirm your repair is stable enough for these activities and guide the specific techniques mentioned, such as ultrasound, electrical stimulation, and manual therapy. Never push into sharp pain. These are general education ideas, not a substitute for individualized clinical care.
Safety Notes and When to Stop Stop and contact your clinician if pain increases during or after exercise, if you develop new swelling, numbness, weakness, or a fever, or if your shoulder feels unstable. People with unstable fixation or compartment syndrome should not do this program. Keep your spine in a neutral, comfortable position throughout. Follow any sling or activity restrictions your surgeon gave you, and never force a movement your body resists.
Weekly Structure You will do two sessions per week, each around 20 minutes, for 14 weeks. Early weeks focus on protected, assisted movement and shoulder-blade control. Middle weeks add gentle active motion and light resistance. Later weeks build strength and control using ankle weights and the balance board. Your therapist decides when you move to the next phase based on how you respond, not just the calendar.
How the 14-Week Plan Is Organized The plan is arranged in phases. The first phase emphasizes protection: gentle assisted motion within limits your therapist sets, elbow movement, and shoulder-blade settling, while keeping pain low. The next phase introduces active-assisted motion and light mobility work. Later phases add progressive resistance with bands and weights and balance-board control work. Aquatic therapy may be used for low-impact motion. Each phase builds only after you meet comfort and movement goals.
What a Typical Session Looks Like Each session follows a warm-up, main work, and cool-down pattern. Your therapist may include modalities like ultrasound or electrical stimulation before or during the main work. The balance board is used for light control and posture work, not for loaded shoulder exercise, and ankle weights add gentle resistance only when cleared. Always finish feeling better or the same, not worse.
Warm-Up, Main Work, and Cool-Down Begin with gentle shoulder-blade setting, relaxed pendulum motions if approved, and easy elbow and wrist movement to warm up. The main work includes the assisted or active exercises and light resistance your therapist prescribes, plus any manual therapy or modalities they provide. Cool down with slow, pain-free motion and relaxed posture. Keep your trunk steady and spine neutral, and stop any exercise that sharply increases pain.
Tracking Progress Keep a simple log of pain before and after sessions, which exercises you did, and how your shoulder felt the next day. Your therapist uses this along with formal measures like the ASES score, Simple Shoulder Test, pain scale, range-of-motion measurements, manual muscle testing, and the SPADI to judge progress. These tools help guide safe advancement rather than relying on how you feel on any single day.
How Progression Criteria Are Used Your therapist moves you between phases when you meet comfort and movement goals, such as keeping pain low during and after exercise and tolerating the current phase without increased evening soreness. Outcome measures track changes in pain, motion, strength, and daily function over time. If symptoms flare, the plan may pause or step back. Progression is individual and supervised, so never advance phases on your own.
Recovery and Self-Care Rest between sessions and protect your shoulder during daily tasks as advised. Use pillows for comfortable positioning, keep up gentle motion your therapist approves, and avoid heavy lifting or sudden reaching until cleared. Good sleep, hydration, and steady pacing support healing. Report any change in symptoms promptly so your care team can adjust the plan safely.
Pain Management Cautions and Red Flags Some mild soreness is common, but stop if pain rises during exercise or lingers afterward. Do not mask increasing pain to push through a session. Seek prompt care for sudden severe pain, new swelling, fever, numbness, or a shoulder that feels unstable or gives way. Ask your clinician about any pain relief questions, including medications, rather than adjusting anything yourself.
Recovery phases
Passive forward flexion to 90 degrees in scapular plane with glenohumeral joint protection,External rotation limited to 0 degrees with arm in scapular plane,Active elbow flexion and extension with shoulder in neutral rotation,Scapular stabilization in neutral with prohibited glenohumeral movement,Pain level maintained below 3/10 at rest and during therapeutic exercises,No active contraction of rotator cuff musculature including supraspinatus, infraspinatus, subscapularis
→ Advance to: Phase 2
Passive forward flexion maintained at 90 degrees in scapular plane,Passive external rotation to 10 degrees with arm in scapular plane at 90 degrees abduction,Continued active elbow flexion/extension with shoulder protected,Introduction of pendulum exercises (Codman) with minimal glenohumeral stress,Pain level maintained below 3/10 with no increase in evening soreness,Tolerance established for wearing sling during functional activities
→ Advance to: Phase 2
Passive forward flexion increased to 120 degrees in scapular plane,Passive external rotation progressed to 20 degrees at 90 degrees abduction,Active-assisted range of motion initiated with wand or pulleys,Introduction of scapular retraction and protraction in prone,Pain level below 2/10 during all exercises with no night pain,Full elbow and wrist active range of motion achieved
→ Advance to: Phase 3
Passive forward flexion to 145 degrees in scapular plane,Passive external rotation to 30 degrees at 90 degrees abduction,Active-assisted range of motion progressing toward active motion,Glenohumeral joint mobs Grade I-II for inferior and posterior glide,Scapular stabilization exercises in side-lying including scapular punch,Pain level below 2/10 with functional activities
→ Advance to: Phase 3
Active forward flexion to 160 degrees in scapular plane,External rotation progressed to 45 degrees at 90 degrees abduction with light resistance,Isometric rotator cuff contractions initiated at submaximal effort,Submaximal isometrics for supraspinatus, infraspinatus, subscapularis,Scapular strengthening including middle trapezius and rhomboids,Pain level below 2/10 during and after exercise sessions
→ Advance to: Phase 4
Full active forward flexion range of motion in scapular plane,External rotation at 45 degrees abduction with 1 lb resistance,Isotonic elbow flexion with biceps protection avoiding compound movements,Progression of scapular stabilization in prone extension to 90 degrees,Rotator cuff isometrics progressed to submaximal resistance,No pain with activities of daily living
→ Advance to: Phase 4
Full active and passive range of motion in all planes achieved,External rotation at 90 degrees abduction with 2 lb resistance,Internal rotation at 90 degrees abduction with 2 lb resistance,Side-lying external rotation with 2 lb for rotator cuff strengthening,Scapular proprioception exercises on unstable surfaces,Pain-free resistance training with tolerance to loading
→ Advance to: Phase 4
Rotator cuff strengthening with theraband at moderate resistance,Progression of internal/external rotation to 90/90 position,Shoulder shrugs and rows with scapular control,PNF diagonal patterns initiated at low resistance,Proprioceptive training with wall pushes and ball against wall,Greater than 75% strength compared to contralateral side
→ Advance to: Phase 5
Rotator cuff strengthening with theraband at resistance level 3-4,External rotation at side with 3 lb progressing to 5 lb,Internal rotation at side with 3 lb progressing to 5 lb,Prone Y-T-W exercises for posterior shoulder and scapular balance,Shoulder endurance training with Theraband rows,Full range of motion without pain or compensation
→ Advance to: Phase 5
Advanced rotator cuff strengthening with dumbbells 5-8 lb,Push-up progression against wall then floor with scapular control,External rotation deceleration exercises for throwing mechanics,Functional reaching and lifting at waist to shoulder level,Scapular control during upper extremity closed chain activities,Greater than 80% strength compared to contralateral side
→ Advance to: Phase 5
Light functional activities at work and home without restrictions,Shoulder endurance with higher repetition lower resistance training,Proprioceptive exercises on unstable surfaces single arm,Progression of push-ups to incline then floor,Internal/external rotation at 90/90 at 5+ lb each side,Pain-free full shoulder function
→ Advance to: Phase 5
Initiation of light overhead activities when ROM permits,External rotation eccentric strengthening for rotator cuff,Upper extremity power training with medicine ball at low intensity,Shoulder complex endurance testing reaching 80% of baseline,Functional movement patterns without compensation,No pain with sustained or repeated activities
→ Advance to: Phase 5
Progression to moderate overhead activities,Advanced theraband and dumbbell strengthening 8-12 repetitions,Push-ups with added resistance or weighted vest progression,Sport-specific or occupation-specific movement introduction,Scapular rhythm normalization during functional tasks,Greater than 90% strength compared to contralateral side
→ Advance to: Discharge
Full return to pre-injury activities without restrictions,Shoulder strength within 10% of contralateral side,Normal scapulohumeral rhythm throughout range of motion,No pain with maximum resistance testing,Functional outcome measures at discharge baseline,Patient education for maintenance program
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 4Transfers and mobility tasks completed without upper limb compensation
Light functional activities and conditioning
Week 6Patient adherence to home exercise programme ≥ 5 days per week
Moderate activity and sport-specific conditioning
Week 8Able to perform light overhead reaching for objects at eye level
Full return to sport, occupation, and recreation
Week 14Able to complete 5 minutes of light kitchen or desk activity
Precautions
- stop-if-pain-increases
- maintain-neutral-spine
Contraindications
- compartment-syndrome
- unstable-fixation
Pain management
- Cryotherapy ice pack application 15-20 minutes post-exercise
- Non-steroidal anti-inflammatory medication as prescribed
- Gentle soft tissue mobilization to trapezius and scapular muscles
- Submaximal isometric contractions for pain modulation
- Heat therapy prior to stretching for tissue extensibility
Equipment & modalities
Frequently asked questions
How much soreness is normal after sessions?
Can I skip ahead to strengthening?
What if I miss a session or have a bad 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