Shoulder instability surgery can significantly improve pain levels and mobility in patients. In this article, we are going to explain the bankart recovery protocols following a posterior shoulder instability procedure.
Goals and Guidelines:
With shoulder stabilization surgeries, we focus and 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 as 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 will be in an immobilizer/sling for 6 weeks after surgery. 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
0-2 weeks
- No specific therapy
2-6 weeks
- Start scapular depression, retraction, protraction and elevation.
- Start ER and abduction isometrics. NO INTERNAL ROTATION
- Start Supine Active Assisted Forward Elevation (SAAFE) with FE no greater than 140°.
- Start External Rotation with stick to 40°.
6-12 weeks
- Transition from SAAFE to SAFE during the first 2 weeks and then progress to active ROM in all planes. No specific posterior capsular stretching until 8 weeks post op.
- Start 4 Way Theraband Strengthening
- At 8 weeks, start deltoid strengthening performing lateral and front raises and 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. Progress to standing and move into flexion, scaption, abduction and PNF patterns.
- At 10 weeks, start more aggressive strengthening exercises. Avoid behind the neck lat pull downs and military presses. Start TVA’s and 6 Pack Back periscapular strengthening exercises. Do not strengthen to the point of fatigue. Once the muscles are fatigued, they can no longer provide dynamic stability and the patient thus relies more on the static restraints that were just repaired.
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 your shoulder blades into the correct position.
- May start light bench press, more aggressive deltoid strengthening and lat pulls in front of body
16-20 weeks
- Continue to increase the intensity of the strengthening exercises
- May start throwing program for overhead athletes.
24 weeks
- Return to sport
