The essential role of rehabilitation in operative and non-operative shoulder management: A 40-year experience (1985–2025)

INTRODUCTION: As early as 1985, Charles S. Neer II and Peter Welsh emphasized that successful shoulder treatment - whether surgical or non-surgical - relies on structured rehabilitation based on simple exercises performed independently by the patient several times daily. The Sarah Jackins auto-rehabilitation program, developed with Frederick A. Matsen and Douglas T. Harryman in Seattle, further reinforced this concept and was widely implemented in clinical practice and training. METHODS: This paper describes the application of four key rehabilitation principles in more than 24,000 patients treated for shoulder conditions, including over 8,000 surgical cases. RESULTS AND DISCUSSION: The protocol is based on (1) simple self-administered exercises performed three to five times daily, (2) supervision by a trained physiotherapist. The paper is well illustrated with examples of all the exercises performed. Type of paper: Descriptive, Level V of evidence, Expert Opinion.