Shoulder Replacements: What they are and Safe Strength Training After Surgery
- drcasey51
- 18 minutes ago
- 5 min read
Shoulder replacements are becoming increasingly common—not just among older adults but also in younger, active individuals who want to regain quality of life and stay mobile. Whether you're a patient recovering from surgery or a fitness professional working with someone who is post-op, understanding the phases of recovery and the right way to return to the gym is key to long-term success.
Why Are We Talking About Shoulder Replacements?
As physical therapists, we're seeing more and more people undergo shoulder replacements and revisions due to an aging population, improved implant technology, and expanded indications. With advancements in surgical techniques and rehab strategies, we’re helping patients get back to doing what they love—whether that’s golfing, playing pickleball, playing with their family or doing everyday tasks.
The Basics: Understanding the Shoulder Joint
The shoulder is a ball-and-socket joint and happens to be the least stable joint in the body, in part because it is able to move in so many different ways. Stability comes from a combination of structures: the joint capsule, labrum, ligaments, and, most importantly, the rotator cuff (a group of muscles and tendons).
Depending on the patient's condition, different types of shoulder replacements may be used:
Hemiarthroplasty (Hemi): Typically used for arthritis, avascular necrosis, or fractures of the proximal humerus.
Total Shoulder Arthroplasty (TSA): For arthritis, revision of hemi, or mobility issues.
Reverse Total Shoulder Arthroplasty (RSA): Often chosen when there’s rotator cuff deficiency or a failed TSA.
To listen to Dr. Casey present this material in more detail you can click here to listen to full presentation.
Phases of Recovery: What to Expect
Recovery doesn’t happen overnight. Understanding what phase you or your client is in helps guide safe and effective rehab.
For Total Shoulder Arthroplasty and Hemiarthroplasty:
0–6 Weeks: Protective Phase
The shoulder is healing, so the focus is on maintaining strength and mobility in the surrounding joints like the cervical spine, elbow, and wrist. A sling is typically worn for 4–6 weeks.
6–12 Weeks: Early Strengthening Phase
As light exercise begins, watch for shoulder shrug compensations as range of motion (ROM) improves. Start closed-chain movements and proprioception drills.
12+ Weeks: Functional Strength Phase
Begin sport-specific or recreational training if cleared by the physician.
For Reverse Total Shoulder Arthroplasty:
0–3 Weeks: Acute/Subacute Phase
A sling is worn and the shoulder is only moved passively (without muscles activating, usually with the help of a PT). Similar focus is on the surrounding joints.
3–6 Weeks: Protective Phase
Light active-assisted ROM and isometric exercises (squeezes without movement) begin here.
6–12 Weeks: Strength Phase
Low intensity, high volume work in the scapular plane. External/internal rotation will remain limited—avoid hyperextension.
12+ Weeks: Functional Phase
Return to higher-level movements while focusing on compensations and protecting the shoulder joint.
Movement Compensations to Watch For
Even after recovery, compensation patterns can sneak in. Muscle compensations are when other muscles take over for weakened, injured, or immobile ones to complete the movement. While this can protect the injury in the short-term, over time it can lead to chronic tightness, soreness, and injury if the compensation pattern becomes dysfunctional.
Common compensations include:
Shoulder Shrug During Elevation (arms moving up): Often a sign the deltoid is overcompensating for poor rotator cuff control.
Internal Rotation Drift During Lifts: May show up during pressing or curling.
Limited External Rotation (ROM & Strength): Especially common in reverse shoulder replacements.
Gym Modifications That Matter
Feeling confident and safe in the gym again starts with smart movement modifications:
Barbell vs. Dumbbells: A barbell offers more control and symmetry in movement, especially early on.
Scapular Plane Focus: Strengthening within the scapular plane respects joint integrity.
Mid-Range Strength Work: Avoid the extremes of motion—especially hyperextension.
Adjust Machine Entry/Exit: Positioning can make or break safe exercise setup.
Exercises that often require modification:
Bicep Curls: Neutral grip or barbell options to reduce drift.
Bench Press/Chest Press: Controlled range and stable surface are key.
Tricep Extensions: Focus on scapular stability throughout.
Pull Downs and Supine Flies: Watch for form breakdown due to rotational weakness.
For more video demonstrations of real life examples of strength training movements in a gym that are modified for a fully recovered bilateral total shoulder replacement you can watch this playlist!
The Big Picture: Long-Term Outcomes
Here’s the good news—many patients return to an active lifestyle post-op. With the right rehab and consistent movement practice, long-term outcomes are encouraging:
TSA: Near full range of motion and strength can be expected.
RSA: Functional range of motion is the goal, with a focus on deltoid and accessory muscle compensation.
Even 10 years post-op, we’ve seen clients safely doing push-ups, bench presses, and other gym-based activities—safely and confidently. When I worked with Eve, she was anxious going into her total shoulder replacement, but after four months, she was confident holding her newest grandchild in her arms.
Final Thoughts
Returning to life and fitness after a shoulder replacement doesn’t just require clearance—it requires education, patience, and thoughtful movement. Whether you're a patient or coach, understanding the surgical background, movement limitations, and smart exercise choices make all the difference.
If you or someone you know is navigating shoulder rehab, reach out—we’d love to help you move well and move often.
Want help now?
Click below to talk to one of our Doctors of Physical Therapy to see how we can help you.
In the meantime, Dr. Casey presents a detailed overview of the different types of total shoulder replacement surgery and how it relates to the recovery process in this informational youtube video:
For more reading material, check out the free article below:
If you’re considering surgery or currently recovering, we’re here to help guide you every step of the way. The more strength and ROM you have going into a surgery (of any kind) the better your rehab potential is afterward. After surgery, targeted guidance can speed up your recovery.
About The Authors
Dr. Dawn Thomas DScPT, OMPT is a lover of all things movement and a doctor of physical therapy with over 30 years of experience. She creates innovative programs for all walks of life, ranging from personalized care to group sessions and online education. Passionate about helping people stay active and independent, she specializes in fall prevention and balance training. Outside of work, you can find her hiking, swimming, adventure traveling, and inspiring her community to move at every age.
Casey Masek, PT, DPT is a dedicated doctor of physical therapy with a decade of experience helping people move and feel their best—whether they’re recovering from an injury or building healthier habits to prevent one. With a passion for proactive, sustainable wellness, she supports clients in making movement a natural part of their daily lives. When she’s not working with patients or creating wellness solutions, you’ll find her outside soaking up the fresh air—walking, hiking, gardening or playing with her kids. She believes that movement is medicine and loves helping others experience that truth for themselves.
Dr. Melissa Tye is a board-certified neurologic doctor of physical therapy passionate about helping people restore movement and achieve their wellness goals through the power of exercise. In addition to her work in physical therapy, Mel also works in healthcare marketing research, speaking directly with consumers to better understand them. Whether it's PT or MR, she feels it is important to achieve a partnership and deep understanding of a client's goals. When not working, Melissa is spending time with her husband and 3 sons or exercising in order to ensure she can keep up with them!
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