0 – 2 Weeks
- Pendulum and Active ROM elbow and hand exercises only
2 – 4 Weeks
- Passive Supine Forward Elevation and Passive External Rotation exercises may be performed by a therapist or family member or using the opposite arm to raise the operative arm. It is imperative that the patient and family member understands the therapy protocol and is able to demonstrate that he/she can perform the exercises, as they are responsible for performing these at home. Ten reps of each exercise is done one time per day. Stress to the patient that there should be no active use of the operative shoulder with these exercises…it is being passively stretched only.
- Start working on scapular stabilization for protraction, retraction, elevation and depression.
4 – 6 Weeks
- Start Supine Active Assisted Forward Elevation (SAAFE)
- Start table slides
6 – 8 Weeks
- Start internal rotation stretching behind the back. It is easy to teach the patient how to use a belt or towel in the nonoperative arm to pull the operative arm up their back. Pulleys can also be used for this.
- Supine Active Forward Elevation (SAFE).
- Start using pulleys for forward elevation.
8 – 12 Weeks
- Start Active forward elevation using good mechanics. Set the shoulder blades by retracting them first. Make sure the patient is not using any trapezial substitution. These should be performed with the thumb up.
- Progress to Wall Slide into Scaption (using the wall as a support).
- Progress to Active Range of Motion in abduction, and scaption with the elbow flexed to decrease the moment arm for the deltoid and RC. If minimal to no soreness and no substitution patterns are seen you may begin strengthening with theraband.
- If good form and mechanics are observed you may begin Standing Overhead Reach.
- Progress to light dumbbell strengthening
12 – 16 Weeks
- Continue more strengthening focusing on deltoid and RC and periscapular strengthening, resisted abduction in scapular plane, and neuromuscular control.
- Continue stretching which can be more aggressive at this point.
16 – 20 Weeks
- Strengthening can include light bench press (being careful not to extend the shoulder). Dumbbell bench on the floor can minimize this extension. Can start lat pulls and seated rows.
- Once good strength is obtained, sport specific exercise such as concentric and eccentric resisted throwing, rebounder throwing, swimming and ground strokes can be started.
- Golfers can start swinging a golf club and work on swing mechanics
- Emphasize proper mechanics for the patient’s desired activities (golf, overhead throwing, etc.)
20 Weeks
- May return to sport and other activities.
