Brooke Army Medical Center Sports Medicine
Outpatient Rehabilitation Protocol
Type II SLAP repair (Type IV see below)
Type IV repairs require biceps precautions. No active biceps activity for 6 weeks, no
loaded biceps activity for 12 weeks.
INPATIENT: Post-operative day (POD) 1 through discharge (d/c) from hospital
Goals:
Protect the anatomic repair
Prevent negative effects of immobilization
Diminish pain and inflammation
PT Sessions: Afternoon visit after surgery and daily supervised sessions
Sling:
1.
2.
Exercises:
1.
2.
3.
Shoulder immobilizer / abduction sling (Donjoy “Ultrasling”)
Wear at all times, even when sleeping for 1st 4-6 weeks after surgery.
Remove 3x/day for PT exercises, and for personal hygiene
Grip Strength w/ foam ball, towel, putty to squeeze repetitively
Hand, wrist, elbow full active range-of-motion (AROM)
Shoulder passive pendulum exercises in sling or forearm supported
PHASE I: Hospital d/c through Week 6 – PROTECTION PHASE
Goals:
Protect the anatomic repair
Prevent negative effects of immobilization
Promote dynamic stability
Diminish pain and inflammation
PT Sessions: 1-2 supervised sessions per week with physical therapist
Modalities:
1.
2.
3.
4.
Cryotherapy 3/day
IFC/TENS if c/o pain
NMES
4-6 weeks: biofeedback inhibition if compensatory shoulder shrug
Weeks 0-2
Sling:
Shoulder immobilizer / abduction sling (Donjoy “Ultrasling”)
1.
2.
3.
Sling for 4-6 weeks.
Wear immobilizer when sleeping for 4-6 weeks after surgery.
Remove sling 3x/day for home PT exercises, and for personal hygiene
Exercises:
 Shoulder passive pendulum exercises in sling or forearm supported
 Scapular retraction; gently pinch shoulder blades together for 5 sec
 Cryotherapy, modalities as indicated
**No active Flexion, ER, Extension, or Abduction. No resistance to elbow
flexion or supination for 6 weeks
Aerobic Conditioning: may ride stationary bike while wearing immobilizer
Weeks 3-4
Sling:
Exercises:
1.
2.
3.
3.
4.
5.
6.
7.
Discontinue use of sling, immobilizer at 4 weeks
Slowly advance PROM; add light AAROM exercises with goal of:
a.
Flexion to >90 deg
b.
Abd to 75-85 deg
c.
ER in scapular plane to 25-30 deg (watch for sharp pain
with ext rotation)
d.
IR in scapular plane to 55-60 deg
No active Flexion, Extension or abduction
No resistance to elbow flexion or supination for 6 weeks
Initiate rhythmic stabilization drills
Initiate proprioception training (no axial loading or CKC exercises x 8
weeks)
Tubing ER/IR at side
Continue Isometrics
Continue use of cryotherapy
Weeks 5-6:
Exercises:
1.
Gradually improve ROM
a.
Flexion to 145 deg
b.
ER at 45 deg abduction: 45-50 deg
c.
IR at 45 deg abduction: 55-60 deg
d.
Initiate light IR/ER at 90 deg abduction
2.
Initiate gentle, global shoulder stretching
3.
Continue tubing IR/ER at side
4.
PNF manual resistance
5.
Initiate Active shoulder abduction (w/o resistance)
6.
Initiate full can exercise (w/o resistance)
7.
Initiate Prone rowing, Prone horizontal abduction
8.
No biceps strengthening
PHASE II: Weeks 7-14 – MODERATE PROTECTION PHASE/EARLY STRENGTHENING
GOALS:
Gradually restore full ROM (week 10)
Preserve the integrity of the surgical repair
Restore muscular strength and balance
PT Sessions: 2-3 supervised sessions per week with physical therapist
Modalities:
1.
2.
3.
4.
Cryotherapy prn
IFC prn
NMES
Biofeedback inhibition if compensatory shoulder shrug
Weeks 7-9:
Exercises:
1.
Gradually progress ROM with goals of:
a. Flexion to 180 deg
b. ER at 90 degrees abduction: 90-95 deg
c. IR at 90 deg abd: 70-75 deg
2.
Strength
a. Continue to progress isotonic/theraband strengthening program
b. Continue PNF strengthening
c. Initiate Throwers 10 program
d. Isokinetic IR/ER at 30/30/30 at 180, 300 deg/sec
3.
Proprioception:
a. Rhythmic stabilization
b. OKC, CKC perturbation training
Aerobic Conditioning: Stationary bike or treadmill walking
Weeks 10-12:
Exercises:
1.
Progress to full functional AROM and stretching
a. Progress ER to thrower’s motion
b. ER at 90 deg abduction (110-115 in throwers)
2.
May initiate slightly more aggressive strengthening
a. Begin light serratus punches
b. Begin light chest press
c. Continue theraband, Thrower’s Ten
d. Isokinetic training 30/30/30
3.
Proprioception
a. Rhythmic stabilization
b. Perturbation training
Criteria for progression to Phase III:
1.
2.
3.
4.
Full non-painful ROM
Satisfactory stability
Muscular strength (Grade IV MMT or better)
No pain or tenderness
PHASE III: Weeks 13-20 – MINIMAL PROTECTION PHASE / ADVANCED
STRENGTHENING & ENDURANCE
Goals:
Establish and maintain full ROM
Improve muscular strength, power, and endurance
Gradually initiate functional activities
PT Sessions: 1-3 supervised sessions per week with physical therapist
Weeks 13-16:
Exercises:
1.
Continue capsular stretches
2.
Continue strengthening exercises (may begin axial loading):
a. Thrower’s Ten Program
b. PNF manual resistance
c. Endurance training
d. Initiate light plyometric program
e. Restricted sport activities (light swimming, half golf swings)
f. Push-up progression (wall, on knees)
Weeks 17-20:
Exercises:
1.
Continue all exercises listed above
2.
Continue all stretching
3.
Continue Thrower’s Ten program
4.
Continue plyometric program
5.
Initiate interval sport program (throwing, etc)
6.
Progress from knee to military push-ups; AVOID anterior capsule
stretching by not dropping below the scapular plane during each rep
7.
Begin isokinetic training (IR/ER)
Aerobic Conditioning:
1.
May begin jogging in addition to bike, elliptical trainer, and stairmaster
2.
Upper body cycle up to 10-15 min forward and 10-15 min backward
Isokinetic Testing: ER/IR (30/30/30 or 90/90 if overhead athlete or laborer)
Criteria for Progression to PHASE IV:
1.
Full, painfree AROM
2.
Satisfactory static stability (MMT 4+/5) or isokinetic testing 75-80% of
uninvolved side
3.
No pain or tenderness
PHASE IV: Weeks 20-26 – ADVANCED STRENGTHENING PHASE
Goals:
Enhanced muscular strength, power, and endurance
Progress functional activities
Maintain shoulder mobility
PT Sessions: 1-2 supervised sessions per week with physical therapist
Exercises:
4. Continue flexibility exercises
5. Continue isotonic strengthening program
6. PNF manual resistance patterns
7. Plyometric strengthening
8. Progress interval sport programs
9. Continue military push-up progression
10. Isokinetic training ER/IR
11. Gradually increase weight training to maximum; must be pain free
12. Advanced pool therapy if available
Isokinetic Testing: ER/IR (30/30/30 or 90/90 if overhead athlete or laborer)
Aerobic Conditioning:
1.
Progress from jogging to running; should be painfree
Criteria for Progression to PHASE V:
1.
Full or nearly full shoulder AROM
2.
Near full strength per manual muscle testing (or 80% isokinetic testing)
3.
Pain-free basic functional training exercises
PHASE V: Months 6-9 – RETURN TO FULL DUTY/ACTIVITY
Goals:
Exercises:
1.
2.
Gradual return to sport activities
Maintain strength, mobility, and stability
Full AROM equal to opposite UE (accept 5-10 loss of ER)
Full shoulder strength per manual testing (or 90% isokinetic testing)
Able to pass APFT, including push-ups
Gradually progress sport activities to unrestrictive participation
Continue stretching and strengthening program
_______________________________
______________________________
MARK BAGG, MD
COL, MC
Chief, Orthopedics
KATHLEEN ZURAWEL
COL, SP
Chief, Physical Therapy
APPROVE / DISAPPROVE
APPROVE / DISAPPROVE
Updated 24 June 2005