Whether you’re having a planned surgery or an injury has suddenly left you facing recovery from an unexpected procedure, a large number of clients we see have one important question for us: how long until I can start my rehab so I can get back to normal life - and where should I start?
As with most things, the answer really does depend on the joint or area that was operated on, the procedure you had, and any other personal factors - which is why only your surgeon and your physiotherapist will be able to give you a more concise answer. With this said, here are some general guidelines for starting rehab after surgery to your shoulder or knee.
The shoulder joint is a large, complex and very mobile (flexible) joint, known as a ball-and-socket joint. It is supported and stabilised by the rotator cuff muscles, ligaments and connective tissues, the labrum (a ring of cartilage that lines and deepens the shoulder socket), and a bursa that helps reduce the friction between the rotator cuff muscles and part of the shoulder blade.
The shoulder joint can be susceptible to injury for several reasons:
- The mobility that makes the shoulder joint versatile to move in all directions also makes it susceptible to instability and injury, such as dislocations and subluxations (partial dislocations)
- The rotator cuff tendons can tear due to overuse, trauma, or degeneration with age, with severe rotator cuff tears potentially requiring surgery
- Injuries to the labrum can occur from trauma or repetitive overhead movements, like pitching in cricket. Labral tears may require surgery to restore stability and function.
- Osteoarthritis, rheumatoid arthritis, or other forms of arthritis can damage the shoulder joint's cartilage, leading to pain and limited mobility. In some cases, joint replacement surgery (arthroplasty) may be necessary
- When the space between the rotator cuff tendons and the acromion narrows, it can result in an impingement syndrome
- Traumatic injuries such as fractures to the humerus, clavicle, or scapula may require surgery to realign and stabilise the bones.
While our physiotherapists work very closely with those with shoulder injuries to get them out of pain and back to activity without the need for surgery, in some cases, such as if you’ve suffered a complex rotator cuff tear or cartilage tear, surgery may be required. This is where your physiotherapist can help best prepare you for the procedure, as well as start you on your post-surgical rehab so you can recover well and get the best results in the least time.
When Can I Start My Shoulder Rehab?
In most cases of shoulder surgery, the earlier the better, so aim to start a few days after your procedure, after the initial surgical pain has reduced. Specifically:
- Rotator Cuff Repair: aim to start rehab within a few days to a week after your surgery. Initially, the focus may be on gentle passive range of motion exercises to prevent stiffness. Active exercises and strengthening usually start a few weeks to a month after surgery.
- Labrum (Cartilage) Repair: aim to start rehab within a week or so. Initial phases may involve range of motion exercises and gradual strengthening exercises.
- Total Shoulder Replacement (Arthroplasty): even for this weighty procedure, rehabilitation also typically begins within days of surgery, mainly focusing on gentle range of motion exercises. Weight-bearing and strengthening exercises are introduced gradually as healing progresses, which your physio will guide you through.
- Fracture Repair: rehab for shoulder fractures can vary widely depending on the type and severity of the fracture and the surgical method used for repair. It may start shortly after surgery or be delayed for a period, being greatly dependent on the fracture’s stability following the procedure. Your surgeon and physio will best guide you on the safest way and time to start your rehab.
- Other Procedures: the timing for rehab after other shoulder surgeries (e.g., acromioclavicular joint reconstruction or biceps tendon repair) can vary, but your physiotherapist will be able to guide you through it once they know all the factors both regarding the surgery and you personally, together with your surgeon’s assessment.
What Happens If I Delay My Rehab?
Delaying your rehab may contribute to weakness and stiffness of the shoulder joint, given that early movement and mobilisation is not occurring and instead you’re keeping the shoulder joint relatively fixed in place. This may lead to contractures of the muscles and ligaments surrounding the shoulder joint, as well as contribute to the development of a frozen shoulder.
How Long Is Recovery?
While this does depend on which surgery you have, your consistency with doing your rehab, and the level and type of sport you wish to return to, we’d generally expect to see you return to full function between 6-12 months following your procedure.
Like the shoulder, the knee joint is also one of the largest and most complex joints in the human body, connecting the thigh bone (femur) to both the shin bone (tibia) and the smaller bone of the lower leg (fibula). It's a hinge joint that allows for bending (flexion) and straightening (extension) of the leg, as well as limited rotational movements.
The knee joint has several notable features, including the articular cartilage that covers the ends of the femur, tibia and patella (kneecap) that is designed to promote smooth a painless movement as the knee bends and straightens, two wedge-shaped pieces of cartilage known as menisci that cushion the ends of the femur and tibia (and help distribute weight and absorb shock), ligaments both within and on the outside of the knee that stabilise the knee joint and control its movement, and the synovium that produces fluid that lubricates the joint to reduce friction during movement.
The knee joint can be susceptible to injury in a range of ways:
- High-impact accidents, falls, sports-related injuries, and car accidents can all lead to fractures, ligament tears and meniscus tears.
- Activities that involve repetitive motion, such as running, can lead to overuse injuries, including patellofemoral pain syndrome or tendinitis.
- Osteoarthritis, a degenerative joint disease, commonly affects the knee joint due to the significant weight placed on the joint in everyday life, causing the breakdown of articular cartilage and leading to pain and loss of function.
- Autoimmune conditions like rheumatoid arthritis can result in chronic inflammation and damage to the knee joint.
- Sudden twisting or injury to the knee can lead to tears in the meniscus, which may require surgical repair or removal.
- Tears or ruptures of the cruciate ligaments within the knee (anterior cruciate ligament and posterior cruciate ligament), or the collateral ligaments on the outside of the knee (medial collateral ligament or lateral collateral ligament) can result from sports injuries or trauma and may require surgical reconstruction.
- Ruptures or tears of tendons, such as the patellar tendon, often require surgical repair.
When these knee injuries are severe or complex, going beyond the what can be achieved with the wide range of non-surgical treatment available, then a big part of your surgery outcome will be dependent on your rehab - including starting it promptly and having the best rehab plan that gradually but effectively builds you up to returning to full strength and function where possible.
When Can I Start My Knee Rehab?
Just like with shoulder surgery, you should try to start your knee rehab as early as it is safe to do so - and the sooner the better. Specifically:
- Arthroscopic Knee Surgery (such as a meniscus repair or debridement): aim to start rehab within a few days to a week of surgery. The initial phases may focus on helping regain knee mobility as swelling reduces.
- Anterior Cruciate Ligament (ACL) Reconstruction: rehabilitation typically starts within days to a week after ACL reconstruction surgery. The initial phases involve gentle range of motion exercises and quadriceps strengthening.
- Total Knee Replacement: rehab generally begins on the same day as the surgery or the day after and involves early mobility exercises, such as walking and knee range of motion exercises.
- Posterior Cruciate Ligament (PCL) Reconstruction: rehab typically begins within days to a week after PCL reconstruction surgery, and focuses on regaining knee range of motion and strengthening the quadriceps.
- Patellar Tendon Repair: rehab often starts within days after surgery, with a focus on regaining knee extension and gradually increasing weight-bearing.
- Meniscus Repair: for a meniscus repair surgery, rehabilitation usually begins within a week after the procedure, with a focus on knee mobility and strengthening exercises.
- Other Knee Surgeries: The timing for rehabilitation after other knee surgeries, such as lateral collateral ligament (LCL) reconstruction or revision surgeries can vary, but your physiotherapist will be able to guide you through it once they know all the factors both regarding the surgery and you personally, together with your surgeon’s assessment.
What Happens If I Delay My Knee Rehab?
Delaying knee rehabilitation after knee surgery carries various risks that can impact the overall success of your surgery as well as the ease of your recovery. First, a delay in starting rehab can increase stiffness and reduce the range of motion available in the knee joint, making it harder to regain full flexibility. Muscle atrophy is another concern, as the muscles around the knee can weaken without active engagement in rehabilitation exercises, reducing joint stability. Delayed rehabilitation can also delay pain relief, increase the risk of scar tissue formation, and extend the overall recovery time.
How Long Is Recovery?
While every person’s recovery journey is unique, generally speaking, your initial recovery stage, which includes pain management and early mobility, can take a few weeks. Achieving functional recovery, where you can return to most daily activities, can take several months. Full recovery, including the return to sports or high-impact activities, often takes six months to a year or more.
Post-Surgery Rehabilitation With PhysioCentral
Following the surgical repair of knee or shoulder injuries, our physiotherapists are fully equipped to follow surgeon suggested protocols or design ones to suit you. With equipment and space at both PhysioCentral and The Pilates Practice, we can tailor make an evidence-based program for your complete post-surgery rehabilitation. We like to include as many home exercises as possible and will take into account your access to a gym or home gym, taking every step to optimise your journey to returning to full fitness and daily living.
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