New York State Medical Treatment Guidelines for Therapeutic Exercise for shoulder Injury in workers compensation patients

The guidelines established by the New York State Workers Compensation Board are crafted to assist healthcare professionals in prescribing suitable therapeutic exercises for shoulder injuries.

Tailored for medical practitioners, these Workers Compensation Board guidelines provide support in determining the appropriate therapeutic exercises for individuals with shoulder injuries.

It’s crucial to note that these guidelines do not substitute clinical judgment or professional experience. The ultimate decision on therapeutic exercises should be a collaborative one, involving the patient and their healthcare provider in consultation.


  • Rehabilitation (supervised formal therapy) required as a result of a work-related injury should be focused on restoring functional ability required to meet the patient’s daily and work activities and return to work; striving to restore the injured worker to pre-injury status in so far as is feasible.


  • Active therapy requires an internal effort by the patient to complete a specific exercise or task. Passive therapy are those interventions not requiring the exertion of effort on the part of the patient, but rather are dependent on modalities delivered by a therapist. Generally, passive interventions are viewed as a means to facilitate progress in an active therapy program with concomitant attainment of objective functional gains. Active interventions should be emphasized over passive interventions.


  • The patient should be instructed to continue both active and passive therapies at home as an extension of the treatment process in order to maintain improvement levels.


  • Assistive devices may be included as an adjunctive measure incorporated into the rehabilitation plan to facilitate functional gains.


Therapy Active:

  • Therapy Active
    • Physical / Occupational Therapy
      • Recommended – to improve function, including range of motion and strength.
      • Frequency/Dose/Duration: Frequency of visits is usually individualized based on the severity of the limitation. Two to three visits per week for two weeks are often used to initiate an exercise program. The total number of visits may be as few as two to three for mild patients or up to 12 to 15 with documentation of objective functional improvement.
      • As part of the rehabilitation plan, patients should be instructed to continue both active and passive therapy at home as an extension of the treatment process to maintain improvement.
      • Indications: All postoperative and conservatively managed patients.
      • Indications for Discontinuation: Resolution of pain, intolerance, lack of efficacy, or noncompliance.
    • Therapeutic Exercise
      • Therapeutic exercise where the therapist instructs the patient in a supervised clinic and home program to increase the strength of the supporting shoulder musculature. Motions and muscles to be strengthened include shoulder internal and external rotators, abductors, and scapula stabilizers.
      • Recommended – in select patients as clinically indicated.
      • Frequency: Typically two to three times/week for eight to 12 weeks as noted below.
        • Weeks 1-3: Isometrics in sling.
        • Weeks 3-8: Progressive isotonic exercises.
        • Weeks 8-12: Begin overhead activities when the rotator cuff strength is normalized, and full active elevation has been achieved.


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