Rehabilitation After Arthroscopic Bankart Labral Repair

Superior Labrum Anterior Posterior (SLAP) Tear

The following protocol is a guideline for rehabilitation after Bankart, SLAP and labral repair surgery. It should not be used as an absolute cookbook type of a program. There are many factors that may accelerate or decelerate the program including the patient’s previous activity level, tissue status, response to surgery, method of fixation and the actual surgical procedure performed. As always, appropriate open communication among the surgeon, patient, therapist and often coaches and parents, is important to the long term success of any surgical procedure. A “hands-on” approach is critical for successful shoulder rehabilitation.

Phase I: Early Postoperative Phase

Goals: Protect the surgical procedure, minimize the effects of immobilization, and diminish pain and inflammation

Weeks 0-3

  • Sling / immobilizer
  • Elbow/hand ROM & Gripping exercises
  • Supine PROM to 90° fwd flexion
  • Cryotherapy, modalities as needed to control pain and swelling

Weeks 3-6

  • Shoulder AAROM & PROM (NO Active Motion & No Pulleys)
  • Flexion to 120°
  • ER in scapular plane to 30°
  • IR in scapular plane 45-60° (except in posterior labral repairs)
  • Abduction to 60-75°
  • No shoulder extension or Combined Abduction/ER
  • Submaximal isometrics
  • Begin submaximal dynamic stabilization at 4-6 weeks
  • Flexion to 120-130° by 4-6 weeks

Begin to access “end feel” at 3 weeks. Be more aggressive in patients with firm “end feel” and slow down in those with a soft feel! If any uncertainty, contact Dr. Goradia.

Weeks 6-8

  • Flexion to full
  • At 45° abduction: ER of 45° and IR of full (except in posterior labral repairs)
  • Initiate posterior capsular stretching (except in posterior labral repairs)
  • Initiate exercise tubing ER/IR (with arm at side)
  • Continue dynamic stabilization, PNF

Weeks 8-10

  • Progress ROM to (at 90° abduction: ER of 90° and IR of 75° with full flexion
  • Joint mobilization, stretching, etc.
  • Continue self-capsular stretching
  • UBE arm at 90° abduction
  • Continue PNF diagonal patterns(rhythmic stabilization techniques)
  • Progressive isotonic strengthening

Phase III: Advanced Strengthening Phase (10-14 weeks)

Goals: Enhance muscular strength, power and endurance, Improve muscular endurance, Maintain mobility

  • Progress to full ROMShoulder Strengthening
  • Continue all stretching exercises
  • In overhead athletes, progress ER past 90°
  • In nonoverhead athletes, maintain 90° ER
  • Throwers Ten Program
  • Isotonic strengthening for entire shoulder complex
  • PNF manual technique
  • Neuromuscular control drills
  • Isokinetic strengthening
  • Strengtheing kinetic chain: Core and Hip
  • Begin sports specific exercises
  • May initiate “light” plyometric exercises
  • May initiate “controlled” swimming, golf swings, etc.
  • May initiate light isotonic machine weight training

Criteria to enter Phase IV

  1. Full range of motion without pain
  2. Core and Hip strength 80% of normal
  3. Good stability
  4. Strength 70-80% of contralateral side

Phase IV: Sports Specific Training

  • Continue all flexibility exercises
    • Self-capsular stretches (anterior, posterior and inferior)
    • Maintain ER flexibility
  • Continue isotonic strengthening program
  • Emphasize muscular balance (ER/IR)
  • Continue PNF manual resistance
  • Continue plyometrics and dynamic exercises
  • Begin ballistic activities at end of this phase
  • Interval throwing program for throwers
  • Functional progression

Phase V: Return to Sports

  • Supervised return to sports if Phase IV complete without pain or instability symptoms
  • Overhead athletes may need to continue throwing program
  • Contact athletes may need functional brace depending on position
  • Continue long term strengthening program that includes core