Beginner Shoulder Tendon Repair Rehabilitation
A 19-week beginner program using bosu balls, balance boards, ankle braces, stationary bikes, and tennis balls 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
- 19
- Sessions/week
- 5
- Minutes/session
- 20
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview This is a 19-week, beginner-level rehabilitation guide for recovery after shoulder tendon repair. It combines gentle progressive exercise, hands-on therapy, and balance training to help you regain movement, strength, and confidence. Sessions are short and frequent, about 20 minutes, five times per week. Your clinician will guide the pace, and this guide explains what to expect and how to take part safely.
Who This Program Is For This program is for people recovering from a surgically repaired shoulder tendon who are new to rehabilitation. The goal is to protect the healing repair early on, then gradually restore shoulder motion, build rotator cuff and shoulder-blade strength, and retrain coordination using equipment such as a bosu ball, balance board, and tennis ball. Progress is slow and steady, and your therapist adjusts it to your healing.
Before You Start Only begin or continue this program under the supervision of your surgeon and physical therapist. They will confirm your repair is stable and healing well. Do not start if you have an unstable repair, an active infection, or severe muscle wasting, as these need medical review first. Follow your sling and activity instructions exactly, and never push into sharp pain. Ask questions whenever something feels unclear.
Safety Notes and When to Stop Your therapist will tell you what movements to avoid while your repair heals. Stop exercise and contact your clinician if pain keeps increasing, swelling or warmth appears, you feel new weakness, or you notice redness, fever, or wound changes. Keep your spine neutral and avoid overloading the shoulder. These are general safety steps and do not replace your care team's specific advice.
Weekly Structure Plan for about 20 minutes per session, five sessions per week, across 19 weeks. Your therapist organizes the weeks into phases: an early protection phase, a gentle movement phase, and later phases that add strengthening and balance work. Equipment may include a bosu ball, balance board, ankle brace, stationary bike, and tennis ball. Your clinician tells you which phase you are in and when to advance.
How the Plan Is Organized The plan blends short daily sessions with periodic check-ins. Early weeks focus on protecting the repair and gentle motion, with your sling used as prescribed. Middle weeks add shoulder-blade control and light resistance. Later weeks introduce balance and coordination work on unstable surfaces and sport-like movements. Each week builds slightly on the last, but only when your therapist confirms you are ready. The equipment supports variety and gradual challenge.
What a Typical Session Looks Like Sessions follow a simple pattern. You warm up gently, often with light arm and shoulder-blade movements or easy pedaling on the stationary bike. The main work includes the exercises your therapist assigns, such as gentle range-of-motion work, light resistance, and balance tasks. Cool-down involves slow stretching and relaxed breathing. A tennis ball may be used for light soft-tissue work, and unstable surfaces are added only when cleared.
Warm-Up, Main Work, and Cool-Down Start with a few minutes of easy movement to warm the shoulder, such as relaxed pendulum motions or light bike pedaling. The main portion includes the stretching, strengthening, and balance drills your therapist sets, using the bosu ball, balance board, or tennis ball as directed. Cool down with gentle stretching and calm breathing. Your therapist decides how much of each activity you do, so follow their guidance rather than pushing ahead.
Tracking Progress Keep a simple log of each session: what you did, how the shoulder felt, and any pain during or after. Note your range of motion and any strength changes your therapist measures. Bring this log to appointments so your care team can see trends. Tracking helps everyone spot problems early and celebrate steady gains.
Using Progression Criteria and Outcome Measures Your therapist uses specific checkpoints, such as pain levels, swelling, and measured range of motion, to decide when you move to the next phase. You do not advance on your own; the clinician confirms each step. Outcome measures like the ASES, Constant-Murley, SANE, and SPADI scores, plus goniometer and dynamometer readings, track your recovery over time and guide adjustments to your program.
Recovery and Self-Care Rest is part of rehabilitation. Use your sling and activity limits as instructed, and avoid lifting or reaching that strains the repair. Ice or other modalities may be used as your clinician advises. Sleep comfortably, stay generally active within limits, and keep appointments. If you feel tired or sore, tell your therapist so your plan can be adjusted.
Pain Management and Red Flags Some mild soreness with activity can be expected, but stop if pain increases or does not settle with rest. Do not self-medicate beyond what your clinician advises. Seek prompt care for fever, spreading redness, wound drainage, sudden severe pain, new numbness, or marked swelling. These could signal a problem needing medical review. Always follow your care team's instructions over general guidance.
Recovery phases
Pain less than 3/10 at rest with ice and medication,Sling immobilization maintained as prescribed,Minimal swelling of glenohumeral and subacromial structures,Passive external rotation to 0 degrees with arm at side,No active motion of repaired rotator cuff or biceps tendon,Patient demonstrates understanding of activity restrictions
→ Advance to: Early Passive Motion Phase
Pain less than 4/10 with gentle dressing activities,Passive forward flexion to 90 degrees in scapular plane,Passive external rotation to 15 degrees at 90 degrees abduction,No provocative strain on AC joint or labral repair,Soft tissue healing progressing at repaired supraspinatus tendon,Patient demonstrates proper scapular posture with sling
→ Advance to: Early Passive Motion Phase
Passive forward flexion to 120 degrees,Passive external rotation to 30 degrees at 90 degrees abduction,Passive abduction to 90 degrees,Minimal pain with pendulum exercises for glenohumeral mobility,No AC joint provocation with cross-body adduction,Scapular mobility maintained with therapist-assisted scapular stabilization
→ Advance to: Active-Assisted Motion Phase
Passive forward flexion to 140 degrees,Passive external rotation to 45 degrees at 90 degrees abduction,Passive internal rotation to 70 degrees at 90 degrees abduction,Pain less than 2/10 with passive ROM,Biceps tendon irritability controlled with activity modification,Patient demonstrates active scapular depression and retraction
→ Advance to: Active-Assisted Motion Phase
Active-assisted forward flexion to 145 degrees supine with wand,Active-assisted external rotation to 45 degrees at 90 degrees abduction,Active-assisted internal rotation to side to thoracic level,Patient demonstrates active humeral head centering in glenoid,No labral clicks or catching with motion,Begin submaximal isometrics for rotator cuff at 0 degrees abduction
→ Advance to: Early Active Motion Phase
Active forward flexion to 160 degrees with good scapular control,External rotation at 90 degrees abduction to 60 degrees,Internal rotation to T10 vertebral level,Full passive ROM achieved in all planes except behind back,Isometric contractions of subscapularis without pain,Patient reports minimal shoulder fatigue with 15-minute exercises
→ Advance to: Early Active Motion Phase
Active forward flexion full range against gravity,Active external rotation at 90 degrees abduction to 70 degrees,Active abduction to 120 degrees,No compensatory scapular hiking during shoulder elevation,Rotator cuff isometric strength 3/5 in pain-free ranges,AC joint stable to palpation with functional movements
→ Advance to: Early Strengthening Phase
Full active forward flexion and abduction against gravity,External rotation at 90 degrees abduction to 80 degrees,Internal rotation to T12 level,Beginning humeral head control in closed-chain scapular exercises,No pain with resisted biceps activation at elbow flexion,Patient demonstrates proper scapulothoracic rhythm
→ Advance to: Early Strengthening Phase
Rotator cuff manual muscle test 3+/5 for supraspinatus in scapular plane,External rotators strength 3/5 at 90 degrees abduction,Subscapularis strength 3+/5 in lift-off position,Scapular stabilizers able to hold against gravity in prone,No increase in AC joint symptoms with weighted exercises,Pain less than 2/10 with resistance bands at low tension
→ Advance to: Progressive Strengthening Phase
Rotator cuff strength 4-/5 in all planes,Begin light resistance training 0.5-1 kg for deltoid,Scapular control maintained during push-up plus against wall,Proprioceptive exercises on unstable surface tolerated,No labral irritation with diagonal PNF patterns,Biceps tendon responding to gradual resistance progression
→ Advance to: Progressive Strengthening Phase
Rotator cuff strength 4/5 in all planes,External rotation at 90 degrees abduction against resistance 2-3 kg,Internal rotation at 90 degrees abduction against resistance 2-3 kg,Scapular strengthening in side-lying and prone progressing,Patient able to perform 10 repetitions of shoulder elevation without substitution,Shoulder endurance improving with repeated motion exercises
→ Advance to: Advanced Strengthening Phase
Full rotator cuff strength 4/5,Scapular stabilizers demonstrating good endurance,No pain with functional reaching tasks at waist and shoulder height,Glenohumeral joint arthrokinematics normalizing,AC joint asymptomatic with overhead activities,Patient reports returning to light activities of daily living
→ Advance to: Advanced Strengthening Phase
Rotator cuff strength 4+/5 approaching 5/5,Begin weighted exercises 3-5 kg as tolerated,External rotators able to resist manual strength testing at 90 degrees,Internal rotators able to resist manual strength testing at 90 degrees,Push-up plus on floor with good scapular motion,No compensatory patterns with overhead activities
→ Advance to: Advanced Strengthening Phase
Rotator cuff strength 5/5 in all planes,Scapular stabilizers demonstrating 4+/5 strength,Patient tolerating resistance training with 5-8 kg for deltoid,Proprioceptive exercises progressing to overhead positions,No labral symptoms with high-speed or high-force movements,Biceps tendon strength 5/5 withresisted elbow flexion
→ Advance to: Sport-Specific Training Phase
Full shoulder strength equal to contralateral side,Endurance testing showing rotator cuff fatigue resistance,Scapular control maintained under load in functional positions,Patient demonstrating proper throwing mechanics at low velocity,No AC joint pain with weighted overhead activities,Ready for progression to sport-specific drills
→ Advance to: Sport-Specific Training Phase
Shoulder endurance equal to contralateral side,Throwing program progressing to 50% velocity,No increase in symptoms with repetitive overhead motion,Patient reporting confidence in shoulder function,Proprioceptive drills including plyometrics tolerated,Rotator cuff and scapular performance metrics improving
→ Advance to: Return to Activity Phase
Throwing program progressing to 75% velocity,Full ROM with speed and power without compensation,No recurrence of labral symptoms with aggressive maneuvers,Patient demonstrating sport-specific movement patterns,AC joint stable with contact or collision activities,Functional strength testing near pre-injury levels
→ Advance to: Return to Activity Phase
Throwing at 90% velocity without pain or mechanical symptoms,Full sport-specific training completed without setbacks,Patient reports confidence at 90% or greater,All outcome measures showing improvement from baseline,No inflammatory response following intense activity,Cleared for return to full practice with monitoring
→ Advance to: Return to Full Activity
Full return to sport or work without restrictions,All shoulder ROM equal to contralateral side,Rotator cuff and scapular strength within 10% of contralateral side,No persistent AC joint or biceps tendon symptoms,Patient satisfied with shoulder function and outcome,Outcome measures demonstrating clinically significant improvement
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 5Rotator cuff strength: supraspinatus grade ≥ 4 out of 5 on make test
Light functional activities and conditioning
Week 8Able to sustain light load ≤ 2kg in functional reach position
Moderate activity and sport-specific conditioning
Week 11No sign of shoulder impingement with resisted empty can test
Full return to sport, occupation, and recreation
Week 19Pain does not radiate during upper limb tension test at Stage 2
Precautions
- stop-if-pain-increases
- maintain-neutral-spine
- avoid-overloading
Contraindications
- unstable-fixation
- infection
- severe-muscle-atrophy
Pain management
- Ice therapy applied for 15-20 minutes multiple times daily to glenohumeral and subacromial regions
- Non-steroidal anti-inflammatory medication as prescribed for inflammation around AC joint and rotator cuff
- Gentle pendulum exercises for pain modulation and joint nutrition
- Soft tissue mobilization to posterior shoulder structures to reduce muscular guarding
- Modalities including cryotherapy and electrical stimulation for pain control
Equipment & modalities
Frequently asked questions
Can I skip my sling if it feels better?
What if an exercise hurts more than usual?
When will I be able to use my arm normally again?
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