Stretching after surgery?

[AnttiFIN]

Greetings from Finland Bill! ( and everyone else reading this forum )

I’m recovering from a SLAP-repair done four months ago and my search for quality rehab advice lead me here… I’ve read everything related to shoulder and / or stretching here and over at T-nation and pretty much everywhere Google has lead me, but I’m still confused how to gain my shoulder ROM back… Well actually it’s pretty much only the external rotation which I’m still struggling with…flexion, abduction etc. are all pretty much back to normal… I would really, REALLY appreciate your guidance…I’m sure I would’ve already booked an appointment to see you if I lived even in the same continent

So…what kind of stretching ( and other mobility work ) would you suggest to someone struggling with surgery induced stiffness? I’ve tried pretty much everything, from mild to very aggressive static stretching, PNF-stretching ( hold-relax ) and also a variety of dynamic mobility work ( arm swings to all directions and active external rotations ). But I’m still confused what methods would be optimal, as I’m not sure what I’m trying to stretch i.e. what causes the tightness? Muscles, ligaments, scar tissue???

I’ve finally been able to get a little progress with very aggressive static stretching combined with 2-3 hold-relax sequences. I’ve used a supine lying position so that I’m able to restrict the scapula movement a little and kept my arm abducted to 90 degrees. Then I’ll just start to press my hand towards the floor ( back ) with a stick, use 2-3 isometric contractions ( antagonist ) on the way down and try to force my hand to the floor at the end and keep it there a while. On a scale of 0-10 I’d rate the pain in the end to probably 6, hard to evaluate really because the whole stretch takes about 2-3 minutes and you kind of “get used” to it during the stretch.

Any advice? I know you’ve had your share of shoulder problems and your input would be highly appreciated… Sorry for the long post BTW

Thank you in advance!

Antti
Finland

[AnttiFIN]

Oh yeah…hurt my shoulder playing football, not that sissy European version ( no offense to any soccer players here ) the American one…yes we do play it in Finland also. The surgery was a SLAP / Bankart-repair, four anchors were used to reattach the labrum and a tenodesis was done to my biceps tendon ( cut and reattached to soft tissue ). Three weeks in a sling, PROM work started maybe three days after surgery and weekly PT sessions also…external rotations started somewhere between weeks 6-8 if I remember correctly.

[AnttiFIN]

Did some more research and re-read my "leikkauskertomus"...what's that in english? I'll just call it as "that paper the surgeon writes about the operation" Anyway...it says that the anterior joint capsule had also been torn with the labrum and that there were no tears in the rotator cuff. So I'm thinking there must be scar tissue in the anterior joint capsule and that's what's limiting my external rotation ROM...would make sense, would it? I'm no PT nor SC professional...only self-learned one

So let me refrase my question? What would be the best way to stretch the joint capsule? I've read here that mild long ( 20-30 min ) stretches keeping the stretched area warm and applying cold afterwards...is there any other efficient ways to accomplish this? Like I said, I feel i've gotten some results with the aggressive approach described above...

[Bill Hartman]

You need to create creep. Low load, passive tension x 20-30 minutes 2 times per day. Heat will help make it comfortable. Short aggressive stretching will provide minimal benefit.

Bill

[AnttiFIN]

Thank you! Had to look up the word "creep"...I knew a couple of meanings but those ones didn't seem to fit this context

I would have a couple of follow-ups...

1. Is the supine with 90 degrees of abduction position described above a good one? Could I also use those stretches to shoulder extension and horizontal abduction ( in lying position )? Wouldn't those also stretch the anterior capsule?

2. How do you feel about doing some active external rotations etc. soon after finishing those stretches? I read somewhere that active ROM-work after joint mobilization would help to realign the affected tissue correctly ( in case of adhesions )...would the same apply here with stretching?

3. Would you suggest some form of joint mobilization work done by a professional also?

4. How much time should there be between strength work for shoulder girdle and those stretches? And vice versa...between stretching and strength work?

If I could get these questions answered, I think I'll be set...and won't bother you again

Thank you again...