Physical Therapy Protocol:

POSTERIOR LABRAL REPAIR

RESTRICTIONS:

• NO active motion for 4 weeks
• NO internal rotation beyond midline of body or reaching behind back for 6 weeks
• NO upper body weight exercises for 3 months

Phase I: Protect Labral Repair (Weeks 0–6)

Primary Goals:

• Protect healing posterior labral tissue
• Minimize pain and inflammation
• Maintain mobility in distal joints

Precautions:

• Sling with external rotation arc brace x6 weeks
• No internal rotation past midline of body or reaching behind back x6 weeks

Interventions:

Shoulder

• Gentle pendulums
• External rotation: to tolerance in scapular plane
• PROM scapular plane elevation; progress to 120 degrees

Pain & Edema Management

• Cryotherapy 15–20 min, x6/day for 2 weeks. As needed following weeks
• Postural education (avoid rounded shoulders)

Scapular and Distal Mobility

• AROM for elbow, wrist, and hand
• Scapular retraction/depression exercises

Criteria to Progress to Phase II

• Pain controlled (≤3/10 at rest)
• Passive elevation ≥120°, ER ≥30°

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

Primary Goals:

• Restore active shoulder motion with proper mechanics
• Initiate gentle rotator cuff and scapular strengthening
• Avoid posterior instability or excessive shear

Precautions:

• Avoid lifting >1–2 lb
• Avoid resisted internal rotation x12 weeks
• No upper body weighted exercises

Interventions:

Active-Assisted and Active Range of Motion

• Progress to AROM in gravity-reduced positions
• Supine → seated AAROM with pulley

• Emphasize isometric and eccentric control

Scapular Stabilization

• Prone and standing scapular retraction/protraction control
• Rhomboid, lower trapezius, and serratus anterior activation
  • Exercises: wall slides with resistance

Early Strengthening

• Begin submaximalisometrics: flexion, extension, ER, abduction in neutral
• Gentletheraband ER (at 0° abduction) once AROM pain-free
• Light deltoid activation (isotonics in supine progressing to seated)

Criteria to Progress to Phase III

• Full, pain-free AROM
• No trapezial substitution or scapular dyskinesis
• Strength ≥4/5 for rotator cuff and scapular stabilizers

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

Primary Goals:

• Restore full strength and endurance of rotator cuff and shoulder muscles
• Progress to overhead and functional activities
• Achieve pain-free performance of ADLs and recreational tasks

Precautions:

• Avoid overloading with fatigue or poor form
• No heavy posterior force weight training (e.g. max bench press) for 6 months

Interventions:

Progressive Strengthening

• Resistance bands → free weights
• ER/IR at 0°, progress to 90° abduction positions
• Scapular plane elevation, prone horizontal abduction, bent-over rows
• Closed-chain progression: wall push-ups → stability ball → floor

Endurance and Kinetic Chain Integration

• High-rep, low-load endurance work (15–20 reps)
• Incorporate trunk and lower extremity strength for kinetic chain contribution

Functional / Sport-Specific Drills

• Simulated ADLs, overhead reach tasks
• Gradual return to recreational activities (golf, swimming, etc.)

At 6 months no formal work or lifting restrictions.