Shoulder Labral Repair Rehab Protocol

Arthroscopic capsulolabral repair; excludes SLAP/superior labral repair — therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 7 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

After hours & emergency numbers → Weekdays, business hours.

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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.

Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.