Intermediate Shoulder Tendon Repair Rehabilitation
A 11-week intermediate program using barbells, balance pads, and therapy putty 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
- intermediate
- Duration
- 11
- Sessions/week
- 3
- Minutes/session
- 45
- Evidence level
- moderate
- ICD-10
- S42
- Cost tier
- moderate
Program Overview — Intermediate Shoulder Tendon Repair Rehabilitation (11 Weeks)
This program is for adults recovering from a shoulder tendon repair who have completed early protected healing and are ready for an intermediate, supervised progression. Over 11 weeks, three 45-minute sessions per week, you will gradually rebuild shoulder motion, strength, and daily function using a barbell, balance pad, and therapy putty, alongside clinician-guided modalities. The goal is a steady, safe return toward normal shoulder use without overloading the repair.
Before You Start
Follow this plan only under your clinician's supervision. Your precautions mean avoiding heavy or sudden loads on the shoulder and keeping your spine in a neutral, supported position during exercise. Because compartment syndrome is listed as a contraindication, stop immediately and seek urgent care if you develop severe, worsening pain, tightness, swelling, numbness, or tingling in the arm. Also stop and call your clinician for new weakness, sharp pain, or pain that stays high after activity.
Weekly Structure
The 11 weeks run three sessions per week at about 45 minutes each. Early weeks focus on protected motion and gentle scapular (shoulder-blade) control. Middle weeks add active motion and light resistance. Later weeks build strength and endurance with the barbell, putty, and balance pad. Your clinician decides when you move between phases based on the progression signs, so faster or slower is normal and expected.
What a Typical Session Looks Like
Sessions follow a warm-up, main work, and cool-down pattern. Warm-up includes gentle pendulum and scapular movements plus light putty squeezes. Main work pairs range-of-motion and scapular exercises with graded barbell and putty strengthening, using the balance pad for controlled stability work, and may include your clinician's modalities. Cool-down includes gentle stretching, myofascial release to the upper back and shoulder-blade muscles as directed, and easy breathing to settle the shoulder.
Tracking Progress
Your clinician uses the phase criteria—such as comfortable range of motion, low pain scores, and pain-free resisted tests—to decide when you advance. Outcome measures like the ASES, Constant-Murley, VAS pain scale, goniometer range of motion, manual muscle testing, and SANE score are repeated to show trends over time. These guide decisions; they are not pass/fail cutoffs you should judge yourself. Report how your shoulder feels between sessions.
Recovery and Self-Care
Use modalities like ultrasound and TENS only as directed by your clinician; they support comfort and healing but do not replace exercise. Rest the shoulder when sore, avoid overloading, and keep your spine neutral during lifts. Watch for red flags—severe or rising pain, tightness, swelling, numbness, tingling, or new weakness—and stop and contact your clinician promptly if they appear.
Recovery phases
Pain at rest ≤ 2/10 on visual analog scale,Active and passive glenohumeral forward flexion within pain tolerance to 90°,No active contraction of supraspinatus to protect repair,Scapular stabilization in neutral position maintained,AC joint loading tolerance with sling immobilization,Biceps tendon protected with elbow flexed at 90°
→ Advance to: Phase II
Pain with glenohumeral movements ≤ 3/10,Passive external rotation to 30° with arm in scapular plane,No aggravation of labral repair with pendulum exercises,Full passive elbow flexion/extension within tolerance,Scapular protraction/retraction without pain,AC joint vertical compression test negative
→ Advance to: Phase II
Active forward flexion to 100° with good scapular mechanics,Passive external rotation to 45° at 0° abduction,Internal rotation to trunk level (T12),No clicking or catching suggesting labral pathology,Isometric rotator cuff contractions without pain,Biceps tendon resisted elbow flexion pain-free
→ Advance to: Phase III
Forward flexion to 120° with controlled scapular upward rotation,External rotation to 60° at 0° abduction,Glenohumeral joint play within physiological limits,Isotonic shoulder abduction to 90° at 2/5 resistance,Pain-free AC joint palpation,Biceps tendon tensioning without anterior shoulder pain
→ Advance to: Phase III
Forward flexion to 145° with minimal scapular winging,External rotation at 90° abduction to 60°,Internal rotation to T8-T10 level,Rotator cuff strengthening at 3/5 manual muscle testing,Scapular retraction strength 3/5,Biceps curl with 2 kg without anterior shoulder discomfort
→ Advance to: Phase IV
Full forward flexion with proper glenohumeral rhythm,External rotation at 90° abduction to 75°,Supraspinatus isolation without impingement signs,Rotator cuff eccentric strengthening tolerated,Scapular stabilization with Theraband in diagonal patterns,Biceps tendon loading progression to 4 kg
→ Advance to: Phase IV
Full range external rotation at 90° abduction,Internal rotation to T7 level,Rotator cuff manual muscle testing 4-/5,Scapular control during loaded elevation tasks,No labral irritation with provocative tests,Biceps tendon functional loading complete
→ Advance to: Phase IV
Full pain-free glenohumeral ROM in all planes,External rotation strength 4/5 at 90° abduction,Internal rotation strength 4/5,Scapular stabilization during push-up plus phase,Rotator cuff closed-chain strengthening without symptoms,AC joint stress test negative
→ Advance to: Phase V
Isokinetic rotator cuff testing within 80% of contralateral side,Scapular dyskinesis absent during functional movements,No labral symptoms with Load and Shift test,Full strength in biceps brachii,Shoulder endurance testing 80% of contralateral side,Plyometric throwing progression initiated
→ Advance to: Phase V
Full sport-specific or occupational glenohumeral ROM,Rotator cuff strength 4+/5 all directions,Scapular mechanics optimized during overhead tasks,No pain with labral stress tests,Biceps tendon speed test negative,Functional movement patterns pain-free
→ Advance to: Discharge
Return to unrestricted activities,Shoulder outcome scores at pre-injury level,Rotator cuff manual muscle testing 5-/5,Scapulothoracic and glenohumeral rhythm normalized,AC joint asymptomatic with full loading,Biceps tendon resisted test 5/5 strength
→ Advance to: Discharge
Return to activity milestones
Pain-free basic activities of daily living
Week 3Able to sustain light load ≤ 2kg in functional reach position
Light functional activities and conditioning
Week 4No sign of shoulder impingement with resisted empty can test
Moderate activity and sport-specific conditioning
Week 6Able to tolerate light resisted flexion and extension without flare
Full return to sport, occupation, and recreation
Week 11Transfers and mobility tasks completed without upper limb compensation
Precautions
- avoid-overloading
- maintain-neutral-spine
Contraindications
- compartment-syndrome
Pain management
- Cryotherapy with ice pack to glenohumeral joint for 15-20 minutes post-exercise
- Non-steroidal anti-inflammatory medication as prescribed
- Soft tissue mobilization to posterior rotator cuff and scapular muscles
- Posterior capsule stretching to address glenohumeral internal rotation deficit
- Electrical stimulation (TENS) to anterior shoulder for biceps tendon protection
Equipment & modalities
Frequently asked questions
How sore is too sore after a session?
Can I skip the balance pad or barbell work?
What if I feel ready to advance before my clinician says so?
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