Recovering from any surgical procedure requires the patient to take a proactive role. In this article, we are going to talk about the Bankart protocol for recovering after anterior shoulder instability surgery.
Goals & Guidelines:
With stabilization surgeries, we focus on isometric strengthening and progress to isokinetic and then functional strengthening. The emphasis is not initially on range of motion as much as it is with other surgeries given that the goal is to tighten up the shoulder. Shoot for about 75% of normal range of motion by about 3-4 months. The protocol focuses on the operative arm but please also work on core strength and conditioning for total rehabilitation of the athlete. Patients are in an immobilizer/sling for 6 weeks. While sleeping, the arm should be kept in the plane of the body with pillows or blankets under the operative elbow. The patient is allowed to use the operative arm for waist level and midline activities such as personal hygiene care but is to do no lifting, pushing or pulling with the arm. The degree of allowed ER for these waist level activities is dictated by postoperative time and is delineated below. No combined ER and abduction until 6 weeks. Teach patient how to perform proper axillary hygiene by bending over at the waist (like doing pendulum exercises).
0 – 2 Weeks
- Start scapular depression, retraction, protraction and elevation.
- Start IR, ER and abduction isometrics
2 – 4 Weeks
- Supine Active Assisted Forward Elevation (SAAFE) to 120° and External Rotation with stick limited to 30°.
4 – 6 Weeks
- Start sub-maximal 4 Way Theraband Strengthening exercises.
- Increase ER to 45°.
- Increase FE to 140°.
6 – 8 Weeks
- Start Active Range of Motion in all planes except for combined abduction and ER
- Increase 4 Way Shoulder Theraband Strengthening
8 – 12 Weeks
- Patient may perform combined ER and abduction actively. Increase ER stretches of the abducted arm as tolerated.
- Begin more aggressive periscapular strengthening exercises that focus on the inferior trap and rhomboids by performing lower rows and seated rows
- Rhythmic Stabilization with Bodyblade beginning with patient’s arm at 90°. Progressions can include increase in tempo and position. Further progression would be into a PNF pattern avoiding abduction and ER.
- At 10 weeks, full active motion is encouraged again not pushing the abduction ER
- Start more aggressive strengthening exercises at 10 weeks for deltoid and rotator cuff. Avoid behind the neck lat pull downs and military presses. No heavy lifting. Do not strengthen to the point of fatigue.
12 – 16 Weeks
- Push-up into wall with ball under uni-lateral hand focusing on scapular retraction. Progress to stability ball on a table while performing a push-up then. Progress to stability ball on the floor. Do not forget to set shoulder blades into the correct position.
- Continue Bodyblade endurance and proprioceptive exercises
16 – 20 Weeks
- Continue to increase the intensity of the strengthening exercises
- May start throwing program for overhead athletes.
24 Weeks
- Return to unrestricted activity
