Knee Exercises 2 – Hospital

Exercises

255A Beyers Naudé Dr,
Rustenburg, 0299
Tel: +27 (0)14 592 8322

www.physiotherapy.co.za
P.O.Box 21533
Protea Park
0305

Hospitale/Hospitals
Netcare Ferncrest/Life
Peglerae/Medicare
Tel: +27 (0)14 592 8322

Knee Rehabilitation after surgery

(Total Knee Replacement)

GENERAL INFORMATION AND ADVICE:

Number 1

Crutches or other assistive devices should be used as prescribed. (See exercises for instructions on how to walk and for climbing up and down stairs. Be very careful of any turning movements at the knee. You may put full weight on the leg unless told otherwise.

Number 2

If you have received orthopaedic stockings use them as prescribed. They are used to control swelling and to prevent blood clotting.

Number 3

If your calf becomes swollen or painful or your knee becomes hot or red, contact the doctors’ rooms.

Number 4

Try to keep your leg elevated when you are resting to reduce the swelling in your leg. Put your foot up on the sofa so that your ankle is higher than your heart. Do not put a pillow under the knee as it increases the risk for a fixed flexion deformity/extension lag.

Number 5

When sitting bend your knee as far as pain allows. When lying down keep the knee as straight as possible.

Number 6

Be very careful of slipping on wet surfaces, steps etc. No sudden movements with the knee.

Number 7

When dressing, dress the operated leg first up to the knee, dress the healthy leg up to the knee and then pull the pants over your buttocks. Be very careful to not turn the knee in or out.

Number 8

You may sleep on your back or on your sides. Put a pillow between your knees when lying on your side.

Number 9

For swelling and pain ice and heat can be used (See exercises for time specific management). If your knee is very swollen, lift the end of your bed.

Number 10

The dressings must not be taken off until your post-operative appointment at the clinic. The dressing must be kept clean and dry at all times.

Number 11

No driving while your knee is recovering. Only start driving when you can safely drive without any pain and your leg is strong enough to perform all the nessasary actions.

Number 12

Please follow the exercises prescribed. Physiotherapy is very important to insure that the knee is fully rehabilitated and functional. It is very important to remember that walking is the best exercise and that we want as much movement as possible as soon as possible.

Number 13

Consult your physio for a biokineticist referral if you want to start doing gym exercises. The following exercises should preferrably never be done again: a) leg extentions

Number 14

No jogging for at least 3 months. No sport participation for at least 9 months. No breast stroke kicking for 6 months.

EXERCISES:

0-2 Weeks
EXERCISES SHOULD NEVER BE EXCESSIVLY PAINFULL
REPEAT ALL EXERCISES APPROXAMITALY 10 TIMES

1 - Breathing Exercises

a. Sit or lie down comfortably.
b. Breath in through your nose.
c. Breath out through your mouth.
d. Keep your shoulders relaxed.
1. Take a deep breath in and out.
2. Take a deep breath in, hold for 3-5 seconds and breath out.
3. Take a deep breath in, then a bit more in, and breath out.

2 - Circulation exercises to prevent blood clotting:

a. Footpumps
1. Keep your knee still.
2. Move your foot up and down.
b. Patella mobs
1. Sit with your knee straight and relaxed.
2. Hold your knee cap between your hands.
3. Move it up and down.
4. Move it from left to right.

3 - Static Exercises

a. Quadriceps
1. Sit with your knee straight.
2. Push your knee as flat into the bed as possible.
3. Hold 5-10 seconds.
b. Gluteus
1. Lie down on your back with your knee straight.
2. Squeeze your buttocks together.
3. Hold 5-10 seconds.
c. Calves
1. Sit down with your knee straight.
2. Point your toes.
3. Hold 5-10 seconds.
d. Hamstrings
1. Lie down on your back with your knee straight.
2. Push your heel down into the bed.
3. Hold 5-10 seconds.

4 - Active Exercises

a. Straight leg raise
1. Lie down on your back.
2. Keep your knee straight and quads tight.
3. Pick your foot up towards the ceiling, bending at the hip. Make sure not to lift the foot to high (10-15 cm off the bed is enough)
4. Lower your leg slowly.
b. Abduction
1. Lie down on your back.
2. Slide your leg outwards.
3. Slide the leg inwards until it touches the other leg.

5 - Knee extension range

a. Feet on pillow
1. Lie on your back or sit with your knee straight.
2. Put a pillow under your ankle.
3. Let your knee hang towards the bed.
4. Hold this position for 2-3 minutes

6 - Knee flexion range

a. Heelslides
1. Keep your heel on the bed.
2. Move your heel to your buttock as far as possible.
3. Hold for 5-10 seconds.
4. Straighten your knee again.
b. Side of bed
1. Sit over the side of the bed.
2. Make sure your thigh is supported.
3. Bend your knee back as far as possible, you may assist with your healthy leg.
4. Straighten the knee as far as possible, assist with your healthy leg.
5. Once you are able to complete this without difficulty, repeat the exercise without assistance of the healthy leg.

7 - Ice for swelling and pain:

a. Cover the surgery with a clean sheet of plastic or a towel in order the protect the wounds and dressings.
b. Put an ice pack over your swollen or panful areas.
c. Keep it on for 10-15 minutes.
d. You can do this 3 times per day

8 - Mobilisation

a. Please not that it is important to move as much as possible.
b. Please walk for atleast 5 min every hour if pain allows.
c. Please try to climb some stairs atleast 3 times daily if pain allows (even if it is just one step atleast
try.)
d. (see number 9 for instructions for mobilising with crutches)

9 - Crutches

a. Walking
1. Find your balance.
2. Move both crutches forward.
3. Move your operated leg forward. If you are allowed to, put the foot down on the floor, otherwise you can keep it in the air.
4. Bring the healthy leg forward, try to move it further forward than the operated leg.
5. Continue in this order.
b. Climbing up stairs
1. Find your balance.
2. Climb up the stair with your healthy leg.
3. Move your operated leg forward/up.
4. Bring the cruthes up onto the step.
5. Find your balance before continuing upwards.
c. Climbing down stairs
1. Find your balance.
2. Move your crutches down onto the floor.
3. Move your operated leg forward/down.
4. Climb down with your healthy leg.
5. Find your balance before continuing down.
d. Stand up with crutches
1. If possible sit on a chair with arm rests. Put one hand on the chair and one on your crutches.
2. Shift your weight forward – if you have a hip replacement please lean back instead of forward.
3. Putting your weight onto your healthy leg, push up into standing.
4. Find your balance and shift one crutch to your other hand.
e. Sit down with crutches
1. Find your balance.
2. Place both cruthces in one hand.
3. Place one hand on the chair.
4. Slowly lower your body into sitting.

Download Exercises - TKR for Hospitals.pdf

(Download the complete hospital exercise guidelines document)

Important!

All knee surgery patients require physiotherapy after dicharge from the hospital, to prevent post-operative complications and failure of surgery.

You will need 2-3 sessions/ week.
Please phone the practice for an appointment ASAP.

Knee Exercises – Hospital

Exercises

255A Beyers Naudé Dr,
Rustenburg, 0299
Tel: +27 (0)14 592 8322

www.physiotherapy.co.za
P.O.Box 21533
Protea Park
0305

Hospitale/Hospitals
Netcare Ferncrest/Life
Peglerae/Medicare
Tel: +27 (0)14 592 8322

Knee Rehabilitation after surgery

(Anterior Cruciate Ligament reconstruction)

GENERAL INFORMATION AND ADVICE:

Number 1

If you have been fitted with a brace post-operatively, it should be worn as prescribed. Your physio will progressively change the brace settings.

Number 2

Crutches should be used as prescribed. (See exercises for instructions on how to walk and for climbing up and down stairs. Be very careful of any turning movements at the knee.

Number 3

If you have received orthopaedic stockings use them as prescribed. They are used to control swelling and to prevent blood clotting.

Number 4

If your calf becomes swollen or painful or your knee becomes hot or red, contact the doctors’ rooms.

Number 5

Try to keep your leg elevated when you are resting to reduce the swelling in your leg. Put your foot up on the sofa so that your ankle is higher than your heart.

Number 6

When sitting bend your knee as far as possible or as far as the brace allows. When lying down keep the knee as straight as possible.

Number 7

Be very careful of slipping on wet surfaces, steps etc. No sudden movements with the knee. Do not pull the knee all the way straight.

Number 8

When dressing, dress the operated leg first up to the knee, dress the healthy leg up to the knee and then pull the pants over your buttocks. Be very careful to not turn the knee in or out.

Number 9

You may sleep on your back or on your sides. Put a pillow between your knees when lying on your side.

Number 10

For swelling and pain ice and heat can be used (See exercises for time specific management). If your knee is very swollen, lift the end of your bed.

Number 11

The dressings must not be taken off until your post-operative appointment at the clinic. The dressing must be kept clean and dry at all times.

Number 12

No driving while your knee is in the brace. Only start driving when you can safely drive without any pain and your leg is strong enough to perform all the necessary actions.

Number 13

Please follow the exercises prescribed. Physiotherapy is very important to insure that the knee is fully rehabilitated and functional.

Number 14

Consult your physio for a biokineticist referral if you want to start doing gym exercises.

The following exercises should preferably never be done again: a) leg extensions.

Number 15

No jogging for at least 3 months. No sport participation for at least 9 months. No breast stroke kicking for 6 months.

EXERCISES:

0-2 Weeks
EXERCISES SHOULD NEVER BE EXCESSIVLY PAINFULL
REPEAT ALL EXERCISES APPROXAMITALY 10 TIMES

1 - Breathing Exercises

a. Lie down comfortably.
b. Breath in through your nose.
c. Breath out through your mouth.
d. Keep your shoulders relaxed.
          1. Take a deep breath in and out.
          2. Take a deep breath in, hold for 3-5 sec and breath out.
          3. Take a deep breath in, then a bit more in, and breathe out.

2 - Circulation exercises to prevent blood clotting:

a. Footpumps
1. Keep your knee still.
2. Move your foot up and down.
b. Heelslides 1
1. Keeping your heel on the bed.
2. Move your heel to your buttock as far as possible.
3. Straighten your knee again.
c. Patella mobs
1. Sit with your knee straight and relaxed.
2. Hold your knee cap between your hands.
3. Move it up and down.
4. Move it from left to right.

3 - Static Exercises

4 - Active Exercises

a. Straight leg raise
1. Lie down on your back.
2. Keep your knee straight.
3. Pick your foot up towards the ceiling, bending at the hip.
4. Lower your leg slowly.
b. Abduction
1. Lie down on your back.
2. Slide your leg outwards.
3. Slide the leg inwards until it touches the other leg.
c. Hip extension
1. Lie down on your stomach.
2. Keep your knee straight.
3. Lift your foot up towards the ceiling using your buttock.
4. Lower your leg slowly!

5 - Knee extension range

a. Feet of bed
1. Lie on your stomach.
2. Make sure your knee is just off the bed and your thigh is supported.
3. Hold this posisiton for 2-3 minutes.
b. Feet on pillow
1. Lie on your back or sit with your knee straight.
2. Put a pillow under your ankle.
3. Let your knee hang towards the bed.
4. Hold this position for 2-3 minutes.

6 - Knee flexion range

a. Heelslides 2
1. Keep your heel on the bed.
2. Move your heel to your buttock as far as possible.
3. Hold for 5-10 seconds.
4. Straighten your knee again.
b. Side of bed
1. Sit over the side of the bed.
2. Make sure your thigh is supported.
3. Bend your knee back as far as possible.
4. Straighten the knee slightly.
c. Knee ups
1. Stand with good posture.
2. If you have weak balance stand against a wall.
3. Lift your knee as high as possible.
4. Remember to bend your knee and hip.

7 - Ice for swelling and pain:

8 - Crutches

Remember: Good leg goes to heaven (up with the good)
Bad leg goes to hell (down with the bad)

a. Walking
1. Find your balance.
2. Move both crutches forward.
3. Move your operated leg forward. If you are allowed to, put the foot down on the floor, otherwise you can keep it in the air.
4. Bring the healthy leg forward, try to move it further forward than the operated leg.
5. Continue in this order.
b. Climbing up stairs
1. Find your balance.
2. Climb up the stair with your healthy leg.
3. Move your operated leg forward/up.
4. Bring the crutches up onto the step.
5. Find your balance before continuing upwards.
c. Climbing down stairs
1. Find your balance.
2. Move your crutches down onto the floor.
3. Move your operated leg forward/down.
4. Climb down with your healthy leg.
5. Find your balance before continuing down.
d. Stand up with crutches
1. If possible sit on a chair with arm rests. Put one hand on the chair and one on your crutches.
2. Shift your weight forward – if you have a hip replacement please lean back instead of forward.
3. Putting your weight onto your healthy leg, push up into standing.
4. Find your balance and shift one crutch to your other hand.
e. Sit down with crutches
1. Find your balance.
2. Place both crutches in one hand.
3. Place one hand on the chair.
4. Slowly lower your body into sitting.

Download Exercises - ACL-RECONSTRUCTION for Hospitals.pdf

(Download the complete hospital exercise guidelines document)

Important!

All knee surgery patients require physiotherapy after dicharge from the hospital, to prevent post-operative complications and failure of surgery.

You will need 2-3 sessions/ week.
Please phone the practice for an appointment ASAP.

Hip Exercises – Rooms

Exercises

255A Beyers Naudé Dr,
Rustenburg, 0299
Tel: +27 (0)14 592 8322

www.physiotherapy.co.za
P.O.Box 21533
Protea Park
0305

Hospitale/Hospitals
Netcare Ferncrest/Life
Peglerae/Medicare
Tel: +27 (0)14 592 8322

Hip Rehabilitation after surgery

(Total Hip Replacement)

PROGRESSIVE EXERCISES

2-4 Weeks
EXERCISES SHOULD NEVER BE EXCESSIVLY PAINFULL
REPEAT ALL EXERCISES APPROXAMITALY 10 TIMES

1 - Calf Raises

a. Stand with your knees slightly bend.
b. Push up on your toes.
c. Slowly lower your heels.
d. Once this is comfortable try with one leg.

2 - Hamstring exercises

a. Hamstring curls
1. Lie down on your stomach.
2. Bend your knee upwards toward your buttock SLOWLY.
b. Heel-ups
1. Stand at a table.
2. Make sure your operated leg is straight.
3. Bend the operated knee backwards up to 90°.
4. Slowly straighten the knee.

3 - Straightening

a. Marching
1. Stand close to a stable surface.
2. Lift your knees alternatively as high as possible.
3. Ie. March on the spot
b. Wall squats 1
1. Stand with your back against the wall.
2. Make sure your toes face forward and your feet are hip width apart.
3. Keep your knees in line with your toes.
4. Tighten your buttocks and hamstring muscles.
5. Keep them tight as you slowly bend your knees and slide down the wall into the squat position.
6. DO NOT BEND MORE THAN 40°.
7. Push up, placing most of your weight on your heels.
8. Do not straighten your knees completely.

4 - Stepping

a. Healthy leg first.
1. On a low/small step.
2. Keep your back straight.
3. Step up with the healthy leg.
4. Make sure your knee stays behind your toes.
5. Bring your operated leg up.
6. Step back down with your healthy leg first.
7. Later: attempt climbing the step sideways.
b. Operated leg
1. Keep your back straight.
2. Place your operated leg on the step.
3. Keep your healthy sides toes on the floor.
4. Put half your weight on the heel of the foot.
5. Make sure your knee stays behind your toes.
6. Hold 5-10 seconds.
7. Lower the operated leg.
8. When you can do this without any pain climb the step with your operated leg first.
9. Later: attempt climbing the step sideways.

4 – 6 Weeks

1 - Abduction

a. Lie down on the healthy side.
b. Make sure your hip and shoulder are in line.
c. Keep your leg straight.
d. Lift the operated leg up towards the ceiling
e. Hold 2-5 seconds.

2 - One leg balance

a. Stand on your healthy leg. Keep your eyes open. Attempt to keep your balance for 1 minute.Repeat 3 times.
b. Now stand on your painfull leg. Keep your eyes open. Attempt to keep your balance for 1 minute. Repeat 3 times.
c. Repeat steps 1-2 with your eyes closed.

3 - Squats – no pain or discomfort!

a. Wall squats 2
1. Stand against a wall.
2. Flatten your back.
3. Slide down the wall bending your hips and knees up to 90°.
4. Remember to keep your knees in line with your toes.
5. Most of your weight should be on your heels, ie behind your knees.
6. When this is comfortable move away from the wall. Start with holding onto a stable surface for balance.
b. Sit to stand
1. Stand up and sit down on a chair.
2. Your weight should be behind your knees, on your heels.
3. Make sure your knee stay in line with your toes and do not pass your toes when standing up.
4. Now try this on a exercise mat or balance board.
5. Later try this while using only one leg.

7+ Weeks

1 - Walking program

a. Start with walking 500m daily.
b. Increase daily to improve cardiovascular fitness.
c. Please remember no treadmill walking as it causes increased compression on the joints.

2 - Theraband

a. Do all exercises with both legs.
b. The leg taking the weight must always be slightly bend.
c. Hip flexion
1. Tie the theraband in a loop around the leg of a bed/table.
2. Bend the knee slightly.
3. Stand with the theraband behind you.
4. Move your leg forward.
5. Make sure you move at the hip not at the knee.
d. Hip abduction
1. Tie the theraband in a loop around the leg of a bed/table.
2. Keep the leg straight.
3. Move the leg outwards against the theraband.
4. Later try walking sideways against the theraband.
e. Knee flexion
1. Tie the theraband around both legs.
2. Stand straight with your leg hanging straight down.
3. Bend your knee backwards against the rubber. (ie heel up).

3+ months (biokineticist)

You may start gym exercises with your biokineticist.
Please avoid running, jogging, jumping rope, plyometrics and other high impact activities.

Download Exercises - THR for Rooms.pdf

(Download the complete hospital exercise guidelines document)

Hip Exercises – Hospital

Exercises

255A Beyers Naudé Dr,
Rustenburg, 0299
Tel: +27 (0)14 592 8322

www.physiotherapy.co.za
P.O.Box 21533
Protea Park
0305

Hospitale/Hospitals
Netcare Ferncrest/Life
Peglerae/Medicare
Tel: +27 (0)14 592 8322

Hip Rehabilitation after surgery

(Total Hip Replacement)

GENERAL INFORMATION AND ADVICE:

1 - PRECAUTIONS: for at least 3 months

a. Avoid bending your hip past 70°.
b. Avoid turning your toes inwards.
c. Avoid crossing your operated leg past the midline of your body.
d. Avoid sitting on low soft surfaces.
e. Use a raised toilet seat for at least 6 weeks

Number 2

Crutches or other assistive devices should be used as prescribed. (See exercises for instructions on how to walk and climb up and down stairs). Be very careful of any turning movements of the leg. You may put weight on the leg as pain allows, unless told otherwise.

Number 3

If you have received orthopaedic stockings use them as prescribed. They are used to control swelling and to prevent blood clotting.

Number 4

If your calf becomes swollen or painful or your knee becomes hot or red, contact the doctors’ rooms.

Number 5

Do not elevate your leg as it could cause a hip flexor contracture. Please use your abduction pillow as prescribed.

Number 6

Please lie on your stomach for at least 30 min daily.

Number 7

When sitting keep your operated leg forward and lean back with your body to avoid bending at the hip past 70° until you are in the correct position. Keep your back straight.

Number 8

Do not walk on wet surfaces to prevent you from slipping.

Number 9

When dressing, dress the operated leg first up to the knee, dress the healthy leg up to the knee and then pull the pants over your buttocks. Be very careful to not turn the leg in or bend your hip past 70°.

Number 10

You may sleep on your back. Do not sleep on your sides.

Number 11

For swelling and pain ice and heat can be used (See exercises for time specific management). If your hip is very swollen, lift the end of your bed, but do not use a pillow under knee.

Number 12

The dressings must not be taken off until your post-operative appointment at the clinic. The dressing must be kept clean and dry at all times.

Number 13

No driving while your hip is recovering. Only start driving when you can safely drive without any pain and your leg is strong enough to perform all the nessasary actions.

Number 14

Use the “golfers lift” when picking up small objects or ask for assistance.

Number 15

Please follow the exercises prescribed. Physiotherapy is very important to ensure that the hip is fully rehabilitated and functional. It is very important to remember that walking is the best exercise and that we want as much movement as possible as soon as possible.

Number 16

Consult your physio for a biokineticist referral if you want to start doing gym exercises.

Number 17

No jogging for at least 3 months. No sport participation for at least 9 months.

EXERCISES:

0-2 Weeks
EXERCISES SHOULD NEVER BE EXCESSIVLY PAINFULL
REPEAT ALL EXERCISES APPROXAMITALY 10 TIMES

1 - Breathing Exercises

2 - Circulation exercises to prevent blood clotting:

a. Footpumps
1. Keep your knee still.
2. Move your foot up and down.
b. Heelslides
1. Keeping your heel on the bed.
2. Move your heel to your buttock – make sure to keep the hip from bending passed 60°.
3. Straighten your knee again.

3 - Static Exercises

4 - Active Excercises

a. Straight leg raise
1. Lie down on your back.
2. Keep your knee straight and quads tight.
3. Pick your foot up towards the ceiling, bending at the hip.
Make sure not to lift the foot to high (10-15 cm off the bed is enough). Do not bend more thatn 60° at the hip.
4. Lower your leg slowly.
b. Abduction
1. Lie down on your back.
2. Slide your leg outwards.
3. Slide the leg inwards until back to the midline.

5 - Hip extension range

a. Bridging
1. Lie down on your back.
2. Bend both knees up.
3. Press your back flat against the bed
4. SLOWLY lift your buttock towards the ceiling.

6 - Hip flexion range

a. Knee ups
1. Stand with good posture.
2. If you have weak balance stand against a wall.
3. Lift your knee upto 60° bending at the hip.
4. Remember to bend your knee and hip.

7 - Ice for swelling and pain:

a. Cover the surgerical site with a clean sheet of plastic or a towel in order the protect the wounds and dressings.
b. Put an ice pack over your swollen or painful areas.
c. Keep it on for 10-15 minutes.
d. You can do this 3 times per day.

8 - Mobilisation

a. Please note that it is important to move as much as possible.
b. Please walk for atleast 5 min every hour if pain allows.
c. Please try to climb some stairs at least 3 times daily if pain allows (even if it is just one step at least try.)
d. (see number 9 for instructions for mobilising with crutches)

8 - Mobilising with crutches

Remember: Good leg goes to heaven (up with the good)
Bad leg goes to hell (down with the bad leg)

a. Walking
1. Find your balance.
2. Move both crutches forward.
3. Move your operated leg forward. If you are allowed to, put the foot down on the floor, otherwise you can keep it in the air.
4. Bring the healthy leg forward, try to move it further forward than the operated leg.
5. Continue in this order.
b. Climbing up stairs
1. Find your balance.
2. Climb up the stair with your healthy leg.
3. Move your operated leg forward/up.
4. Bring the crutches up onto the step.
5. Find your balance before continuing upwards.
c. Climbing down stairs
1. Find your balance.
2. Move your crutches down onto the floor.
3. Move your operated leg forward/down.
4. Climb down with your healthy leg.
5. Find your balance before continuing down.
d. Stand up with crutches
1. If possible sit on a chair with arm rests. Put one hand on the chair and one on your crutches.
2. Shift your weight forward – if you have a hip replacement please lean back instead of forward.
3. Putting your weight onto your healthy leg, push up into standing.
4. Find your balance and shift one crutch to your other hand.
e. Sit down with crutches
1. Find your balance.
2. Place both crutches in one hand.
3. Place one hand on the chair.
4. Slowly lower your body into sitting.

Download Exercises - THR for Hospitals.pdf

(Download the complete hospital exercise guidelines document)

Important!

All knee surgery patients require physiotherapy after dicharge from the hospital, to prevent post-operative complications and failure of surgery.

You will need 2-3 sessions/ week.
Please phone the practice for an appointment ASAP.

Shoulder Exercises – Rooms

Exercises

255A Beyers Naudé Dr,
Rustenburg, 0299
Tel: +27 (0)14 592 8322

www.physiotherapy.co.za
P.O.Box 21533
Protea Park
0305

Hospitale/Hospitals
Netcare Ferncrest/Life
Peglerae/Medicare
Tel: +27 (0)14 592 8322

Shoulder Rehabilitation after Rotator Cuff surgery

PROGRESSIVE EXERCISES

EXERCISES SHOULD NEVER BE EXCESSIVLY PAINFULL
REPEAT ALL EXERCISES APPROXAMITALY 10 TIMES

2 – 4 Weeks

1 - Passive flexion: (This excersice will improve the forward movement of the
shoulder).

a. Lie down comfortably on your back.
b. Fold both forearms across your chest, hold each elbow with the opposite hand.
c. Slowly lift both your arms away from the body opening up the armpits.
d. The healthy arm must do all the work, while the operated arm should just relax.

2 - Passive abduction: (This excersice will improve the outward movement of the shoulder).

a. Lie down comfortably on your back.
b. Keep your arm as straight as possible.
c. Walk/Crawl outwards with your hand to open up your armpit.

3 - Passive external rotation: (This excersice will improve the rotation of the shoulder).

a. Lie down comfortably on your back.
b. Bend your elbow 90°.
c. Allow gravity to just let the arm fall away from the body.
d. When this is comfortable:
1. Hold a stick in both hands.
2. Use the stick to gently push the hand further.

4 - Hot pack for pain and muscle spasm.

a. Put a hotpack on the affected muscles for up to 20 min.
b. Do not over heat the hotpack.
c. Be carefull not to burn.

4 – 6 Weeks
THESE EXERCISES WILL PROGRESS YOUR PREVIOUS EXERCISES

1 - Active assisted flexion:

a. Wall crawls.
1. Stand infront of a wall.
2. Place both hands on the wall.
3. Use your fingers to crawl as high as possible up the wall.
4. When you cannot crawl higher:
a. Try to put your elbows against the wall.
b.Try to touch the wall with your forehead
5. Guide your arm down with your healthy hand.
b. Pulley 1.
1. Use a small pulley and rope attatched above your head. If you do not have this improvise using a towel/rope/tie over a rail/beam/branch.
2. Use your healthy hand to pull the operated arm up as high as possible in front of you.
3. Repeat this up and down movement.

2 - Active assisted abduction:

a. Table top/Window sill:
1. Stand an arms length away from a table or window sill facing sideways.
2. Rest your hand on the table.
3. Slowly bend your knees in order to open up the armpit as far as possible.
4. Slowly stand up.
b. Pulley 2.
1. Use a small pulley and rope attatched above your head. If you do not have this improvise using a towel/rope/tie over a
rail/beam/branch.
2. Use your healthy hand to pull the operated arm up as high as possible away from your side.
3. Repeat this up and down movement.

3 - Active assisted external rotation against wall:

a. Stand close to a wall. Face away from the wall.
b. Push your operated sides shoulder blade, buttock and elbow flat against the wall.
c. Bend your elbow 90°.
d. Use a stick to gently push your hand towards the wall.

4 - Hand behind back (HBB):

Always progress in the following order and only advance to the next exercise if possible without severe pain.

a. First touch your buttock on the same side as your operated arm.
b. Then touch the opposite buttock.
c. Then try to move your hand up to the small of your back
d. Then try to move your hand up inbetween your shoulder blades.
e. Now hold a towel behind your back and pull the hand up higher.

5 - Scapula retraction: (Pulling back shoulder blades)

a. Lie on your stomach.
b. Keep your arms at your sides.
c. Lift your shoulder blades up towards the ceiling and down to the buttocks.
d. Hold this position for 10 seconds.

6+ Weeks

1 - Light stretches: Progress weekly.

a. Hold the position for 30 secs.
b. Repeat 3 times.

2 - Active movement.

a. Flexion
1. Short arm/chicken wing: bend your elbow and move your arm forward.
2. Straight arm: keeping your arm straight move your arm forward.
b. Abduction
1. Short arm/chicken wing: bend your elbow and move your arm outward.
2. Straight arm: keeping your arm straight move your arm outward.

3 - Hand behind head.

a. Put your hand behind your head as if you are washing/brushing your hair.
b. Move your hand further down towards your neck.

4 - Scapula retraction: (Pulling back shoulder blades).

e. Lie on your stomach.
f. Keep your arms at your sides.
g. Lift your shoulder blades up towards the ceiling and down to the buttocks.
h. Lift your hand upwards toward the ceiling.
i. Hold this position for 10 seconds.

5 - Theraband exercises: NB both sides!

a. Flexion
1. Tie the theraband to a door handle. Close the door.
2. Face away from the door.
3. Hold on to the other end.
4. Slowly move your arm forwards to roughly 45°.
b. Extension
1. Face the door.
2. Hold on to the other end.
3. Slowly move your arm backwards to roughly 45°.
c. Abduction
1. Turn so that the healthy shoulder is closest to the door.
2. Hold on to the other end.
3. Slowly move your arm outwards to roughly 45°.
d. Adduction
1. Turn so that the operated shoulder is closest to the door.
2. Hold on to the other end.
3. Slowly move your arm inwards to roughly 45°.
e. External rotation.
1. Turn so that the healthy shoulder is closest to the door.
2. Hold on to the other end.
3. Bend your elbow 90°.
4. Slowly turn your arm outwards as far as possible without your elbow leaving your side. (If you struggle with this keep a small towel between the elbow and your body.)
f. Internal rotation
1. Turn so that the operated shoulder is closest to the door.
2. Hold on to the other end.
3. Bend your elbow 90°.
4. Slowly turn your arm flat against your body without your elbow leaving your side. (If you struggle with this keep a small towel between the elbow and your body.)
g. Scapula setting
1. Hold the theraband behind your back.
2. Keep your hands close together.
3. Gently pull on the theraband apart while taking your hands slightly down and backwards.

Download Exercises - ROTATORCUFF REPAIR for Rooms.pdf

(Download the complete hospital exercise guidelines document)

Shoulder Exercises – Hospitals

Exercises

255A Beyers Naudé Dr,
Rustenburg, 0299
Tel: +27 (0)14 592 8322

www.physiotherapy.co.za
P.O.Box 21533
Protea Park
0305

Hospitale/Hospitals
Netcare Ferncrest/Life
Peglerae/Medicare
Tel: +27 (0)14 592 8322

Shoulder Rehabilitation after Rotator Cuff surgery

GENERAL INFORMATION AND ADVICE:

Number 1

The sling must be worn for 4-6 weeks (depending on doctor’s orders) in order for the tissue to heal properly. (See exercises for how to wear the sling).

Number 2

Do not lift your elbow away from the body using you operated shoulder’s muscles. This will put too much tension on the affected area and could result in the operated tissue tearing.

Number 3

Physiotherapy is very important 2 – 3 x per week (depending on each patient’s progress). The physio must ensure that the shoulder retains good movement and does not become stiff. The aim is to have as much movement as possibe when the sling comes off. This is a delicate process and must be monitored constantly in order not to damage the surgery. The physio will also adress neck stiffness, muscle spasms, pain and swelling.

Number 4

Only after the sling has been removed and the doctor/physio is happy that the healing is sufficient, may the patient start doing gentle strenghtening exercises.

Number 5

Keep the wound dry while the wound is dressed. Plasters can usually be removed after 14 days or as the doctor ordered. If your wounds are red,warm or have a yellow discharge contact the doctors rooms. Carefully wash under the armpit with a cloth without lifting your elbow away from your body.

Number 6

Button down shirts are easiest to wear. When dressing, your operated shoulder should be into the sleeve first. When undressing your operated shoulder should be undressed last.

Number 7

Do not sleep without the sling. Do not sleep on the operated shoulder. Use a pillow to support the operated shoulder and arm when sleeping on the healthy side.

Number 8

Do not lift or grab anything while the arm is in the sling. No sudden movements with the arm.

Number 9

No driving while your arm is still in the sling. Only start driving when you can safely drive without any pain and your shoulder is strong enough to perform all the necessary actions.

Number 10

Maintain good posture (See exercises for examples of good posture).

Number 11

For swelling and pain ice and heat can be used (See exercises for time specific management).

Number 12

Do not do any gym exercises before 12 weeks post surgery. Consult your physio for a biokineticist referral
if you want to start doing gym exercises. The following exercises must preferably not be done in the gym
again:

a) Upward rows
b) Military Presses
c) Front/lateral fly’s
d) Dips

Number 13

Do not lift any heavy objects or play sport before a biokineticist is satisfied that you have reached the final stages of your gym-rehab.

EXERCISES:

0-2 Weeks
EXERCISES SHOULD NEVER BE EXCESSIVLY PAINFULL
REPEAT ALL EXERCISES APPROXAMITALY 10 TIMES

1 - Breathing Exercises

a. Sit or lie down comforatably.
b. Breath in through your nose.
c. Breath out through your mouth.
d. Keep your shoulders relaxed.
1. Take a deep breath in and out.
2. Take a deep breath in, hold for 3-5 sec and breathe out.
3. Take a deep breath in, then a bit more in, and breathe out.

2 - Pendulem exercises:

a. Keep your back straight.
b. Use your body movement to get your arm swinging passively.
1. Straight forward and backwards.
2. Straight sideways from left to right.
3. In small circles clockwise and anti-clockwise.

3 - Shoulder protraction/retraction:

a. Lie down on your back.
b. Lift your shoulders off the bed (forward).
c. Relax your shoulders and push your shoulder blades flat against the bed (backwards).
d. When you are comforatable with this exercise you can also do it while sitting.

4 - Elevation/ depression:

a. Lie down on your back.
b. Lift your shoulders up towards your ears.
c. Relax your shoulders and push then down towards your feet.
d. When you are comforatable with this exercise you can also do it while sitting

5 - Posture correction:

a. Sit on a hard chair.
b. Keep your back straight.
c. Pull in your stomach.
d. Tuck your chin backwards (ie make a dubble chin).
e. Pull your shoulder blades slightly down and backwards.
f. Now hold this position for 10 seconds.

6 - Circulation exercises to prevent blood clotting:

a. Keep your arm close to your body.
b. Carefully remove your forearm from the sling.
c. Use your healthy hand to stabilise your operated upper arm.
d. Gently do the following movements.
1. Straighten and bend the elbow.
2. Turn your hand up toward the roof and down toward the floor.
3. Move your wrist in circles.
4. Exercise your fingers.

7 - Ice for swelling and pain:

8 - Put the sling on correctly:

a. The strap around your neck should not be too tight.
b. The strap around your body should be nice and tight.
c. Your arm should be against your body.
d. Your elbow should be bend to 90°.
e. Your wrist should be well supported.

Download Exercises - ROTATORCUFF REPAIR for Hospitals.pdf

(Download the complete hospital exercise guidelines document)

Important!

All shoulder surgery patients require physiotherapy after dicharge from the hospital, to prevent post-operative complications and failure of surgery.

You will need 2-3 sessions/ week. Please phone the practice for an appointment ASAP.

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