For specific post-op photographic based rehab exercises to support the below protocol please see:
Stab Phase 1 Protocol in PDF
Stab Phase 2 Protocol in PDF
Stab Phase 3 Protocol in PDF
Pre-op
Rehabilitation is advisable, and should consist of core stability, cuff and general shoulder conditioning exercises.
Post op
Day 1 – 4 weeks (Phase I)
- Ice packs may be used for the first 2 weeks in 20 min intervals to assist with pain relief
- Sling for 4 weeks including the back strap – remove for exercises 4 times daily. To be worn in bed at night time
- Teach axillary hygiene
- Hand, wrist and elbow ROM exercises
- Pendular exercises
- Check operation notes for degree of allowed external rotation. Generally 0 deg of external rotation. This to be done gently, and actively – no passive stretching.
- Hand to mouth movements
- Teach postural awareness and scapular setting
- Core stability exercises throughout rehabilitation
- See Phase I above
5 – 8 weeks (Phase I, progressing to phase II)
- Wean off sling – still to be worn at night
- Active assisted flexion / forward elevation as comfortable
- Active External rotation to neutral
- Proprioceptive exercises (minimal weight bearing below 90 degrees)
- Commence isometric exercise and theraband work
- Scapula strengthening exercises
8 – 12 Weeks (Phase II)
- Increase ROM – External rotation now beyond neutral, still actively
- Strengthen through range
- Increase proprioception through open & closed chain exercise
- Regain scapula control & normal shoulder control
- Incorporate sports-specific rehabilitation
- No stretching of the capsule – allow the range of motion to return only with active movement, no passive stretching.
- See Phase II above
3 Months + (Phase III-IV)
- Commencement of graded strengthening program
- Work on obtaining a pain free AROM of 90% of the full ROM at around 4 months
- No passive stretching in ER, or AB/ER
- Minimise GIRD
- Work through Phase III +/- Phase IV depending on requirements
| Milestones | |
| Week 6 | Active elevation to 80% of pre-op level |
| Week 12 | Aim for 70% range of external rotation compared to asymptomatic side |
Return to contact sport and heavy work is dependent on each precise situation. This will be discussed at the time of surgery with each patient.
- Assessment with Closed Chain Upper Extremity Stability Test and Upper-Quater Y Balance Test prior to return to contact sport
- During strengthening, avoid shoulder presses, unsupported bench press and inclined presses. These strengthening programs can potentially damage the repair.
- Bench presses may be done with the scapula supported on the floor, and military presses may be done with the hand in front of the face.
Some general guidelines are:
6 weeks – gentle jogging on hard, flat surfaces. Commence work on a stationary bike trainer.
12 weeks – Commence swimming. Generally with breaststroke, then progressing to freestyle as strength and ROM increase.
6 months – Depending on progress and the degree of engagement in rehabilitation contact sports, heavy overhead lifting, surfing, throwing, basketball, and netball may be recommenced.