Surgery & Physical Therapy Are Complete: Now What?

If you’re like 460,000 other people in the United States, you had surgery to repair your rotator cuff.

The surgery is over, and you finished physical therapy; now what?

If your experience was like most of those 460,000 other people, the pain was better after you were discharged from physical therapy, but you don’t feel 100% confident that your shoulder can handle the things you want to do.

Yes, you can do things around the house and fulfill your responsibilities at work, but that doesn’t mean you feel confident enough to play catch with your kids or play racquetball on the weekends with your friends.

Why?

The job of physical therapy is to get you living independently, and you don’t need to throw a football or play racquetball to do that. As far as the medical and insurance industries are concerned, if you’re back to 80% by the time you’re discharged, your rehab was successful.

That means it’s up to you to get the last 20% back.

How do you do that?

You need to understand a concept called Load vs. Capacity.

Load vs. Capacity explains how all injuries happen, what needs to happen to fully rehab an injury, and how to improve performance. 

We will use the graph above to illustrate the concept of Load vs. Capacity.

This dotted line represents your capacity or what your body can handle. In this case, it’s how much your shoulder can handle.

If you stay below this threshold, you have a low potential for pain or injury. When you cross that dotted line, you exponentially increase your potential for pain or injury. 

We say the potential for pain, rather than declaring this an absolute, because if you have 100 hundred pounds of overhead pressing capacity and load  100 hundred pounds on the bar, the weight will go up. If you load  100 hundred and five pounds on the bar, it won’t move. You’ve exceeded your capacity, but it’s not painful. 

On the flip side, if your shoulder has exceeded its capacity due to excessive high-speed movements, too much work overall, or being forced into compromising positions will definitely be at higher risk for injury.

Unfortunately, it’s more than just exercise that can cause you to exceed your capacity and get injured.

The Three Categories

There are three categories that you wake up with every day that move your body closer to crossing the line of capacity.

1. Anatomical dysfunction - These are things you can’t change about your body without surgery—the shape of your hip socket, a torn meniscus, a bulged disc, etc.

2. Recovery - Your body has to recharge and repair itself every day. It can only do that if you give it the opportunity to do so, and that’s through sleep, diet, and stress. The more you have those things dialed in, the smaller this box will be, which means you have more capacity to work with. 

3. Functional diagnosis - These are the things about your body that you can change—flexibility, mobility, strength, coordination, etc. In your case this is the tissues around your shoulder that aren’t back to full strength yet.

Now we have to account for everything else in your life.

Now we can see what it looks like if you have home life, work life, and a couple of movements in your workout piled on top. As you can see, you’re bumping up against the line of capacity. 

What happens if you exceed your capacity?

Kettlebell swings put you over the limit. This is where you would be in pain, and there’s something important you need to recognize about that. 

It wasn’t the last kettlebell swing that “caused the pain.”

You can see the kettlebell swings were “the straw that broke the camel’s back.” They weren’t the root cause; they were the cherry on top of everything else piled up throughout the day. 

If you want to keep your shoulder pain-free, you must get back below the dotted line.

Let’s look at two different scenarios for how to do that.

In scenario 2, we see a very different stack of blocks; they’re all smaller except for the “anatomical dysfunction” box because we can’t change that one, remember?

Everything else can be adjusted. If you budget the time and attention necessary, you can improve your recovery. You can address strength, flexibility, and coordination problems. 

You can even improve your stress management at home and work.

The result?

You can keep exercising or doing whatever meaningful activity you choose without pain.

What if you want to do more?

The good news is you’re not stuck with the same capacity level forever. If you spend time working near the margin of your capacity, your body will adapt. 

This means you’ll be able to handle more, and your capacity will increase.