As passive motion improves, and the fracture becomes fully consolidated, active motion against gravity and resistance exercises are added to build strength and endurance. Many surgeons advise forward flexion before abduction against gravity, which puts significant strain on the supraspinatus.
Elastic devices can be used to provide varying degree of resistance, and ultimately the athletic patient can progress to resistance machines and free weights.
Physical therapy instruction and supervision may be helpful for optimal rehabilitation or if the patient is not progressing satisfactorily.
Remember to monitor rotator cuff strength. Significant weakness may indicate an unidentified rotator tendon cuff rupture in need of surgical repair.