Phase I –Protective Phase (0 to 6weeks)
- Maintain shoulder range of motion (ROM), diminish pain and inflammation while protecting repair of SLAP lesion.
- Protect SLAP repair by avoiding active elbow flexion.
- Sling: continue sling/shoulder immobilizer use for 4weeks. Must wear sling at night.
- Pendulum exercises.
- Supine active assisted forward elevation (FE) to pain tolerance.
- Once patient understands the difference between active and passive motion, the patient should start passive FE with pulleys, and given instructions for home pulley system.
- Passive and gentle active-assisted ROM exercises
- Flexion to 60°(week1) progress to 145 ° by week 6.
- Elevation in scapular plane to 60°.
- External rotation to 15 °(week 1) progress to 45 ° by week 6.
- Internal rotation to 45 °
- Use modalities to control pain and swelling (i.e. cryotherapy, HVGS, TENS).
- Home exercise program should be established so patient performs exercises 3-5 times per day.
Phase II –Early Intermediate Phase(7 to 14 weeks)
- Discontinue shoulder immobilizer.
- Gradually progress ROM to full.
- Flexion progress to 180° by week 10.
- External rotation at 90° abduction to 90° by week 10.
- Internal rotation at 90° abduction to 60° by week 10.
- Begin increased strengthening exercises at week 10.
- Progress ROM to functional demands (throwing etc) at week 10.
Phase III – Intermediate phase (14 to 19 weeks)
- Patient should have full nonpainful ROM before progressing to phase III.
- Add isometric IR, ER, and FE exercises.
- Progress with muscle strengthening program, stretching and ROM exercises.
- Cybex strength testing – goal >85% of contralateral side at 19 weeks.
Phase IV – Advanced Strengthening (19 to 24 weeks)
- Patient should have full nonpainful ROM and muscular strength 75% of the contralateral side before progressing to phase IV.
- Progressive Resistance Exercises. Start light, progress as tolerated.
- UBE 90°/sec-120°/sec for endurance.
- Wall pushups, press-ups.
- Total Gym – rows, presses, pullovers.
- Rockwood exercises – flex, abd, ext, add, IR, ER, rows, presses.
- Can use dumbbells or theraband tubing for Rockwood exercises.
Phase V – Return to Activities (After 6months) (24weeks)
- Patient should have full nonpainful ROM and muscular strength 90% of the contralateral side before progressing to phase V.
- Work on any focal deficits.
- Progress with sport specific training.
- Establish home program for strength and ROM maintanence.
- Improvement continues for 12 months post op.
For Detailed Rehabilitation protocols see:
- Brotzman SB, Clinical Orthopaedic Rehabilitation, Mosby, 2003.