Intermediate Shoulder Tendon Repair Rehab
A 14-week intermediate program for rehabilitation after shoulder tendon repair, incorporating foam rollers, balance pads, 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
- 14
- Sessions/week
- 5
- Minutes/session
- 30
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview — Intermediate Shoulder Tendon Repair Rehabilitation (14 Weeks)
This program is for people recovering from shoulder tendon repair who have completed early protected rehabilitation and are ready for an intermediate, structured progression. Over 14 weeks, five weekly sessions of about 30 minutes each combine progressive range-of-motion work, gentle strengthening, scapular stabilization, and proprioceptive training. The goal is to restore comfortable shoulder motion and control, rebuild rotator cuff and scapular muscle strength, improve balance and coordination of the arm, and help you return to everyday activities with confidence, all while protecting the repaired tendon. Progress is gradual and guided by your clinician.
Before You Start
Only begin or advance this program under the supervision of your physical therapist or surgeon, and follow their specific instructions about your sling or orthosis and any activity limits. Tell your clinician if you have severe osteoporosis or a history of compartment syndrome, as these conditions require modified or excluded exercises. Warm up before every session, keep your spine in a neutral position, and stop if pain increases. Stop and contact your clinician promptly for sharp or worsening pain, sudden swelling, new weakness, numbness, or a fever.
Weekly Structure
The 14 weeks are organized into phases that build on each other. Sessions occur five times per week at roughly 30 minutes each, using a foam roller, balance pad, and therapy putty. The early phase focuses on protected motion, gentle scapular activation, and keeping the elbow, wrist, and hand moving. The middle phase advances active motion and light strengthening. Later weeks emphasize rotator cuff and scapular strengthening, balance and control on unstable surfaces, and preparing for daily tasks. Your clinician decides when you move to the next phase.
What a Typical Session Looks Like
Each session follows a warm-up, main work, and cool-down pattern. A brief warm-up might include gentle pendulums, posture resets over the foam roller, and light shoulder-blade squeezes. The main work progresses through range-of-motion and strengthening exercises, scapular stabilization drills, therapy putty for the hand and wrist, and balance-pad or closed-chain control work as appropriate for your phase. Cool-down includes slow, comfortable stretching and relaxed breathing, with cold therapy or other modalities if your clinician recommends them. Keep movements controlled and within a comfortable range.
Tracking Progress
Progression between phases is based on meeting specific criteria — for example, reaching a target range of motion within pain tolerance, tolerating prone positioning, showing good scapular control, and keeping pain low during key movements. Your clinician uses these checkpoints rather than a fixed calendar to decide when you advance. Outcome measures such as the ASES and Constant-Murley scores, the SPADI, goniometry for range of motion, manual muscle testing, and upper-quarter balance tests are recorded periodically to show change over time and guide adjustments to your program.
Recovery and Self-Care
Manage discomfort with the guidance of your clinician, using cold therapy and rest as advised, and avoid pushing through sharp or escalating pain. Keep up your home exercises on non-supervised days, protect the shoulder during sleep and daily tasks, and maintain good posture and a neutral spine. Contact your clinician for increasing pain, new swelling, redness, warmth, numbness, or unexpected loss of motion or strength. Recovery after tendon repair takes time, so expect gradual gains and be patient with the process.
Recovery phases
Passive glenohumeral flexion to 90 degrees within pain tolerance,Scapular stabilization in neutral with gentle scapular retraction,Active elbow, wrist, and hand ROM to maintain distal function,Tolerance to prone positioning for scapular kinematics,Minimal pain response (VAS < 3/10) during passive glenohumeral external rotation to 0 degrees,Proper orthotic positioning and cuff protection compliance
→ Advance to: Phase II
Passive glenohumeral flexion to 110 degrees,Active-assisted glenohumeral abduction to 70 degrees,Scapular retraction and protraction in supported side-lying,Pain-free glenohumeral pendulums (Codman exercises),Tolerance to light scapular stabilization isometric contractions,Isometric rotator cuff contractions at 0 degrees abduction
→ Advance to: Phase II
Passive glenohumeral flexion to 130 degrees,Active-assisted glenohumeral abduction to 90 degrees,Glenohumeral external rotation in scapular plane to 30 degrees at 0 degrees abduction,Scapular stabilization with resistance bands (light),Progressed isometric rotator cuff contractions,Pain-free active assisted range of motion with opposite arm assistance
→ Advance to: Phase II
Passive glenohumeral flexion to 145 degrees,Active glenohumeral abduction to 90 degrees,Glenohumeral external rotation to 45 degrees at 0 degrees abduction,Full pain-free scapular range of motion including upward rotation, Glenohumeral internal rotation to 70 degrees in scapular plane,Ability to perform scapular stabilization during active arm movement
→ Advance to: Phase III
Passive glenohumeral flexion to 160 degrees,Active glenohumeral abduction to 120 degrees,Glenohumeral external rotation to 60 degrees at 0 degrees abduction,Rotator cuff isometric contractions at 30 degrees abduction,Scapular proprioception training with perturbation,Full elbow flexion and extension active ROM
→ Advance to: Phase III
Passive glenohumeral external rotation to 75 degrees at 0 degrees abduction,Active glenohumeral flexion to 140 degrees,Glenohumeral internal rotation to 55 degrees,Scapular retraction against resistance (Theraband),Progressed rotator cuff isometric to light resistance (1-2 lbs),Functional reach patterns at waist level without pain
→ Advance to: Phase III
Full passive glenohumeral ROM in all planes,Active glenohumeral abduction to 145 degrees,Glenohumeral external rotation at 90 degrees abduction to 60 degrees,AC joint mobilization tolerance (if indicated),Biceps tendon glide exercises without irritation,Scapular control during overhead reaching activities
→ Advance to: Phase III
Full active glenohumeral ROM equal to contralateral side,Glenohumeral internal rotation at 90 degrees abduction to 70 degrees,Rotator cuff light resistance (2-3 lbs) in all planes,Scapular stabilization against moderate resistance,Biceps tendon isometrics at multiple angles,Functional overhead activities to 90 degrees flexion
→ Advance to: Phase III
Rotator cuff progressive resistance (3-5 lbs) with proper form,Scapular strengthening: rhomboids, middle trapezius, lower trapezius,Glenohumeral proprioception training in closed chain,Biceps tendon progressive resistance (light-moderate),Internal and external rotation against resistance at functional angles,Scapular rhythm normalization during elevation
→ Advance to: Phase IV
Rotator cuff resistance progression to 5-8 lbs,Scapular stabilization with overhead exercises,Proprioceptive training: unstable surface support,Biceps tendon progressive loading without pain,Pectoralis major and deltoid progressive strengthening,Endurance training for rotator cuff (higher repetitions, lower resistance)
→ Advance to: Phase IV
Rotator cuff functional strengthening at multiple angles,Advanced scapular stabilization: push-up plus, planks,Glenohumeral joint position sense training,Biceps tendon functional loading including speed work,Progressive throwing program initiation if applicable,Core stability integration with upper extremity movements
→ Advance to: Phase IV
Rotator cuff isotonic strengthening at 90 degrees abduction,Scapular acceleration and deceleration exercises,Sport-specific or occupation-specific movement patterns,Biceps tendon functional training including eccentric loading,Internal and external rotation at 90 degrees abduction at 90 degrees,Movement quality assessment under load
→ Advance to: Phase IV
Full rotator cuff strength (greater than 85% contralateral side),Scapular control during high-velocity activities,AC joint stress tolerance without symptoms,Biceps tendon load tolerance for functional activities,Glenohumeral complex endurance for sustained activity,Proper scapulohumeral rhythm during overhead tasks
→ Advance to: Discharge/Transition to Maintenance
Complete return to unrestricted activity tolerance,Rotator cuff and scapular endurance at required activity levels,Full functional range with no compensations,Biceps tendon return to full activity demands,Patient education for maintenance program,Outcome measures at goal achievement level
→ Advance to: Discharge/Transition to Maintenance
Return to activity milestones
Pain-free basic activities of daily living
Week 4Rotator cuff strength: supraspinatus grade ≥ 4 out of 5 on make test
Light functional activities and conditioning
Week 6Able to sustain light load ≤ 2kg in functional reach position
Moderate activity and sport-specific conditioning
Week 8No sign of shoulder impingement with resisted empty can test
Full return to sport, occupation, and recreation
Week 14Pain does not radiate during upper limb tension test at Stage 2
Precautions
- warm-up-before
- stop-if-pain-increases
- maintain-neutral-spine
Contraindications
- severe-osteoporosis
- compartment-syndrome
Pain management
- Cryotherapy (ice pack) for 15-20 minutes post-session and as needed
- Pharmacologic consultation for NSAID use as indicated
- Soft tissue mobilization to scapular stabilizers and posterior capsule
- Glenohumeral joint mobilization (Grades I-II) for pain modulation
- Neuromuscular electrical stimulation (NMES) to rotator cuff if indicated
Equipment & modalities
Frequently asked questions
Can I advance to the next phase on my own?
Is it normal to feel some soreness after sessions?
What if I miss a session or a few days?
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