PHYSICAL THERAPY PROTOCOL

Posterior Labral Repair
Physical Therapy Protocol

Rehabilitation following arthroscopic posterior labral repair is designed to protect the healing posterior capsulolabral complex while progressively restoring shoulder motion, strength, endurance, and dynamic stability.

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0–6 Weeks

Protect Repair

6–12 Weeks

Restore Motion

12–20 Weeks

Strengthening

Goal

Dynamic Stability

Important Note

This protocol is intended as a general guideline. Patients undergoing concomitant Bankart repair, SLAP repair, rotator cuff repair, multidirectional instability surgery, or revision surgery may require modifications. The surgeon's postoperative instructions always take precedence.

Rehabilitation Philosophy

The posterior labrum requires time to heal securely back to the glenoid. Early rehabilitation protects the repair while preventing postoperative stiffness. Strengthening and return to athletic activities should progress only after adequate biologic healing and restoration of normal shoulder mechanics.

Phase I: Protection Phase

Timeframe: 0–6 Weeks

Goals

Protect the posterior labral repair
Control pain and swelling
Prevent excessive stiffness
Maintain elbow, wrist, and hand motion
Begin protected passive shoulder motion

Sling

Sling full time except hygiene and therapy
Sleep in sling
No lifting
No supporting body weight
Avoid positions stressing the posterior capsule

Exercises

Pendulum exercises
Passive forward elevation
Protected passive external rotation
Elbow, wrist, and hand range of motion
Grip strengthening
Scapular retraction exercises

Avoid

Cross-body adduction under load
Forceful internal rotation
Horizontal pressing exercises
Pushing up from a chair
Heavy lifting

Phase II: Motion Phase

Timeframe: 6–12 Weeks

Goals

Restore passive motion
Progress active-assisted motion
Restore active motion
Normalize scapular mechanics
Discontinue sling

Exercises

Cane-assisted exercises
Table slides
Wall walks
Pulleys
Scapular stabilization
Gentle stretching as tolerated

Phase III: Strengthening Phase

Timeframe: 12–20 Weeks

Goals

Restore rotator cuff strength
Improve posterior shoulder endurance
Restore dynamic stability
Normalize shoulder mechanics

Exercises

Theraband strengthening
External rotation strengthening
Scapular strengthening
Closed-chain stabilization
Proprioception exercises
Progressive dumbbell strengthening

Phase IV: Return To Activity

Timeframe: 20–24+ Weeks

Strength

Restore balanced shoulder strength and endurance.

Function

Progress work-specific and sport-specific activities.

Stability

Demonstrate excellent shoulder control before unrestricted activity.

Return To Activity Guidelines

Desk Work

Usually within 1–2 weeks.

Driving

After sling discontinuation and when safe control of the vehicle has returned.

Daily Activities

Progress gradually after the first 6 weeks.

Weight Training

Usually begins around 3 months, avoiding aggressive horizontal pressing initially.

Throwing Program

May begin around 5–6 months depending on strength, mechanics, and stability.

Contact Sports

Typically around 6 months after demonstrating restored strength and dynamic stability.

Therapist Notes

Protect the posterior capsulolabral repair during the first 6 weeks.
Avoid excessive posterior loading early.
Restore normal scapular mechanics before advanced strengthening.
Progress closed-chain stabilization gradually.
Pay particular attention to athletes involved in football, weightlifting, rowing, and other posterior loading sports.
Contact the office if recurrent instability, excessive stiffness, or unexpected pain develops.

Red Flags

Contact The Office For

Increasing pain
Drainage or redness
Recurrent instability
Loss of shoulder motion
Sudden loss of shoulder function

Seek Urgent Care For

Chest pain
Shortness of breath
Calf pain or swelling
Severe uncontrolled pain

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