Recovery tips after reverse shoulder replacement

Since there were no responses to my inquiry, I thought I would summarize my swimming recovery from my total reverse shoulder replacement on June 2nd, about 14 weeks ago. My surgeon released me to return to the water at 6 weeks, after I had 4 weeks of occupational therapy focused only on Assisted Range of Motion. At that point, I had not started any active range of motion exercises and had just been given permission to be out of my immobilizer shoulder sling. The recommendation was that I start with water walking, using a modified breast-stroke pull and a sort of underwater crawl stroke. 

Once I got in the water, I realized that I could use fins and do a one-arm (non-surgical) freestyle and backstroke. I held my surgical arm straight down against my side, and started by just doing sidewinder, open turns. I alternated water walking and one-arm swimming for about 5 weeks, until I was 11 weeks out from surgery. During that time, I started to raise my surgical arm to 90 degrees while pulling backstroke with my other arm, then lowering my surgical arm back down (not raising it past 90 degrees).

--At about 8 weeks, I realized I could do a flip turn holding my surgical arm tightly to my chest so it wouldn't move and then at 10 weeks I started doing a semi-normal flip turn with a modified streamline since I still couldn't extend my arm fully.

--Around 9 weeks, I was able to do a backstroke pull with my surgical arm, but entering the water at 90 degrees and "pulling" slowly underwater, very little application of pressure. I was able to do the "corkscrew" drill with the surgical arm pulling backstroke and the non-surgical arm pulling freestyle around 9 weeks as well.

--With freestyle, I started just lifting my elbow about six inches out of the water with a very strong rotation to that surgical side at about 10 weeks.   --At 11 weeks, I started to "pull" freestyle with my surgical arm with a very foreshortened entry (my arm still didn't and doesn't extend fully). I also started a more normal backstroke pull. At this point, I stopped using the fins.

--I would estimate that at 14 weeks, the backstroke arm is entering at about 100, maybe 110 degrees, still. My freestyle arm is entering more normally, but I still can't fully extend it underwater close to the surface of the water. It sort of droops down.

One of the issues with a reverse shoulder replacement is that your rotator cuff no longer stabilizes your joint--all of the stabilization comes from your deltoid. The ball is now on the socket side, and the socket on the ball side of your joint. Therefore, the strengthening of your deltoids is very important--if you are considering a shoulder replacement, be sure that you request pre-surgical occupational or physical therapy as well to get started on this and to develop trust with your therapist.

At this point just over 14 weeks after surgery, I am about 15% slower than I was pre-surgery. I am doing an hour to an hour and a quarter of home exercises recommended by my occupational therapist, and I will continue occupational therapy until at least 20 weeks. Neither my occupational therapist nor my surgeon had ever worked with competitive or masters swimmers before. I'm educating my therapist a fair amount about swimming but she is very responsive and accepting of my input. I will be switching to a physical therapist at 19 weeks, with some overlap with the occupational therapist. Apparently the physical therapist has worked with swimmers before--we'll see about her knowledge level.

I'll try to post again in a couple months but I would appreciate any input from others who have had a reverse shoulder replacement. Happy to answer any questions.

--Katherine Branch, New Mexico Masters

Since there were no responses to my inquiry, I thought I would summarize my swimming recovery from my total reverse shoulder replacement on June 2nd, about 14 weeks ago. My surgeon released me to return to the water at 6 weeks, after I had 4 weeks of occupational therapy focused only on Assisted Range of Motion. At that point, I had not started any active range of motion exercises and had just been given permission to be out of my immobilizer shoulder sling. The recommendation was that I start with water walking, using a modified breast-stroke pull and a sort of underwater crawl stroke. 

Once I got in the water, I realized that I could use fins and do a one-arm (non-surgical) freestyle and backstroke. I held my surgical arm straight down against my side, and started by just doing sidewinder, open turns. I alternated water walking and one-arm swimming for about 5 weeks, until I was 11 weeks out from surgery. During that time, I started to raise my surgical arm to 90 degrees while pulling backstroke with my other arm, then lowering my surgical arm back down (not raising it past 90 degrees).

--At about 8 weeks, I realized I could do a flip turn holding my surgical arm tightly to my chest so it wouldn't move and then at 10 weeks I started doing a semi-normal flip turn with a modified streamline since I still couldn't extend my arm fully.

--Around 9 weeks, I was able to do a backstroke pull with my surgical arm, but entering the water at 90 degrees and "pulling" slowly underwater, very little application of pressure. I was able to do the "corkscrew" drill with the surgical arm pulling backstroke and the non-surgical arm pulling freestyle around 9 weeks as well.

--With freestyle, I started just lifting my elbow about six inches out of the water with a very strong rotation to that surgical side at about 10 weeks.   --At 11 weeks, I started to "pull" freestyle with my surgical arm with a very foreshortened entry (my arm still didn't and doesn't extend fully). I also started a more normal backstroke pull. At this point, I stopped using the fins.

--I would estimate that at 14 weeks, the backstroke arm is entering at about 100, maybe 110 degrees, still. My freestyle arm is entering more normally, but I still can't fully extend it underwater close to the surface of the water. It sort of droops down.

One of the issues with a reverse shoulder replacement is that your rotator cuff no longer stabilizes your joint--all of the stabilization comes from your deltoid. The ball is now on the socket side, and the socket on the ball side of your joint. Therefore, the strengthening of your deltoids is very important--if you are considering a shoulder replacement, be sure that you request pre-surgical occupational or physical therapy as well to get started on this and to develop trust with your therapist.

At this point just over 14 weeks after surgery, I am about 15% slower than I was pre-surgery. I am doing an hour to an hour and a quarter of home exercises recommended by my occupational therapist, and I will continue occupational therapy until at least 20 weeks. Neither my occupational therapist nor my surgeon had ever worked with competitive or masters swimmers before. I'm educating my therapist a fair amount about swimming but she is very responsive and accepting of my input. I will be switching to a physical therapist at 19 weeks, with some overlap with the occupational therapist. Apparently the physical therapist has worked with swimmers before--we'll see about her knowledge level.

I'll try to post again in a couple months but I would appreciate any input from others who have had a reverse shoulder replacement. Happy to answer any questions.

--Katherine Branch, New Mexico Masters