SLAP Repair Protocol

Phase 1 Goals: This phase focuses on diminishing pain, promoting limited joint motion to prevent the negative effects of immobilization while protecting the repair, and promoting recruitment of the shoulder musculature.

Week 0-2:

  • Sling for 4 weeks; sleep in sling for 4 weeks (come out for HEP 2-3 x day)
  • Continuous use of cryotherapy/modalities for pain and swelling control
  • Wrist and hand ROM/hand gripping exercises
  • Submaximal, subpainful deltoid and RC isometrics all directions
  • Passive and gentle AAROM exercise in supine
    • Flexion to 60-75° week 1; to 90° week 2
    • Abduction forward of scapular plane to 60°
    • ER to 10°-15° in scapular plane
    • IR to 45° in scapular plane
    • No active Extension, Abduction or ER

Precautions: NO Biceps contractions/elbow flexion exercises
                     No rotating the arm outward or holding objects in the hand over 2 lbs.

Week 3-4:

  • Discontinue sling at 4 weeks
  • Continue gentle PROM and AAROM exercises
    • Flexion to 110°
    • Abduction 75°-85°
    • ER in scapular plane to 25°-30°
    • IR in scapular plane to 55°-60°
  • Initiate rhythmic stabilization drills and proprioception training
  • Continue isometrics and cryotherapy
  • Scar massage at week 4 based on patients’ tolerance and tissue healing constraints

Precautions: NO Biceps strengthening or holding objects in hand over 2 lbs.
                     No active extension or elevation, limit ER to restrictions

Week 5-6:

  • Gradually improve ROM
    • Flexion to 145°
    • ER at 45° abduction: 45-50°
    • IR at 45° abduction: 55-60°
  • May initiate gentle IR/ER RANGE OF MOTION at 90° abducted position (in scapular plane)
  • Initiate tubing IR/ER, start tubing row to 0°
  • PNF light manual resistance
  • Initiate active shoulder abduction
  • Initiate prone row, prone extension to 0°, and prone horizontal abduction

Precautions: NO Biceps Strengthening

Phase 2 Goals: This phase focuses on restoring full ROM (week 10), preserve the integrity of the repair, restore muscular strength and balance, and normalize joint Kinematics.

Week 7-9:

  • Gradually progress ROM
    • Flexion to 180°
    • Horizontal abduction at 120°
    • ER to 90° abduction: 90-95°
    • IR at 60° abduction: 55-70°
  • Continue to progress isotonic strengthening program
  • Start light biceps work against gravity only with light resistance added over 6 weeks
  • Initiate Throwers Ten Program (except 90/90 ex.)

Week 10-12:

  • Initiate slightly more aggressive strengthening
    • Mod/high velocity IR/ER isokinetics at modified neutral
  • Progress ER to throwers motion (depends on individual)
    • ER at 90° abduction to 100-110°
  • Continue stretching (emphasis on horizontal adduction, IR) and capsular stretches

Phase 3 Goals: This phase focuses on establishing and maintaining full ROM, improving muscular strength, power and endurance and gradually incorporate functional activities.

Week 12-14:

  • Initiate strengthening in 90/90 position
    • Prone LR, tubing MR, tubing LR, etc.
  • Initiate bilateral plyometrics program (plyoballs, two handed throwbacks, etc)

Week 14-16:

  • Continue capsular stretching
  • Maintain throwers motion (especially ER)
  • Continue strengthening exercises
    • Throwers Ten Program
    • PNF manual resistance
    • Endurance Training (UBE, Bodyblade)
    • Initiate Unilateral plyometrics program (ball on wall, plyoball throwbacks, etc)
  • Restricted sport activity (light swimming, half golf swings)

Week 16-20:

  • Continue to progress strengthening
    • Low/Mod IR/ER isokinetics at modified neutral
    • Mod/High IR/ER isokinetics at 90/90 abduction
  • Continue manual resistance exercises
  • Continue Throwers Ten and other shoulder strengthening exercises
  • Continue Plyometric Program
  • Initiate Interval Sport Program (i.e. Interval Throwing Program)

Phase 4 Goals: This phase focuses on enhancing muscular strength, power and endurance, progressing functional activities, and maintaining shoulder mobility.

Weeks 20-26:

  • Continue strengthening program with emphasis on power (isotonic, manuals, isokinetics)
  • Continue flexibility exercises
  • Progress interval sport program

Phase 5 Goals: This phase incorporates a gradual return to sport activities, maintaining full strength, mobility, and stability of the shoulder.

Month 6-9:

  • Gradually progress sport activities to unrestrictive participation
  • Mound throwing program initiated at 26 weeks (6 months/2 weeks)
  • Continue with comprehensive posterior shoulder stretching
  • Continue with comprehensive RC/shoulder strengthening maintenance program