Isolated Biceps Tenodesis: SMOG Rehab Protocol

Accelerated rehabilitation is dependent on patient having intraoperative findings of good bone and tendon quality. Poor quality requires reverting to a traditional rehabilitation protocol

Overriding tenet is that patient may progress as tolerated as long as they do not experience pain during or immediately after exercising

Phase 1: Immediate postoperative period (weeks 0-1)

• Maintain / protect the integrity of repair
• Gradually increase AROM
• Diminish pain and inflammation
• Prevent muscular inhibition
• Become independent with modified ADLs

• Maintain arm in Shoulder Immobilizer for comfort. Can remove as tolerated for exercises or ADL’s
• No sudden jerking motions
• Keep incision clean and dry

Criteria for Progression to Phase 2
• Active forward flexion to full
• Active ER to full
• Active IR to full
• Active abduction to full in the scapular plane

Days 1 to 6
• Shoulder Immobilizer for comfort
• Pendulum exercises
• Finger, wrist, and elbow AROM without weights
• Begin scapula musculature isometrics / sets; cervical ROM
• Cryotherapy for pain and inflammation

Days 3 to 6
• Begin pulley exercises in forward flexion and abduction without restrictions
• Maintain proper posture, joint protection, positioning and hygiene
• Begin table slides.

Days 7 to 28
• Continue with Shoulder Immobilizer at night and day for comfort only
• Pendulum / pulley exercises
• Begin AROM to tolerance. No weight restrictions but must avoid rapid acceleration activities and / or loading of biceps
• ER in scapular plane
• IR in scapular plane
• Continue elbow, wrist, and finger AROM / resisted
• Maximal isometrics for all cuff, periscapular, and shoulder musculature
• Cryotherapy is needed for pain control and inflammation
• May resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin one week postoperative

Phase 2: Protection and active motion (weeks 1-6)

• Allow healing of soft tissue
• Do not overstress healing tissue
• Full AROM
• Dynamic shoulder stability
• Gradual restoration of shoulder strength, power, and endurance
• Optimize neuromuscular control
• Gradual return to functional activities
• Decrease pain and inflammation

• No sudden jerking motions

Criteria for progression to Phase 3
• Full AROM

Weeks 3-4
• Discontinue Shoulder Immoilizer
• Continue Cryotherapy as needed
• Gradually improve AROM
o Flexion and elevation in the plane of the scapula
o Abduction to full
o External / Internal rotation to full
o Extension to tolerance
• May use heat before ROM exercises
• Ice after ROM exercises
• Aquatherapy OK for AROM exercises

Weeks 5-6
• Continue AROM and stretching exercises
• Continue rotator cuff isometrics
• Continue periscapular exercises
• Gradually improve AROM
o Flexion and elevation in the plane of the scapula to full
o Abduction to full
o External / Internal rotation to full
o Extension to tolerance

AAROM = active assisted range of motion
ADL = activity of daily living
AROM = active range of motion
ER = external rotation
IR = internal rotation
PROM = passive range of motion
ROM = range of motion

Phase 3: Advanced strengthening (weeks 7-12)

• Maintain full non-painful AROM
• Advance conditioning exercises for enhanced functional use
• Improve muscular strength, power and endurance
• Gradual return to full activities

Week 7
• Continue ROM and self-capsular stretching for ROM maintenance
• Continue progression of strengthening
• Advance proprioceptive, neuromuscular activities
• Light sports (golf chipping / wedges, tennis ground strokes) if doing well
• Continue strengthening and stretching
• Continue stretching if motion is tight
• Initiate interval sports program (e.g., golf, doubles tennis) if appropriate