SLAP (Superior Labrum Anterior to Posterior) repair surgery is a common shoulder procedure to reduce pain and improve range of motion. In this article, we are going to talk about the recovery goals and guidelines after SLAP repair.
Goals and Guidelines:
The goals of the labral repair are to regain full range of motion of the operative shoulder while emphasizing both static (ligamentous) and dynamic (muscular) stability for a pain-free return to activity or sport. If the patient is an overhead athlete, then focusing on lower extremity strength, flexibility, and core stabilization are vital components inability to return to sport. Overhead activities such as the serve in tennis, throwing a baseball or football, or swinging a golf club involves the funneling of energy from the feet, through the legs, pelvis, trunk, into the shoulder, through the elbow out of the hand. The patient will usually begin therapy within 3-5 days after surgery.
For the first couple weeks, most patients are more comfortable sleeping in their sling and a recliner but they may move to a bed when comfortable. While sleeping in bed, the patient is to place a pillow or a stack of blankets under the elbow and arm of the operative extremity in order to have the arm/shoulder in the plane of the body (extension of the shoulder is both painful and stresses the repair). Therapists should teach patient how to perform proper axillary hygiene by bending over at the waist (like doing pendulum exercises).
0-2 weeks
- Immediately start Pendulums when comfortable, start Supine Active Assisted Forward Elevation (SAAFE), and External Rotation With Stick. It is imperative that the patient understands the exercises and are able to demonstrate that they can perform the exercises properly, as they are responsible for performing these at home. Stretching exercises should be performed once a day.
- All ranges of motion should be taken to tolerance and focus on long slow stretches with appreciable gains being realized each week.
2-4 weeks
- Begin scapular depression, retraction, protraction and elevation.
- Start IR, ER and abduction isometrics
- Start Functional Internal Rotation using a towel or belt to pull the operative arm up behind the back.
4-6 weeks
- Patient may begin sub-max 4 Way TheraBand Strengthening
6-8 week
- May begin posterior capsule stretching at this point. Joint Mobilizations to stretch the posterior capsule may be appropriate to prevent or address glenohumeral Internal Rotation Deficit (GIRD) leading to SLAP tears.
- Start Active Range of Motion in all planes (flexion, scaption, abduction) for deltoid strengthening.
8-12 weeks
- Begin more aggressive peri-scapular strengthening exercises that focus on the inferior trap and serratus anterior strengthening. TVA’s exercises– named because of the position the arms are in when performing the exercises (T=prone horizontal Abduction, V=MMT position for inferior trap—focus on scapular depression and retraction during the movement, A= the patient is prone with arms straight and in 30º-45º of abduction, focus on scapular retraction and depression.
- Rhythmic Stabilization beginning with patient’s arm in 90° of flexion and manual resistance given by the therapist in different planes and with different resistances. The patient’s goal is to try and prevent the therapist from moving his/her arm. Progressions can include increase in tempo and resistance. Further progression would be into a PNF pattern. Progress to standing and move into flexion, scaption, abduction and PNF patterns.
12-16 weeks
- Start more sport specific or work hardening rehab.
- Work on neuromuscular control with body blade (sagittal plane, scapular plane, frontal plane, internal rotation, external rotation at waist level progressing to 90° of abduction, then to a PNF pattern)
- Internal and external rotation plyometrics with trampoline/rebounder
16-20 weeks
- Gradual return to sport. If the sport requires overhead throwing then the patient should follow the throwing program.
