Labrum/SLAP Repair: SMOG Rehab Protocol

Phase 1: Immediate postoperative period (weeks 0-6)

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

Precautions
• Maintain arm in Shoulder Immobilizer, remove only for exercise
• No shoulder AROM, lifting of objects, shoulder motion behind the back, excessive stretching or sudden movements, supporting of any weight, lifting a body weight by hands
• Keep incision clean and dry

Criteria for Progression to Phase 2
• Passive forward flexion to > 90°
• Passive ER to 10°
• Passive IR to 45°
• Passive abduction > 90° in the scapular plane

Days 1 to 6
• Shoulder Immobilizer
• 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 < 90°
• Maintain proper posture, joint protection, positioning and hygiene

Days 7 to 28
• Continue with Shoulder immobilizer at night and day for comfort
• Pendulum / pulley exercises
• Begin PROM to tolerance (done supine; should be pain free)
o Flexion to 90°
o ER in scapular plane to 25-30°
o IR in scapular plane to 55-60°
• Continue elbow, wrist, and finger AROM / resisted
• Submaximal 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 three weeks postoperative

Phase 2: Protection and active motion (weeks 6-12)

Goals
• Allow healing of soft tissue
• Do not overstress healing tissue
• Gradually restore full PROM (weeks 4-5)
• Decrease pain and inflammation

Precautions
• No lifting
• No supporting body weight with hands and arms
• No sudden jerking motions
• Avoid upper extremity bike and ergometer

Criteria for progression to Phase 3
• Full AROM

Weeks 5-6
• Discontinue Shoulder Immobilizer at night
• Between weeks 4-6, use Shoulder Immobilizer for comfort only
• Discontinue Shoulder Immobilizer at end of week 6
o Gradually improve PROM and AROM
o Flexion and elevation in the plane of the scapula to 145°
o Abduction to 145°
o External rotation 45-50° at 45° abduction
o Internal rotation 55-60° at 45° abduction
o Extension to tolerance
• Continue cryotherapy as needed
• May use heat before ROM exercises
• Aquatherapy OK for light AROM exercises
• Ice after exercise

Weeks 6-8
• Continue AROM, AAROM, and stretching exercises
• Begin rotator cuff isometrics – No empty can in forward plane
• Continue periscapular exercises
o Gradually progress PROM and AROM
o Flexion, elevation in the plane of the scapula
o Abduction to 180°
o External rotation 90-95° at 90° abduction
o Internal rotation 70-75° at 90° abduction
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: Early strengthening (weeks 10-16)

Goals
• Full AROM (weeks 10-16)
• Maintain full PROM
• Dynamic shoulder stability
• Gradual restoration of shoulder strength, power, and endurance
• Optimize neuromuscular control
• Gradual return to functional activities

Precautions
• No lifting objects >5 pounds, sudden lifting or pushing activities, sudden jerking motions, overhead lifting
• Avoid upper extremity bike and ergometer

Criteria for progression to Phase 4
• Ability to tolerate progression to the low level functional activities
• Demonstrated return of strength / dynamic shoulder stability
• Reestablishment of dynamic shoulder stability
• Demonstrated adequate strength and dynamic stability for progression to more demanding work- and sport-specific activities

Week 10
• Continue stretching and PROM, as needed
• Dynamic stabilization exercises
• Progress ER PROM and AROM to thrower’s motion
o ER 110-115 at 90° abduction in throwers (weeks 10-12)
• Progress shoulder isotonic strengthening exercises as above
• Continue all stretching exercises as need to maintain ROM.
• Progress ROM to functional demands (i.e., overhead athlete)

Week 12
• Begin gentle resisted biceps isotonic strengthening @ week 12

Week 14
• Continue all exercises listed above
• Progress to fundamentals shoulder exercises

Phase 4: Advanced strengthening (weeks 16-22)

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

Week 16
• 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

Week 20
• Continue strengthening and stretching
• Continue stretching if motion is tight
• Initiate interval sports program (e.g., golf, doubles tennis) if appropriate