Phase 1: Immediate postoperative period (weeks 0-1)
Goals
Maintain / protect the integrity of repair
Gradually increase AROM
Diminish pain and inflammation
Prevent muscular inhibition
Become independent with modified ADLs
Precautions
Maintain arm in KnappSak2 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
KnappSak2 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
Days 7 to 28
Continue with KnappSak2 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)
Goals
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
Precautions
No sudden jerking motions
Criteria for progression to Phase 3
Full AROM
Weeks 3-4
Discontinue KnappSak2
Gradually improve AROM
Flexion and elevation in the plane of the scapula
Abduction to full
External / Internal rotation to full
Extension to tolerance
Continue cryotherapy as needed
May use heat before ROM exercises
Aquatherapy OK for AROM exercises
Ice after exercise
Weeks 5-6
Continue AROM and stretching exercises
Continue rotator cuff isometrics
Continue periscapular exercises
Gradually progress AROM
Flexion, elevation in the plane of the scapula to full
External rotation to full
Internal rotation to full
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)
Goals
Maintain full non-painful AROM
Advance conditioning exercises for enhanced functional use
Improve muscular strength, power and endurance
Gradual return to full activities
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