There are no specific time guidelines to progress the patient through each phase. However, it is important to review the Phase duration guidelines proposed and not progress the patient too quickly. The therapist must take into consideration the individual patient’s healing rate; extent of surgery; subjective and objective findings before advancing to the next phase.
For Throwing Athletes: throwing should only begin when full pain free ROM and full strength is achieved.
Phase I (0-6 weeks)
Goals:
- Protect surgery
- Decrease pain
- Decrease inflammation
- Patient Education
- Home Exercise Program
Plan:
- Sling: 0-6 weeks (usually 3 weeks – check with physician)
- Pendulum/cane – begin at 3 weeks
- Pulley – begin at three weeks
- Cervical Spine Stretches
- Scapular mobilization and strengthening – as soon as possible
- PROM – begin at 3-4 weeks ****To protect labrum: avoid abduction/External rotation at extreme end-range
- Aquatic Physical Therapy
- Isometrics
- Modalities
****Avoid heavy bicep work*****
Phase II (about 4 — 6 weeks)
Goals:
- Control pain
- Control Inflammation
- Improve functional ROM
- Increase Strength
- Home Exercise Program
Plan:
- Modalities
- Continued scapular and glenohumeral mobilization
- Advance Scapular and Rotator cuff strengthening with light theraband and PRE’s.
- UBE
- Advance pool exercises
Phase III (6 weeks +)
Goals:
- Functional ROM
- Normalize Strength/power
- Return to activities (work, sports)
- Light sports at 3 – 4 months
- Heavy throwing at 4 – 6 months
Plan:
- Advance strengthening program: weight training
- Improve coordination: i.e.: diagonal lifting, plyoball,
- Sports Specific training
- Home Exercise Program