This is a generalized protocol and may need modifications. We recommended you perform these exercises under the supervision of your physiotherapist and also stick to your surgeon’s advice.

Phase 1: (1-3 weeks) Goals
  • Restore non-painful range of motion (ROM)
  • Retard muscular atrophy
  • Decrease pain/inflammation
  • Improve postural awareness
  • Minimize stress to healing structures
  • Independent with activities of daily living (ADLs)
  • Prevent muscular inhibition
  • Wean off sling
  • Care should be taken with abduction (with both active range of motion (AROM) and passive range of motion (PROM) to avoid unnecessary compression of subacromial structures
  • Creating or reinforcing poor movement patterns, such as excessive scapulothoracic motion with upper extremity elevation, should be avoided.
Range of Motion:
  • PROM (non-forceful flexion and abduction)
  • Active assisted range of motion (AAROM)
  • AROM
  • Pendulums
  • Pulleys
  • Cane exercises
  • Isometrics: scapular musculature, deltoid, and rotator cuff as appropriate
  • Cryotherapy
Criteria for progression to phase 2:
  • Full active and passive ROM
  • Minimal pain and tenderness
Phase 2: Intermediate Phase (3-6 Weeks) Goals:
  • Regain and improve muscular strength
  • Normalize arthrokinematics
  • Improve neuromuscular control of shoulder complex
  • Initiate isotonic program with dumbbells
  • Strengthen shoulder musculature- isometric, isotonic (theraband internal and external rotation in 0 degrees abduction), Proprioceptive Neuromuscular Facilitation (PNF)
  • Strengthen scapulothoracic musculature- isometric, isotonic, PNF
  • Initiate upper extremity endurance exercises
Manual Treatment:
  • Joint mobilization to improve/restore arthrokinematics if indicated
  • Joint mobilization for pain modulation
  • Cryotherapy
  • Electrical stimulation – inferential current to decrease swelling and pain (as indicated and/or needed)
Criteria for Progression to Phase 3:
  • Full painless ROM
  • No pain or tenderness on examination
Phase 3: Dynamic (Advanced) Strengthening Phase: (6 weeks and beyond) Goals:
  • Improve strength, power, and endurance
  • Improve neuromuscular control
  • Prepare athlete to begin to throw, and perform similar overhead activities or other sport specific activities
Emphasis of Phase 3:
  • High speed, high energy strengthening exercises
  • Eccentric exercises
  • Diagonal patterns
  • Continue dumbbell strengthening (rotator cuff and deltoid)
  • Progress theraband exercises to 90/90 position for internal rotation and external rotation(slow/fast sets)
  • Theraband exercises for scapulothoracic musculature and biceps
  • Plyometrics for rotator cuff
  • PNF diagonal patterns
  • Isokinetics
  • Continue endurance exercises