Intermediate Rehabilitation for Shoulder Tendon Repair
A 19-week intermediate program for individuals recovering from shoulder tendon repairs, incorporating rowing machines and therapy putty.
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
- intermediate
- Duration
- 19
- Sessions/week
- 2
- Minutes/session
- 30
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Shoulder Tendon Repair — Intermediate Rehabilitation Program (19 Weeks)
This program is for people who are partway through recovery after shoulder tendon repair surgery and are ready for a supervised intermediate plan. It is designed for those whose surgeon has cleared them to progress beyond early protection. The goal is to gradually restore shoulder movement, strength, and everyday function over 19 weeks, using guided exercise, hands-on therapy, and equipment such as a rower and therapy putty. Progress is paced to your own response, and your clinician adjusts the plan as you improve.
Before You Start
Only begin this program with your surgeon's and physical therapist's approval. Tell your care team if you have an unstable repair, severe bone thinning (osteoporosis), or any active infection — these are reasons this program may not be safe for you. Always warm up before exercise and avoid overloading the shoulder. Stop and call your clinician if you have sudden severe pain, new weakness, swelling, fever, or redness around the shoulder, or if pain keeps getting worse rather than settling.
Weekly Structure
The plan runs 19 weeks with two sessions per week of about 30 minutes each, using a rower and therapy putty. It moves through phases in plain steps: first protecting the repair while a therapist helps move your arm, then gentle active motion, then building strength and control. You do not jump ahead on your own — your therapist decides when you are ready for the next phase based on how your shoulder responds, your pain, and your movement.
What a Typical Session Looks Like
Each session starts with a warm-up to prepare the shoulder and body, often light rowing at an easy effort and gentle arm movements. The main work includes progressive resistance exercise, scapular (shoulder blade) control drills, movement patterns guided by your therapist, and hands-on techniques as needed; putty may be used for light grip and rotator cuff work, and electrical stimulation may support muscle activation. The session ends with a cool-down of gentle stretching and easy motion to settle the shoulder.
Tracking Progress
Your therapist uses specific checkpoints — such as pain levels, how far your shoulder moves, and how well you tolerate sessions — to decide when to move to the next phase. These are guides, not targets you must hit alone. Standard outcome measures, including shoulder function scores, pain ratings, range-of-motion and strength testing, are recorded over time to show your progress and shape the plan. Honest feedback about pain and function helps your clinician fine-tune each step.
Recovery and Self-Care
Follow your care team's guidance on activity and rest, and avoid pushing through sharp or escalating pain. Keep using any sling or supports exactly as prescribed. Do not add new exercises or increase effort on your own — overloading can set recovery back. Seek prompt medical advice for red flags such as fever, spreading redness, sudden loss of movement or strength, chest pain, or shortness of breath.
Recovery phases
Pain at rest ≤2/10 on visual analog scale,Passive glenohumeral flexion to 90° achieved without pain,Passive external rotation at 0° abduction to 20° achieved,No active shoulder motion permitted,Sling immobilization maintained as prescribed,Scapular stabilization exercises initiated in neutral
→ Advance to: Phase 2
Pain at rest ≤2/10 maintained,Passive glenohumeral flexion to 110° achieved,Passive external rotation at 0° abduction to 30° achieved,Passive internal rotation at 90° abduction to 50° achieved,No compensatory scapular hiking during passive motion,Tolerance to 30-minute session without increased symptoms
→ Advance to: Phase 2
Passive flexion to 140° achieved,Passive external rotation at 0° abduction to 40° achieved,Active-assisted shoulder flexion to 90° pain-free,Active-assisted external rotation at 0° abduction to 20° achieved,Scapular retraction during supine arm elevation confirmed,No increase in morning stiffness >30 minutes
→ Advance to: Phase 3
Active-assisted flexion to 120° achieved,Active-assisted external rotation at 0° abduction to 30° achieved,Active elbow flexion and extension with shoulder stabilized,Scapular protraction/retraction control in prone demonstrated,Gravity-eliminated abduction to 60° achieved,Subjective improvement in functional baseline
→ Advance to: Phase 3
Active-assisted flexion to 140° achieved,Active-assisted external rotation at 90° abduction to 30° achieved,Full passive glenohumeral ROM maintained,Active shoulder abduction to 60° in scapular plane achieved,No lag during scapular stabilization tests,Tolerance of isometric rotator cuff contractions at low resistance
→ Advance to: Phase 3
Active shoulder flexion to 150° achieved,Active shoulder abduction to 90° in scapular plane achieved,External rotation at 90° abduction to 45° achieved,Internal rotation at 90° abduction to 70° achieved,Grade 4/5 manual muscle testing for infraspinatus and supraspinatus,Scapular control during active arm elevation without winging
→ Advance to: Phase 4
Full active shoulder flexion achieved,Full active shoulder abduction in scapular plane achieved,External rotation at 90° abduction to 60° achieved,Internal rotation at 90° abduction to 80° achieved,Rotator cuff isometric exercises at 50% effort pain-free,Prone scapular stabilization exercises initiated
→ Advance to: Phase 4
Full active ROM in all planes maintained,Grade 4/5 supraspinatus manual muscle testing,Grade 4/5 infraspinatus and teres minor manual muscle testing,Grade 3/5 subscapularis manual muscle testing,Scapular upward rotation during arm elevation demonstrated,Patient report of decreased catching with overhead activities
→ Advance to: Phase 4
External rotation at side against resistance 3/5 grade,Internal rotation at side against resistance 3/5 grade,Shoulder flexion against gravity to 160° no lag,Scapular stabilization endurance >20 seconds in modified push-up position,Biceps tendon resistance exercises initiated at minimal load,No reproduction of acromioclavicular joint pain during ADL
→ Advance to: Phase 5
External rotation at 90° abduction 3/5 grade achieved,Internal rotation at 90° abduction 3/5 grade achieved,Supraspinatus resistance in empty can position 3/5 grade,Scapular retraction against resistance 4/5 grade,Progressive biceps curl resistance to 3kg tolerated,Shoulder flexion endurance >10 repetitions at moderate resistance
→ Advance to: Phase 5
Full rotator cuff strength 4/5 in all planes,Scapular stabilization 4/5 on manual muscle testing,Biceps strength 4/5 on manual muscle testing,Closed-chain scapular exercises tolerated,Proprioceptive exercises in quadruped position initiated,AC joint stability confirmed without pain on cross-body adduction
→ Advance to: Phase 5
Rotator cuff strength 4-5/5 in all planes,Scapular stabilization endurance >30 seconds,Biceps strength 4-5/5 with functional resistance,PNF diagonal patterns initiated with resistance,Shoulder proprioception at 90° flexion achieved,Patient able to perform light ADL without compensation
→ Advance to: Phase 6
External rotation at 90° abduction against resistance 4/5 grade,Internal rotation at 90° abduction against resistance 4/5 grade,Push-up plus exercises initiated,Wall dribbles for internal rotation mobility achieved,Rhythmic stabilization in quadruped position tolerated,Labral repair stability confirmed on compression test
→ Advance to: Phase 6
Full shoulder strength compared to contralateral side,Functional reach without pain or instability,Shoulder endurance 80% of contralateral side,Sport-specific or occupation-specific movements initiated at low intensity,Proprioceptive exercises at 135° abduction achieved,No pain with resisted biceps activities
→ Advance to: Phase 6
Shoulder flexion endurance 90% of contralateral side,External rotation strength 90% of contralateral side,Internal rotation strength 90% of contralateral side,Timed functional tests within 10% of baseline,Patient confidence 8/10 on shoulder specific questionnaire,No pain with functional progression
→ Advance to: Phase 7
Isokinetic shoulder evaluation within 85% bilateral ratio,Push-up test >20 repetitions without fatigue,Scapular control during loaded overhead activities,Return to light manual work activities tolerated,AC joint loading without symptoms,Biceps tendon load tolerance without anterior pain
→ Advance to: Phase 7
Full return to work activities without restrictions,Sport-specific drills at 75% intensity tolerated,Shoulder endurance tests within 5% of pre-injury baseline,Patient satisfaction >8/10 on global rating of change,No recurrence of symptoms with increased activity,Cleared for full sport or occupational participation
→ Advance to: Phase 8
Sport-specific or job-specific training at 90% intensity,Shoulder biomechanics normalized during complex movements,Proprioceptive retraining at high-speed activities completed,Maintenance program independently performed,No fear of movement or re-injury anxiety,Strength ratios within normal limits for population
→ Advance to: Phase 8
Full return to pre-injury activity level,Shoulder outcome measures meet success criteria,Maintenance exercise program independently understood,Patient educated on warning signs requiring follow-up,No limitations in activities of daily living,Discharge criteria met for therapeutic conclusion
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 5No sign of shoulder impingement with resisted empty can test
Light functional activities and conditioning
Week 8Able to tolerate light resisted flexion and extension without flare
Moderate activity and sport-specific conditioning
Week 11Pain ≤ 3/10 during functional reaching and lifting activities
Full return to sport, occupation, and recreation
Week 19Patient adherence to home exercise programme ≥ 5 days per week
Precautions
- warm-up-before
- avoid-overloading
Contraindications
- unstable-fixation
- severe-osteoporosis
- infection
Pain management
- Cryotherapy (ice pack application 15-20 minutes post-exercise)
- Non-steroidal anti-inflammatory medication as prescribed
- Gentle soft tissue mobilization to posterior capsule
- Subcutaneous needling or dry cupping for myofascial trigger points
- Activity modification and ergonomic education
Equipment & modalities
Frequently asked questions
Will I be sore after sessions?
Can I do extra sessions or exercises at home?
How will I know I'm ready for the next phase?
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