PHYSICAL THERAPY PROTOCOL
Subacromial Decompression
Physical Therapy Protocol
Rehabilitation following arthroscopic subacromial decompression emphasizes early restoration of shoulder motion, normalization of scapular mechanics, progressive strengthening, and return to unrestricted daily activities, work, and athletics.
Restore Motion
Normalize Function
Strengthening
Full Activity
Important Note
This protocol serves as a general guideline. Patients who undergo additional procedures such as rotator cuff repair, biceps tenodesis, distal clavicle excision, or labral repair should follow the more restrictive rehabilitation protocol. The surgeon's postoperative instructions always take precedence.
Rehabilitation Philosophy
Because no tendon repair requires protection, rehabilitation following isolated subacromial decompression focuses on early restoration of motion and rapid return of shoulder function. Progression is guided primarily by pain, swelling, and restoration of normal shoulder mechanics.
Phase I: Early Motion
Timeframe: 0–2 Weeks
Goals
- Control pain and swelling
- Restore passive and active motion
- Prevent stiffness
- Normalize scapular mechanics
- Resume light daily activities
Sling
- Sling for comfort only
- Discontinue as tolerated
- Remove frequently throughout the day
- Encourage normal arm use within comfort limits
- Avoid heavy lifting initially
Exercises
- Pendulum exercises
- Passive and active shoulder motion
- Table slides
- Wall walks
- Pulleys as tolerated
- Scapular retraction exercises
Phase II: Functional Recovery
Timeframe: 2–6 Weeks
Goals
- Restore full range of motion
- Normalize shoulder mechanics
- Improve endurance
- Return to unrestricted daily activities
Exercises
- Active range of motion
- Posterior capsule stretching
- Scapular stabilization
- Rotator cuff activation
- Closed-chain stabilization
- Progressive functional exercises
Phase III: Strengthening
Timeframe: 6–12 Weeks
Goals
- Restore full shoulder strength
- Improve endurance
- Normalize movement patterns
- Return to unrestricted activity
Exercises
- Theraband strengthening
- Progressive dumbbell strengthening
- Rotator cuff strengthening
- Deltoid strengthening
- Scapular strengthening
- Sport-specific strengthening
Return To Activity Guidelines
Desk Work
Often within several days.
Driving
When comfortable and no longer taking narcotic pain medication.
Daily Activities
As tolerated with progressive increase during the first several weeks.
Golf
Putting and chipping as comfort allows. Full swing often by 6–8 weeks.
Weight Training
Usually resumes between 6–8 weeks as strength returns.
Sports
Return once full motion, strength, and pain-free function have been restored.
Therapist Notes
- Encourage early restoration of full motion.
- Restore normal scapulothoracic rhythm.
- Progress strengthening according to symptoms.
- Avoid prolonged immobilization.
- Emphasize quality of movement before increasing resistance.
- Notify the office if pain worsens unexpectedly or recovery plateaus.
Red Flags
Contact The Office For
- Increasing redness
- Drainage
- Persistent swelling
- Progressively worsening pain
- Loss of shoulder function
Seek Urgent Care For
- Chest pain
- Shortness of breath
- Calf pain or swelling
- Severe uncontrolled pain
Related Resources
Questions About Subacromial Decompression Rehabilitation?
Most patients recover quickly after isolated subacromial decompression. Early motion, restoration of normal shoulder mechanics, and progressive strengthening are the keys to an excellent outcome.
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