After a SLAP or Bankart repair, it is critical to ensure healing of the labrum and capsule down to the rim of the glenoid.
Therefore, it is important to protect the repair for six weeks after surgery.
Work and Activity Restrictions
• 0–6 weeks: No work, no use of operative hand
• 6 weeks–3 months: 5 lb weight limit in the operative hand (ideally nothing heavier than a fork, knife, or toothbrush); can return to work using the opposite hand only
• 3 months: No lifting greater than 10 pounds
• 4 months: No lifting greater than 20 pounds
• 5 months: No lifting greater than 30 pounds
• 6 months: Released from restrictions, return to full work duties
• Return to sport at 5–6 months; minimum of 6 months for contact sports and climbing
• Initiation of throwing program at month 4, with goal of return to game participation at 9 months
0–2 Weeks: Protect Repair
• Sling at all times except for elbow, wrist, and hand exercises (flexing and extending the hand, wrist, and elbow)
2–6 Weeks: Begin Gentle, Restricted ROM
• At 4 weeks post-op, begin weaning out of the sling during the day as comfort allows; continue wearing the sling at night
• Begin formal physical therapy at 4 weeks post-op
– Begin JPL Exercises Phase I
– 3–5 repetitions per set, 5 sets per day
• Continue elbow, wrist, and hand range-of-motion exercises
6 Weeks–3 Months: Regain ROM
• Discontinue sling completely; active reaching of the arm is permitted, avoiding abduction and external rotation
• Maintain a 5 lb weight limit on the operative side
• Transition to JPL Phases II and III as tolerated
– 3–5 repetitions per set, 5 sets per day
• In physical therapy, focus on AROM, AAROM, and PROM in external rotation, flexion, and internal rotation
– External rotation (limit to 75% of contralateral shoulder as tolerated)
– Flexion
– Sleeper stretch
– Internal rotation stretch (cross-body and up-the-back with towel)
– External rotation at 90 degrees
• Begin gentle strengthening with theraband: internal rotation, external rotation, low row, biceps curl
– Strengthening once daily; begin light
• Add progressive resisted exercises (PREs) for scapular stabilizers: seated rows, shoulder extension, scapular retraction
• Begin dynamic resistance with proprioceptive neuromuscular facilitation (PNF) patterns and manual techniques
• Begin closed kinetic chain (CKC) exercises with table or wall weight shifts
3 Months: Strengthening
• Use operative extremity to lift 10 lbs for 1 month, then 20 lbs for 1 month; expect no restrictions at 6 months post-op
• Begin sport-specific training
• Progress PREs in all planes
• Add rhythmic stabilization drills (prone medicine ball eccentric drops, free throws, ball taps, etc.)
• Progress CKC exercises
• Normalize strength, endurance, neuromuscular control, and power
• Gradually increase stress to anterior capsulolabral tissues
• Gradual return to full ADLs, work, and recreational activity
• Include terminal external rotation stretches
• Overhead lifting and pull-ups may begin at 4 months
Goals to Progress to Return to Sport
- Progress functional activities toward return to sport
- Enhance neuromuscular control
- Improve strength, power, and endurance
- Achieve muscular strength no less than 80% of the contralateral side
- Regain full functional ROM and 5/5 scapular and rotator cuff strength
