Approximately 12 weeks to 6 months post-operative
Once the patient reaches approximately 12 weeks and has satisfactory range of motion, good scapular control and a clinically stable shoulder, rehabilitation can progress toward strengthening and functional restoration.
At this stage, the capsulolabral repair has undergone substantial biological healing, but maturation continues for several months. Loading should therefore increase progressively rather than moving immediately to unrestricted activity.
Range of Motion
Continue working toward full functional range of motion.
Residual restriction in external rotation following anterior stabilisation or internal rotation following posterior stabilisation can now be addressed more confidently, but stretching should remain controlled. Forceful end-range stretching that produces apprehension or significant discomfort should be avoided.
For combined repairs, particular care should continue to be taken at both rotational extremes.
The objective is a functional, comfortable and stable shoulder rather than achieving maximal passive range at the expense of stability.
Progressive Strengthening
Strengthening now becomes the major focus of rehabilitation.
Progressively strengthen the rotator cuff, deltoid, serratus anterior and scapular stabilisers, together with the remainder of the upper-limb kinetic chain. Resistance can be increased using therabands, free weights, cable resistance and controlled gym-based exercises.
Exercises should progress from the arm close to the body toward increasingly elevated and overhead positions as strength and control improve.
Closed-chain exercises can progress from the wall to more demanding weight-bearing positions. Push-up progressions, controlled rows, resisted rotation, scaption and increasingly challenging scapular exercises can be incorporated.
The emphasis should remain on control, endurance and stability before maximal strength.
Dynamic Stability and Proprioception
Proprioceptive rehabilitation should become progressively more challenging. Ball-on-wall drills, rhythmic stabilisation, perturbation training and closed-chain stability exercises can progress into elevated and eventually overhead positions.
For athletes, rehabilitation should increasingly reproduce the positions and loads encountered in their sport. Throwing, racquet sports, swimming and other overhead activities require progressive restoration of dynamic control through the entire kinetic chain rather than simply isolated shoulder strength.
Gym and Functional Loading
Patients can progressively return to upper-body gym work during Stage 3, initially using light resistance and controlled technique.
Resistance and complexity can then increase according to symptoms, strength and movement quality. Heavy bench pressing, deep dips, maximal lifting and uncontrolled loaded positions at the extremes of shoulder motion should initially be avoided.
For patients following anterior stabilisation, particular caution should be exercised with heavily loaded abduction/external rotation and extension.
Following posterior stabilisation, caution should be exercised with heavily loaded flexion, horizontal adduction and internal rotation, particularly pressing movements that reproduce posterior translation.
Patients with a combined repair should progress both patterns conservatively.
Manual work can also be progressively reintroduced, with lifting, pushing, pulling and overhead activities advanced according to strength and control.
Return to Sport
Sport-specific rehabilitation can usually begin progressively during Stage 3. Running and general conditioning can be introduced earlier provided there is minimal risk of falling onto the operated shoulder.
Non-contact skills should generally precede contact training.