Shoulder surgery can be an anxious time for some particularly if it affects how much work you can do and if it in turn affects your financial situation. The rehab process after shoulder surgery can also be frustrating if it is not going the way you want.
It is important to get it right so you can get the best outcome from your shoulder surgery and get back to the activities you enjoy and love! Or maybe just getting back to work.
I have put together a few of the more important aspects and factors to consider before and during your shoulder rehab.
Expectations and Adherence
Expectations play a big role in a successful outcome in shoulder surgery, generally patients tend to overestimate the effectiveness of the surgery and expect a shorter recovery period. When in fact pain and reduced function can last much longer then you expect
Up to 85% of patients have unrealistic expectations of how long it will take to get back to sleeping properly, getting back to their normal activities of daily living and returning to a chosen sport or activity. This is a big dilemma for you as when expectations don't meet reality at any point in time this can lead to you getting discouraged which can lead to an increase in symptoms again, patients satisfaction is reduced and no great surprise, this all leads to a decreased adherence to rehab.
The reality is, if you don't adhere to your exercises you have been given or you don't adhere to the movement limitations you have been given then you are increasing your risk of the surgery failing or not providing you with a satisfactory outcome.
Remember just because things are not happening the way you were hoping does not mean the surgery was a failure as everyone recovers differently and many different factors impact on recovery ability and duration. The important thing is that you keep on track.
Listening to your health professional
It may seem funny that I have added this in as a factor to consider but in reality the communication between your surgeon and other health professionals is really important in setting those realistic expectations. During a visit with your health professional there is so much information that is needed to be understood and sometimes bits of information can be missed or misunderstood. This is why really listening to your health professional is so important so everything is clear and understood and both you and the health professional are on the same page.
It is normal to see your pain decreased significantly in the first 3 months after surgery however pain can still exist at 6 months and even 12 months after surgery.
Unfortunately some people are more likely to experience pain for longer periods or a greater amount of pain than others and these factors should be considered and discussed prior to surgery.
Nowadays our understanding of pain and the mechanism behind pain is much improved and this has led to the understanding that persistent pain after surgery is more highly correlated with beliefs, expectations, knowledge, past history, anxiety and worry than what it is with structure and function.
Keeping this in mind, we know that if you have higher than expected pain after your shoulder surgery this does not necessarily mean there is any structural damage.
Once someone has had shoulder surgery they often worry their shoulder will get stiff and this will impact their recovery and function when they start to try and incorporate their arm into their daily activities.
After surgery you are immobilized for a period of time and then on restricted movements for a period of time and depending on who your surgeon or health professional is these time frames vary.
With these restrictions of movement it is expected that the function of the shoulder and potentially its range of movement is going to be affected and in 20% of cases after shoulder surgery there is some shoulder stiffness. However of those 20% of people only 5% ever need anything done about it through other techniques.
So yes shoulder stiffness can happen but it really isn't as big a deal as we think and can be overcome if it does occur.
Understand your safe zones
Your surgeon will address this when they see you after your surgery but I believe it is an important concept to understand particularly early on in your shoulder rehab.
Safe Zones are there to make sure you are not putting unnecessary stress on the surgical site or undoing the surgeons good work. Each surgery has slightly different safe zones and safe movements as different movements put stress on different parts of the shoulder capsule. Furthermore, different surgeons have different preferences on how to treat each surgery.
So for now I have a basic picture for your safe zones with zone A being the safest for the majority of surgeries.
If you are not allowed to move, what to do?
Each surgeon or health professional has different shoulder rehab processes, things that could vary are the positions you are allowed to be in, the amount of time in a sling, the amount of movement you are allowed to do during each rehab stage and more.
The most important thing is that you listen to your surgeon and what they recommend, not your friend, relative or random person who may have had shoulder surgery also. The surgeon has completed the surgery and has the best idea of what has happened and how to best promote a positive outcome.
If your surgeon is being very conservative in his approach to getting you moving, there are strategies you can use to help enhance your rehab including but not limited to using your hand and using your brain.
Using your hand
Small simple strategies make a big difference when it comes to rehab after a shoulder surgery, these strategies can be an effective way to make sure you continue to progress when movement may be limited.
Continual use of your hand on your affected side is a small strategy you can use to enhance your rehab, by doing so you can continue to use the pathways that connect your hand and your brain.
In really simple terms, your shoulders are there to facilitate movement for your hand to be positioned to do tasks. By using your hand to do tasks during shoulder rehab you can influence your muscles around your shoulder and influence the brain-muscle connection.
When using your hand it is important that your arm is supported and you are not actually using your shoulder. Really simple exercises are a ball squeeze, using the remote to change the TV channel, eating with your elbow supported and washing your hair leaning forward.
Making use of your brain
Did you know you can use it to enhance your shoulder rehab after you have had surgery.
During shoulder rehabilitation we as health professionals try to use a concept called cross education. Cross education involves using your non affected arm in shoulder exercises and movements to try and enhance your affected side.
Believe it or not it works, and it works by improving the brain's connection with the arms no matter what arm you are using. Some exercises you can do are bouncing a ball on the ground or wall, catching and throwing a ball or simple one armed gym exercises.
What to do now?
The above advice is general in nature and again the most important thing is that you listen to your surgeon. When you're going through rehab after a shoulder operation it is important you get help to get you on the right track but more importantly that you have realistic expectations of how you will progress.
If you want any help with starting or progressing in your shoulder rehab after surgery contact the clinic and book an appointment.
Accredited exercise physiologist