SLAP Repair Protocol

Phase One (Immediate Postoperative Phase)

At this stage, the most important goals are patient education and gentle ROM. The tissues are healing and the focus should be on positions and postures that place the least amount of stress on the tissues.

Sling: To be worn for 3 weeks at all times and for five weeks while sleeping or out in public. It may be beneficial to use a pillow for support while sleeping once the sling is removed. When your sling is off your elbow should remain by your side.

Ice: 2-3 times per day for 10-15 minutes to help decrease inflammation and pain.

Physical Therapy: Start physical therapy 1x per week for 6 weeks at 10-14 days postop. At 6 weeks post-op, physical therapy should be 2 x per week for 10-14 weeks.

Remember that these guidelines should take into account the patient's symptoms and one should not progress to the next phase if the patient cannot successfully complete the previous phase.

Weeks 2-4

· Small Pendulums/Tummy Rubs
· Wrist and elbow ROM
· Theraputty/gripping exercises
· Posture education/awareness
· Pulleys
· Initiate submaximal isometrics (all planes, shoulder in neutral, elbow bent to 90 with bolster under arm)
· Begin open chain rhythmic stabilization exercises o
· PROM (Supine)

o Flexion to 90 (week 2), flexion to 120 (week 4)
o Abduction to 90-100 (week 4)
o External Rotation @ 45 to 10 (Week 2), ER @ 45to 35 (Week 4)
o Internal Rotation @ 45 to 45 (Week 2), IR @ 45 to 55 (Week 4)
o No excessive ER, extension, or abduction
o Avoid isolated biceps contractions

Weeks 4-6

· Gradually increase ROM in all planes

o Flexion to 160
o Abduction to 120
o ER @ 45 to 55-65
o IR @ 45 to 55-60

· AAROM (wand or T-Bar) in supine for flex, abd, add, and IR/ER in scapular plane
· IR/ER with theraband at 0 abduction
· Initiate active shoulder abduction (no resistance)
· Initiate "full can" exercise (no resistance)
· Initiate prone rowing and prone horizontal abduction
· Begin weight bearing exercises on all fours to help facilitate scapular neuromuscular control
· UBE (Week 6)
· No biceps strengthening

Phase Two (Intermediate Phase)

This phase of rehabilitation focuses on restoring full ROM, regaining normal scapulohurneral mechanics, and restoring muscular strength and balance/proprioception.

Weeks 6-8

· Gradually increase to full ROM in all planes except ER
· Increase isotonic exercises to include: adduction, abduction, flexion, extension, IR, and ER
· Initiate Proprioceptive Neuromuscular facilitation (PNF) patterns with manual resistance
· Begin rhythmic stabilization exercises
· Begin active elbow flexion ROM
· May initiate light stretching (No posterior capsule stretching until week 12)

Weeks 8-12

· Gradually increase to full ROM in all planes by week 12
· Initiate slightly more aggressive strengthening exercises
· Progress to isotonic elbow flexion
· Progress isotonic strengthening exercises
· Begin PNF patterns with bands/pulleys/weights
· Begin wall push-ups and progress to floor as tolerated
· Progress weight bearing exercises to include unstable surfaces (Airex, Bosu ball, etc)

Phase Three (Advanced Activity and Strenethenine)

The goals of phase three include maintaining full ROM: improving muscular strength, power, and endurance; introduce functional activities; and enhance neuromuscular control.

Weeks 12-16

· Continue strengthening exercises

o PNF manual resistance
o Muscular Endurance training
o Increased resistance with isotonics and bands

· Initiate more aggressive strengthening

o Push-ups
o Bench Press (do not allow arm below body)
o Seated Row (do not allow arm behind body)
o Lat pull-downs (in front of body)

· Continue all stretching exercises
· Begin 2 handed plyometrics @ week 12

o 3-5 lb ball
o Chest pass
o Side to side throw
o Overhead soccer throw

· Progress to single hand plyometric throwing (approximately 2 weeks after initiation of 2 handed)

o 90-90 throws
o Wall dribbles

Weeks 16-22

· Continue all exercises listed above
· Continue all stretching
· Continue plyometric program
· Initiate interval sport program (throwing, etc.)

Phase 4 (Return to Activity)

During the final stage of rehab, emphasis is placed on gradual return to sport activities and maintaining strength, mobility, and stability of the shoulder.

Weeks 22-26

· Emphasis is on work or sport specific exercises
· Continue stretching and strengthening in functional or sport-specific positions
· Gradually progress sport or work activities to full participation