Rehabilitation after Arthroscopic Posterior Bankart Repair

Phase 1: 0 to 2 weeks after surgery

POSTOPERATIVE INSTRUCTIONS

You will wake up in the operating room. A sling and an ice pack will be in place. You will go to
the recovery room and generally will be discharged after 1-2 hours. You can get out of bed when
you wish. Apply ice to the shoulder to reduce pain and swelling. You may remove the sling
whenever you wish and gently move the elbow, wrist and fingers. Follow Dr. Gill’s instructions
regarding moving your shoulder after surgery.

GOALS:
1. Control pain and swelling
2. Protect the repair
3. Begin early shoulder motion

ACTIVITIES WHEN YOU GO HOME:

1. Apply ice to the shoulder as tolerated to reduce pain and swelling. You can change the
dressing to a smaller one to allow the cold therapy to reach the shoulder.
2. Remove the sling on the first day after surgery.
Move your elbow, fingers and hand several times a day.
3. Begin the pendulum exercise several times a day:

Pendulum exercise
Bend over at the waist and let the arm hang down. Using your body
to initiate movement, swing the arm gently forward and backward
and in a circular motion. Repeat for 2 to 3 minutes at a time.

4. Remove the outer dressing on the second day after surgery and shower. Leave the little
pieces of tape (steri-strips) in place. You can get the wound wet after 2 days in a shower, but do
not soak in a tub. To wash under the operated arm, bend over at the waist and let the arm
passively swing away from the body. It is safe to wash under the arm in this position.
5. You may use your hand on the operated arm as long as you do not raise the hand
above your head or reach across the front of your body. Also, do not reach your hand
behind you as if to tuck in your shirt or to loop your belt. You should bend your arm at
the elbow and use your fingers and hand, such as to reach up and touch your face. Keep
your elbow in front of you.
6. Call the doctor’s office for any concerns, including, but not limited to, severe pain, fevers,
chills or redness.

OFFICE VISIT: Please arrange to return to Dr. Gill’s office 7-14 days after surgery for
examination and further instructions.
 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Rehabilitation after Arthroscopic Posterior Bankart Repair

Phase One: 5 to 6 weeks after surgery

Goals:
• Gradual increase in ROM
• Improve strength
• Decrease pain/inflammation
• Protect the labrum repair

Activities:

1. Sling
The sling is no longer necessary.

2. Use of the operated arm

You may now carefully use your arm. Avoid having the arm forcefully pulled behind you
or across your chest in front of you. Continue to avoid heavy weight lifting or manual
labor. Follow any further instructions given to you by your doctor.

3. Precautions
You may use your hand on the operated arm as long as you do not raise the hand above
your head or reach across the front of your body. Also, do not reach your hand behind
you as if to tuck in your shirt or to loop your belt. You should bend your arm at the elbow
and use your fingers and hand, such as to reach up and touch your face. Keep your elbow
in front of you. Do not bear the weight of the body on your arm.

4. Ice
Use ice or cold as necessary 15-20 minutes.

STRETCHING / ACTIVE MOTION

Days per week: 7 Times per day: 1-3 Times per day: 1

Program: Theraband internal and external rotation:

Pendulum exercises (internal rotation to neutral only)
Supine External Rotation Standing forward flexion to 90° (scaption)
Hands-behind-head stretch Prone row
Standing external rotation stretch Prone extension
Supine forward flexion: Biceps curl
Limit 140º week 6 Sidelying external rotation

STRENGTHENING EXERCISES
Days per week: 7
 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Rehabilitation after Arthroscopic Posterior Bankart Repair

Phase Two: 7 to 12 weeks after surgery

Goals:
1. Protect the shoulder repair
2. Regain full range of motion
3. Continue gradual strengthening

Activities:
1. Use of the operated arm
You may now use your arm in a more normal fashion. You may move the arm into all
positions including behind the back if it is comfortable. Avoid having the arm forcefully
pulled behind you, pulled across the chest or bearing weight as if doing a push-up.
Continue to avoid heavy weight lifting or manual labor. Follow any further instructions
given to you by your doctor.

2. Precautions
Do not lift heavy objects overhead with the weight going behind the head. In other
words, keep objects in front of you where you can see them.

Exercise Program:

STRETCHING / RANGE of MOTION

Days per week: 7 Times per day: 1-2
STRENGTHENING / THERABAND
Pendulum exercises
External rotation @90° abduction stretch Days per week: 7 Times per day: 1
Wall slide Stretch External Rotation
Hands-behind-head stretch Internal Rotation
Standing external rotation stretch Standing Forward Punch
Standing Forward Flexion Shoulder Shrug
Behind the back internal rotation: starts after the
8th week after surgery Dynamic hug
Horizontal adduction stretch: starts after the 8th “W”’s
week after surgery
Seated Row
Biceps curl
 4

STRENGTHENING / DYNAMIC

Days per week: 7 Times per day: 1

Side-lying External Rotation

Prone Horizontal Arm Raises ‘T’s
Prone scaption ‘Y’
Prone row
Prone extension
Standing forward flexion “full-can” exercise
Rhythmic stabilization and proprioceptive
training drills with physical therapist
 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Rehabilitation after Arthroscopic Posterior Bankart Repair

Phase Five: 13-20 weeks after surgery onward

Goals:
1. Progression of functional activities
2. Maintain full range of motion
3. Continue progressive strengthening

Exercise Program:

STRETCHING / RANGE OF MOTION

Days per week: 5-7 Times per day: 1
Continue all exercises from phase 4

STRENGTHENING / THERABAND
Days per week: 3 Times per day: 1

Continue from phase 4

STRENGTHENING / DYNAMIC
Days per week: 3 Times per day: 1

Continue from phase 4

PLYOMETRIC PROGRAM
Days per week per physical therapist
May process weight bearing program:
• Ball on wall
• Pushup on unstable surface

WEIGHT TRAINING

Days per week per physical therapist

See weight training precautions section
Machine resistance (limited ROM):
Latissimus dorsi pull downs
Seated row

Seated bench press

 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Guidelines for Returning to Weight of the head, to the chest, with a medium(not
Training After Arthroscopic Labrum wide) grip.
Repair 2. Shoulder press overhead should be done
carefully, avoiding heavy weights. If doing
You should not return to training using shoulder presses, always start with the hand in
heavy weights or on weight machines until front of the shoulder and end overhead where
Dr. Gill determines that it is safe. In general, you can still see your hand. For persons using
it is usually safe to return to heavier weight barbells, this is the “military press”.
training at three to four months following 3. If bench pressing, your grip should be no wider
labrum repair. than the wider than the width of your shoulders.
Avoid any exercises using grips wider or
Before embarking on a weight-training narrower than shoulder width.
program, you should have full range of 4. Lateral deltoid raises should be avoided because
shoulder motion and normal strength in the of the impinging and wearing effect on the
rotator cuff and scapular muscles. The rotator cuff. Forward raises in the “thumb-up”
doctor or a physical therapist will test your position are usually safer and can be done with
motion and strength before you start weight reasonable weights. Lateral raises from the
training. prone or bent over position can be done as a
substitute for standing lateral deltoid raises.
When starting your weight-training program, 5. When doing incline bench press with barbells,
you can start with 3 sets of 15-20 repetitions. there is a danger of shoulder dislocation if the
Training with high repetition sets ensures lifter loses control of the bar when returning the
that the weights that you are using are not barbell to the rack of the incline bench. Always
too heavy. have a spotter for removing and replacing the
barbell in this exercise.
NEVER perform any weight training 6. If you are doing any type of “chest-fly”, keep in
exercise to the point of muscle failure. mind the following precautions.
“Muscle failure” occurs when, in performing Do not do any chest-fly exercise with straight
a weight training exercise, the muscle is no elbows. Always allow the elbows to bend and
longer able to provide the energy necessary never lower your hands (holding dumbbells)
to contract and move the joint(s) involved in below the level of your chest.
the particular exercise. Joint, muscle and 7. If you are using a “Pec-Deck” machine, never let
tendon injuries are more likely to occur the weight stretch the arms so that your elbows
when muscle failure occurs. pass behind your chin. You can set the arms on
this machine a few clicks forward to adjust the
The following weight training exercises maximum motion allowed.
should be avoided after Bankart repair for 8. If you a performing “dips” using a set of parallel
shoulder instability: bars, never lower yourself below the point where
1. Pull downs behind-the-neck (wide-grip) the elbows reach a 90-degree angle.
2. Behind-the-neck shoulder press 9. For triceps exercises, triceps pushdowns on a
3. Wide-grip bench press pulley system are safe as well as bent-over
4. Standing lateral deltoid raises triceps extensions.
5. Triceps press overhead 10. When doing the upright-rowing exercise, keep
your grip at least 12 inches apart. When pulling
The following exercises require special the bar upward toward the chin, do not raise the
cautions: bar higher than the point at which the elbow
1. Pull downs should only be done in front reaches shoulder level.
 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Exercises Usually Problem-Free

1. Biceps Curls
2. Cable and bent-over rowing
3. Shoulder shrugs

If your goal is returning to high-level weight

training or weight lifting, it will take 3 to 6
months of cautious, gradual progression to
return to top form. In general, avoid
increasing the amount of weight lifted by
more than 10-15% (at a time) of your present
working weight every 10-14 days.

Remember: Weight training is beneficial to

improve muscular strength and protect the
joints from injury. If done improperly by
using too much weight and/or improper
technique, weight training can cause serious
injury.
 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Rehabilitation after Arthroscopic Posterior Bankart Repair

Phase Four: 21-28 weeks after surgery onward

Goals:

1. Progression of functional activities

4. Maintain full range of motion
5. Continue progressive strengthening

STRETCHING / RANGE OF MOTION

Days per week: 5-7 Times per day: 1
Continue all exercises from phase 5

STRENGTHENING / THERABAND
Days per week: 3 Times per day: 1

Continue from phase 5

STRENGTHENING / DYNAMIC
Days per week: 3 Times per day: 1

Continue from phase 5

PLYOMETRIC PROGRAM
Days per week per physical therapist
May process weight bearing program:
• Rebounder’ throws with arm at side
• Wall dribbles overhead
• Rebounder throwing/weighted ball
• Deceleration drills with weighted ball
• Wall dribbles at 90°
• Wall dribble circles

WEIGHT TRAINING

Days per week per physical therapist

See weight training precautions section
Progress per MD instructions

INTERVAL SPORT PROGRAMS at 28 to 32 weeks

See individual programs for golf, tennis, swimming and throwing.

 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Post-op phase Sling Range of Motion Therapeutic exercises Precautions

Phase 1 Per MD No stretching 0-4 *Isometrics: ER, IR, No internal
0 to 4 weeks after surgery instructions. *Flexion to 120 weeks FLX, EXT, ABD rotation
Goals: Per MD degrees as tolerated
*Allow healing of instructions. *ER @ 0º to *Pendulum exercises *Rythmic stabilization No horizontal
repaired capsule. tolerance, for IR/ER, FLX/EXT adduction
*ER@ 90º to *Supine forward
*Initiate early protected and tolerance flexion with wand *Propriocetion drills No closed
restricted range of motion. *No IR behind back, chain positions
*No IR@90º, *Supine ER at *Ball squeeze
*Minimize muscular *No horizontal neutral No activities
atrophy. adduction *Elbow and forearm above head.
*Scapular retraction exercises
*Decrease with ER
pain/inflammation.
At 5-6 weeks: At 5-6 weeks:
IR in plane of *Side lying ER
5 to 6 weeks after surgery scapula: 30º At 5-6 weeks: *Prone row
Goals: Standing ERN *Prone extension
*Flexion to 120º as stretch * Standing forward
*Gradual increase in ROM tolerated flexion to 90º
*Biceps curl
*Improve strength
*Theraband exercises
*Decrease ER, IR (limit IR to
pain/inflammation neutral)

Phase 2 D/C *ER at 90º *Gradually improve Theraband exercises:, Gradual ROM
7 to 12 weeks after surgery
abduction to ROM all planes Continue phase1 for IR behind
tolerance (should Add Shrug, Dynamic back, IR at 90º
Goals: be 85-90º by *Rope and pulley: hug, ‘W’s. abduction and
*Gradually restore range of Biceps curl horizontal
week 8)
motion *Elevation in Row adduction
*Increase strength scapular plane Forward punch
*Shoulder flexion to
*Improve neuromuscular (serratus punch) No push-ups
tolerance (165 º by
control *Wall slide or pushing
week 8)
*Enhance proprioception Dynamic exercises: movements
and kinesthesia *IR behind back to PRE 1-3 lb as tolerated
*IR in plane of
beltline only Continue phase1
scapula: 60
Add:
*Horizontal *Side-lying scaption
*IR at 90º abduction
adduction reach only *Prone ‘T’s
to 30-45º week 10
*Standing scaption
Progress cautiously
*Hands behind-the- *Isotonic biceps curl
and gradually to 60-
head stretch *Prone ‘Y’s
65º by week 12
*ER @ 90º *Rhythmic stabilization
*ER @ 90º progress
abduction stretch
to 90° (110-115º for
*Propriocetion drills
throwers)
*Scapulohumeral
Rhythm exercises
 St. Elizabeth's Medical Center
Orthopedics Department
736 Cambridge Street Brighton, MA 02135
www.semc.org/ortho

Post-op Phase Therapeutic Exercises Return to Precautions

Sports
Phase 2 *Transition IR Not yet Continue to avoid
continued gradually from Theraband: add ‘T’s, excessive or
plane of diagonal up and down, forceful horizontal
scapula to External rotation at 90°, adduction and
coronal plane Internal rotation at 90° internal rotation

*Progress IR to Dynamic:
*Continue previous
60-65 degrees
*Initiate push-ups into wall at
at 90 degrees week 12 (then push-up
abduction by progression per MD)
week 12 *Emphasize muscle strength
of ER, scapular region

Phase 3 *Progress to *Continue theraband and Gradual return to See weight training
13-20 weeks after surgery full ROM dynamic exercises from recreational precautions.
*Side lying IR @ phase 1 and 2 activities
Goals: 90º limit 60 to 65º *Weight training can
* Progress to full ROM at week 12 and begin.
*Improve: full by week 20. *Machine resistance (limited
strength/power/endurance *Horizontal ROM):
*Improve neuromuscular control adduction stretch *Front pull downs
*Improve dynamic stability *IR behind *Seated row
*Improve scapular muscular back full *Seated bench press at week
strength
16
*May progress CKC program:
Ball on wall
Pushup on unstable surface
at 20 weeks

Phase 4 Full ROM Plyometric exercises: Interval sports Weight training

21-28 weeks after surgery onward *Rebounder throws arm at programs can precautions.
Goals: side begin between
Progressively increase activities to *Wall dribbles overhead 28-32 weeks. Shoulder brace
prepare patient for unrestricted *Rebounder throws with sometimes for
functional return weighted ball, Strength athletes collision sports.
*Decelerations, wall dribbles can gradually
at 90º resume regular
*Wall dribble circles training