Principles
- Progression is criterion-based; the timelines below are guidelines. Advance only when the current phase's criteria and quality of movement are met.
- The goal is gradual, controlled application of stress to the healing capsulolabral repair — integrating ROM, rotator cuff/scapular control, and stability work.
- Individualize to repair location, tissue quality, concomitant procedures, and surgeon direction.
Direction-Specific Precautions (First ~6 Weeks)
Anterior (Bankart)
- Protect against the apprehension position — limit external rotation and avoid combined abduction + external rotation. No ER at 90° abduction and no shoulder extension past neutral early.
Posterior
- Protect against posterior loading — limit internal rotation and cross-body (horizontal) adduction. Keep the hand from crossing in front of the body and avoid reaching behind the back until ~6 weeks; a neutral or slight-external-rotation brace is used.
Phase 1 · Weeks 0–4 (Maximum Protection)
- Sling/brace ~4 weeks (anterior: sling in neutral; posterior: neutral or slight-ER brace), including sleep early.
- PROM/AAROM in a safe range: flexion/scaption to ~90°; ER limited to ~15° in the scapular plane. Respect the direction-specific limits above.
- Pendulums; elbow/wrist/hand ROM; submaximal deltoid and cuff isometrics (avoid the at-risk direction); scapular sets; cryotherapy.
- Goals: protect the repair, control pain, gentle protected motion.
Phase 2 · Weeks 4–8 (Progressive ROM)
- Wean the brace by ~4–6 weeks.
- Progress ROM: ER ~30° (week 5), ~45° (week 6), then ~75% of the other side by ~8 weeks; flexion toward full; progress abduction. Posterior: gradually restore IR and controlled cross-body adduction after ~6 weeks. Avoid the end-range apprehension/at-risk position until ~6 weeks.
- Begin light rotator cuff and periscapular strengthening (Theraband ER/IR in neutral, scapular retraction, prone rows/extension); rhythmic stabilization.
- Goal: full passive ROM by ~9–10 weeks.
Phase 3 · Weeks 8–14 (Strengthening)
- Progress to full active ROM, including ER at 90° abduction as tolerated (target full AROM by ~12 weeks).
- Progressive isotonic rotator cuff, deltoid, and periscapular strengthening; dynamic stabilization and proprioception; PNF; endurance; closed-chain work.
- Criteria to advance: full pain-free ROM, good dynamic stability, no apprehension, emerging strength symmetry.
Phase 4 · Months 3–6 (Advanced & Return to Sport)
- Advanced strengthening and plyometrics; sport-specific and interval programs; gradual return to overhead, contact, and collision activity.
- Return-to-sport criteria: full pain-free ROM, strength ≥90% of the other side, no apprehension, and sport-specific/functional testing passed.
- Typical return ~4.5–6 months for non-contact; contact/collision and overhead athletes are often 6+ months (up to ~9 for high-demand). Criterion-based, not calendar-based.
References
- The American Society of Shoulder and Elbow Therapists' Consensus Rehabilitation Guideline for Arthroscopic Anterior Capsulolabral Repair of the Shoulder. J Orthop Sports Phys Ther, 2010.
- Rehabilitation Following Posterior Shoulder Stabilization. Int J Sports Phys Ther / PMC.
- Rehabilitation Protocol for Bankart Repair. Massachusetts General Hospital.
- Return to Sport After Arthroscopic Treatment of Posterior Shoulder Instability. PubMed.
Built from current published guidance for anterior and posterior capsulolabral (instability) repair. SLAP/superior labral repair is intentionally excluded and follows a separate protocol.