RESTRICTIONS:

• NO shoulder motions for 6 weeks
• NO upper body weighted exercises for 3 months
• NO heavy pressing exercises (e.g. bench press) for 6 months

Phase I: Protection and Early Passive Motion (Weeks 0–6)

Primary Goals

• Protect tendon repair
• Control pain and inflammation
• Initiate safe, limited passive motion
• Maintain mobility of adjacent joints

Precautions

• Sling (without adduction pillow): worn continuously for ~6 weeks
• No active shoulder motion except for gentle pendulums
• Avoid abduction and external rotation beyond prescribed limits
• No lifting, pushing, pulling, or weight bearing

Interventions

Pain & Edema Management

• Cryotherapy 15–20 min, 2–3×/day
• Patient education on posture and sling positioning

Passive Range of Motion (PROM) 

• Forward elevation: gradual progression to ~90° by week 6
• External rotation: limited to ≤15° in neutral
• Abduction: limited to ≤45°
• Internal rotation: to chest/abdomen only
• Gentle pendulums (small arc)

Distal and Scapular Mobility

• Elbow, wrist, and hand AROM
• Scapular retraction/depression
• Cervical mobility and posture training

Criteria to Progress to Phase II

• Pain controlled (≤3/10 at rest)
• PROM within prescribed limits without guarding
• Intact repair (no signs of excessive strain)

Phase II: Active Motion and Early Strengthening (Weeks 6–12)

Primary Goals

• Gradually restore active shoulder motion
• Initiate gentle muscle activation without stressing repair
• Maintain scapular control and proper movement patterns

Precautions

• Avoid resisted horizontal adduction, IR, or pressing motions
• Limit ER and abduction progression to tolerance
• No lifting >1–2 lb initially
• Avoid stretching into pain

Interventions

AAROM → AROM Progression

• Supine → seated → standing progression
• Forward elevation and scaption within tolerance
• Gradual restoration of ER and abduction (controlled)

Early Strengthening

• Submaximal isometrics:
  • Deltoid (flexion, abduction)
  • Rotator cuff (ER emphasis)
• Avoid direct pec activation early
• Begin light theraband exercises (ER, scapular stabilizers)

Scapular Stabilization

• Serratus anterior activation (wall slides, punches)
• Prone “T” and “Y” (light resistance)
• Emphasis on posterior chain strength

Criteria to Progress to Phase III

• Full or near-full AROM without pain
• No anterior shoulder tightness or repair irritation
• Strength ≥4/5 in surrounding musculature
• Good scapulohumeral mechanics

Phase III: Strengthening and Functional Return (Weeks 12–24+)

Primary Goals

• Gradually restore pectoralis major strength
• Improve upper extremity power and endurance
• Return to work, sport, and lifting activities

Precautions

• Avoid aggressive pec loading (e.g. heavy bench press) until ≥6 months.
• Gradual progression with pressing and horizontal adduction
• Avoid sudden eccentric overload

Interventions

Progressive Strengthening

• Initiate light isotonic pec activation:
  • Isometrics → light bands → light weights
• Gradually introduce:
  • Horizontal adduction
  • Internal rotation strengthening
• Progress to compound movements:
  • Chest press (machine → free weights)
  • Push-ups (wall → incline → floor)

Dynamic Stability and Endurance

• Closed-chain progression
• Perturbation training
• High-rep, low-load endurance work

Functional / Sport-Specific Training

• Gradual return to lifting and athletic activity
• Bench press progression (light → moderate load)
• Sport-specific drills when appropriate

Criteria for Discharge / Return to Activity

• Full, pain-free ROM
• Strength ≥90–95% of contralateral side
• No pain with resisted horizontal adduction
• Successful functional testing (lifting, pushing)

Avoid max effort single rep bench press indefinitely unless willing to risk a retear. At 6 months may return to heavy, but sub-max effort bench press.