Labral Repair Protocol

Phase 1: MAXIMAL PROTECTIVE PHASE (Weeks 0-6)

Goals:

  • Protect anatomy of the repair
  • Decrease pain and inflammation
  • Promote dynamic stability
  • Retard muscle atrophy

Precautions:

  • No active abduction, external rotation, or extension
  • No isolated biceps lifting without weight
  • Sling may be discontinued as pain permits

Exercises:

  • Pendulums
  • Self-PROM/AAROM in Flexion to tolerance
  • Self-PROM/AAROM in External Rotation to Neutral
  • Scapular, Shoulder and Rotator Cuff Isometrics
  • Elbow, Wrist, Hand AROM
  • Modalities as needed

PHASE 2: INTERMEDIATE PHASE-MODERATE PROTECTION PHASE (Weeks 6-10)

Goals:

  • Decrease pain and inflammation
  • Restore full PROM and AROM
  • Gradual increase in strength

Precautions:

  • Patients are not allowed to lift weight above the shoulder
  • Patients should not lift > 5 pounds

Early Intermediate Phase (Weeks 5-7)

  • Gradually progress P/AROM
    • Flexion, Elevation in plane of Scapula to tolerance
    • Abduction to 145°
    • External Rotation to 45-50° at 45° Abduction
    • Internal Rotation to 55-60° at 45° Abduction
    • Extension to Tolerance
  • Initiate gentle rhythmic stabilization exercises
  • Initiate proprioceptive exercises
  • Initiate Rotator Cuff strengthening with arm in neutral
  • Strengthening exercises for the hand, wrist, elbow and scapular musculature
  • Modalities as needed

Late Intermediate Phase (Weeks 8-14)

  • Gradually progress P/AROM
    • Flexion, Elevation in plane of Scapula and Abduction to 180°
    • External Rotation to 90-95° at 90° Abduction
    • Internal Rotation to 70-75° at 90° Abduction
    • Extension to Tolerance
    • Continue distal Upper Extremity and scapular strengthening
  • Continue rhythmic stabilization
  • Initiate shoulder strengthening exercises with weights/Thera-band progressing as tolerated
  • Initiate “Throwers Ten” program
  • Modalities as needed

Criteria for progression to Phase III

  • Full non-painful ROM
  • Good stability
  • Muscular strength, 4/5 or better
  • No pain or tenderness

PHASE 3: MINIMAL PROTECTION PHASE (Weeks 14-20)

Goals:

  • Maintain full, non-painful ROM
  • Improve shoulder strength, power, and endurance
  • Improve neuromuscular control
  • Gradual return to functional activities

Early Minimal Protection Phase (Weeks 14-16)

  • Continue all stretching exercises (capsular strengthening)
  • Maintain thrower’s motion (especially external rotation)
  • Continue rotator cuff, shoulder and periscapular strengthening exercises
  • Resisted PNF exercises
  • Endurance training
  • Initiate light plyometric exercises
  • Restricted sports activities (light swimming, half golf swings)

Late Minimal Protection Phase (Weeks 16-20)

  • Continue all strengthening exercises
  • Continue all stretching and flexibility exercises
  • Continue “Thrower’s Ten” program
  • Continue plyometric program
  • Initiate interval sports program (e.g. throwing)

Criteria for Progression to Phase III

  • Full non-painful ROM
  • Satisfactory static stability
  • Muscular strength 75-80% of contralateral side
  • No pain or tenderness

PHASE 4: ADVANCED STRENGTHENING PHASE (Weeks 14-20)

Goals:

  • Enhance shoulder strength, power and endurance
  • Maintain shoulder stability
  • Progress functional activities

Weeks 20-26:

  • Continue flexibility exercises
  • Continue isometric strengthening exercises
  • PNF manual resistance patterns
  • Plyometric strengthening
  • Progress interval sports programs

PHASE 5: RETURN TO ACTIVITY PHASE (Months 6-9)

Goals:

  • Gradually progress sports activities to unrestrictive participation
  • Continue strengthening and stretching program

Early Advanced Strengthening Phase (Weeks 10-12)

  • Continue exercises above
  • Advance strengthening exercises including empty can as tolerated
  • General conditioning program

Late Advanced Strengthening Phase (Weeks 12-Discharge)

  • Continue all strengthening exercises
  • Continue all flexibility exercises
  • Gradual progression of functional activities per patient needs