PT Protocols

Posterior Bankart Repair/ Posterior Capsular Plication

Phase I: Immediate post-operative phase (Restrictive motion)

Goals:

  • Protect the anatomic repair
  • Prevent negative effects of immobilization
  • Promote dynamic stability
  • Decrease pain and inflammation

Weeks 0 to 4

  1. Sling for 4 weeks in ER
  2. Sleep in immobilizer for 4 weeks
  3. Elbow and hand ROM exercises
  4. Hand gripping exercises
  5. ***No active IR or adduction
  6. Cryotherapy, modalities as indicated

Week 4

  1. Discontinue sling at 4 weeks
  2. May use immobilizer for sleep
  3. ROM exercises (PROM and AAROM)
    1. Flexion to 90-110 in scapular plane
    2. Abduction to 75-85
    3. ER in scapular plane to 30
    4. No IR
  4. No active IR, adduction, or elevation
  5. Continue isometrics, modalities and cryotherapy

Weeks 4 to 6

  1. Gradually improve ROM, begin AROM in all planes at 4 weeks
    1. Flexion:140
    2. ER at 45 degrees abduction: 25-30
    3. IR to 20 with arm at side
  2. Initiate exercise tubing ER (arm at side)
  3. PNF manual resistance

Phase II: Intermediate phase (Moderate protection)

Goals:

  • Gradually restore full ROM
  • Preserve the integrity of the surgical repair
  • Restore muscular strength and balance

Weeks 7 to 9

  1. Gradually progress ROM
    1. Full flexion
    2. ER at 90 abduction: 45-70
    3. IR at neutral to belly
    4. Begin IR in 30 deg abduction to 30
  2. Progress isotonic strengthening program
  3. PNF strengthening
  4. ****Protect posterior repair

Weeks 10 to 14

  1. Slightly more aggressive strengthening
  2. Continue all stretching exercises
  3. ***Progress ROM to functional demands
  4. Progress IR motion in abducted position.
  5. May begin to increase IR at 90 deg of abduction (12 weeks)
  6. ****Protect posterior repair

Phase III:  Minimal protection phase

Goals:

  • Establish and maintain full ROM
  • Improve muscular strength, power and endurance
  • Gradually initiate functional activities

Criteria to enter phase III:

  1. Full pain-free ROM
  2. Satisfactory stability
  3. Strength improving
  4. No pain or tenderness

Weeks 15 to 18

  1. Continue all stretching exercises
  2. Progress IR as tolerated
  3. Continue strengthening exercises
    1. Fundamental throwing exercises
    2. PNF manual resistance
    3. Endurance training
    4. Initiate light plyometrics
    5. Light swimming

Weeks 18 to 21

  1. Continue all above exercises
  2. Initiate ITP

Phase IV:  Advanced strengthening phase

Goals:

  • Enhance strength, power and endurance
  • Progress functional activities
  • Maintain shoulder mobility

Criteria to enter phase IV:

  1. Full pain-free ROM
  2. Satisfactory static stability
  3. Strength 75-80% of contralateral side
  4. No pain or tenderness

Weeks 20 to 24

  1. Continue flexibility exercises
  2. Continue isotonic strengthening program
  3. PNF manual resistance patterns
  4. Plyometric strengthening
  5. Progress ITP

Phase V: Return to activity phase (6 to 9 months after surgery)

Gradually progress sport activities to unrestricted participation