Or Tho Associates - Shoulder Rehabilitation Protocols

33 Sewall Street
Portland, ME 04102
(207) 828-2100
www.orthoassociates.com
ROTATOR CUFF HOME PROGRAM

PHASE I
Unconditioned, imbalanced muscles of the shoulder area can cause rotator cuff injuries. As the rotator
cuff fatigues from excessive use, weakness, or lack of endurance, the ball of the shoulder joint becomes
more mobile and moves upward. This causes the rotator cuff tendons to come in contact with bone, which
can lead to irritation of the tendon, then inflammation and pain, then ultimately an injury (shoulder
tendonitis, bursitis, impingement, etc.). Along with keeping the ball firmly in its socket, the rotator cuff has
functions related to performance in sports. The rotator cuff provides power and control for the golf swing,
tennis stroke, baseball/softball throw and pitch, volleyball serve and spike, and swimming.
The exercises described below are to help you strengthen the muscles in your shoulder (especially the
muscles of the rotator cuff--the part that helps circular motion). These exercises should not cause you
pain. If the exercise hurts, stop exercising. Start again with a lighter resistance.
RESISTANCE
The exercises described below are designed to improve endurance of the shoulder musculature, with
strength gains being secondary. Therefore the emphasis is on controlled movement with low resistance
and high repetitions. The use tubing is required for several of the exercises below with the others utilizing
body weight or small dumbbells. . You should strive for perfect execution throughout your routine to help
restore the proper movement patterns and reduce the symptoms in your shoulder.
FREQUENCY
Perform all the exercises 5 days per week, 1-2 times per day. Begin by performing 15 repetitions of each
exercise for the first 3 days and then progressing to 2 sets of 15 repetitions. After 10 days progress
yourself to performing 3 sets of 15 to 20 repetitions.
POSTURE
Perfect posture is one of the key elements in maintaining a healthy shoulder. Think of a skeleton hanging
in a classroom. Its shoulders are naturally hanging back and down, giving it perfect posture and
alignment. Unfortunately, most people have a tendency to slump forward, with their shoulder blades
sliding forward and up. If you spend much of your day in front of a computer, as many Americans do,
you’re probably slumping over, even if you’re not conscious of it. Keep your Shoulder blades pulled Back
and Down (SBD) towards your waist, as if you’re thrusting your chest up. It is important to keep your
shoulders in this position throughout the exercises and in life.
EXERCISES
1. PULLDOWNS
Place the band above your head so you’re pulling it down at a 45 degree angle. Standing with great
posture (SBD) grab the band with both hands, elbows straight, and thumbs pointing up. Pull the band
down to your pockets and about 6-8 inches away from your body. Pause for 2 seconds in this position
emphasizing a squeeze between your shoulder blades. Slowly return the band to the starting position.
33 Sewall Street
Portland, ME 04102
(207) 828-2100
2. STANDING ROWS
Place the band at mid sternum height so you are pulling in a straight line. Standing with great posture
(SBD) grab the band with both hands, elbows slightly bent, and thumbs pointing up. Pull the band
towards your chest by contracting your shoulder blades and bending your elbows. The finish position
should have a great SBD, elbows bent at 90 degrees and located at mid torso. Hold that position for 2
seconds then return to the starting position.
3. EXTERNAL ROTATION
33 Sewall Street
Portland, ME 04102
(207) 828-2100

(SBD), place your elbow at your side, bent at 90 degrees and gripping the band with the thumb pointed
up. Hold a towel between your elbow and your side to you remind you to maintain this position. Your
forearm begins by pointing across your body. Slowly rotate your shoulder out, keeping your elbow bent,
and fixed to your side. Rotate out as far as possible by limits of motion or pain. Hold that position 2
seconds and slowly return to the starting position.
4. INTERNAL ROTATION
(SBD), place your elbow at your side, bent at 90 degrees and gripping the band with the thumb pointed
up. Hold a towel between your elbow and your side. Your forearm begins by pointing away from your
body. Slowly rotate your shoulder in, keeping your elbow bent, and fixed to your side. Rotate in as far as
possible by limits of motion or pain. Hold that position for 2 seconds and slowly return to the starting
position.
33 Sewall Street
Portland, ME 04102
(207) 828-2100

5. STANDING HITCHHIKER
Stand with perfect posture (SBD) with hand placed on your thighs and your thumbs pointed upward.
While gliding your shoulder blades back and down toward your waist raise your arms up at a 45 degree
angle. Raise your arms to shoulder height only and keep your elbows straight. Hold this position for 2
seconds and slowly return to the starting position. Begin this exercise with no resistance and gradually
progress to 1-5lb dumbbells. Do not use weights heavier than 5lb. The smaller muscles of the rotator
cuff are difficult to isolate using heavy weight.
6. BICEP CURL
Stand with perfect posture (SBD). Keep your elbows next to your torso while holding a dumbbell or band.
Initiate the movement by flexing your elbow and then slowly returning the starting position while
maintaining good posture.
33 Sewall Street
Portland, ME 04102
(207) 828-2100

7. TRICEP PRESS
Begin the exercise with great posture (SBD), elbows by your side and bent to 90 degrees. Extend your
elbows against resistance until you reach full extension. Hold this position for 2 seconds then slowly
return to your starting position.
8. SERRATUS PUNCH
Begin the exercise with the band wrapped around you thumb, sitting underneath your armpit, and your
elbows bent to 90 degrees at your side. Extend your elbows forward until they are straight and then
round your shoulders at the end of the movement. Hold this position for 2 seconds then slowly return to
your starting position.
33 Sewall Street
Portland, ME 04102
(207) 828-2100

CAUTION
If any of these exercises increases your shoulder pain, stop doing that exercise and contact your
physician or physical therapist.
PHASE II
For those individuals requiring further strengthening to perform overhead activities should be progressed
to PHASE II. Exercises for this phase require instruction from a physical therapist. See your physician or
therapist for instruction on proper exercise technique and progression.
33 Sewall Street
Portland, ME 04102
(207) 828-2100
LARGE ROTATOR CUFF REPAIR PROTOCOL
Includes Treatments for:

Open Repair Large Rotator Cuff Tear
Arthroscopic Repair Large Rotator Cuff Tear
Post-op
0-2 Weeks Sling/swathe at all times, except for exercises

PROM limits to: 90 pure abduction, 20 extensions, 70 internal
rotations (not behind back)
1. Pendulum exercises 3x/day minimum
2. PROM within pain tolerance
3. Elbow and wrist AROM 4x/day minimum
4. Cryocuff/ ice: days 1-2 as much as possible, then post activity for
pain
2-6 Weeks Sling/swathe at all times, except for exercises, bathing, or

sitting quietly. ROM limits continued.
1. PROM within limits and pain tolerance
2. Manual resistance for scapular motions
3. Postural awareness education
4. Gentle soft tissue mobilization and joint mobilization
5. Modalities as indicated for pain or inflammation
6-12 Weeks Sling for comfort, but may be discontinued. No ROM limits.
1. Initiate AAROM (wand and pulleys), unless specified by
physician to progress more slowly
2. Joint mobilization for scapula and glenohumeral mobility
3. Gentle exercises for scapular stabilizers and rotator cuff, may
include sub-max isometrics, PNF, and supervised UBE
4. Progress AROM, with education for quality of motion to avoid
shoulder hiking.
*Patient must be able to elevate without hiking shoulder to
progress to next phase.
12-18 Weeks RESISTIVE EXERCISES HELD AS PER SURGEON’S

INSTRUCTIONS.
33 Sewall Street
Portland, ME 04102
(207) 828-2100
MEDIUM ROTATOR CUFF REPAIR PROTOCOL
Includes Treatment for:

Open Repair Medium Rotator Cuff Tear
Arthroscopic Repair Small and Medium Rotator Cuff Tear
Post op
0-2 Weeks Sling/swathe at all times, except for exercises.

PROM limits to: 90 pure abduction, 20 extension, 70 internal
rotation (not behind back), no limitations for flexion, external
rotation as tolerated (unless specified by physician)
2. PROM within pain tolerance
4. Cryocuff ice: days 1-2 as much as possible, then post activity
for pain
2-6 Weeks Decrease use of sling during the day, except in uncontrolled
situations and at night. ROM limits continued
1. PROM within limits and pain tolerance
4. Gentle soft tissue mobilization and joint mobilization
6-12 Weeks Discontinue sling at night. No ROM limits

1. Initiate AAROM/ AROM including wand and pulleys
3. Gentle exercises for scapular stabilizers and rotator cuff
May include sub-max isometrics, PNF, and supervised UBE.
Emphasis of strengthening on high reps and low weight with
postural awareness
Goal: Involved shoulder AROM grossly WNL by 12 weeks

33 Sewall Street
Portland, ME 04102
(207) 828-2100

12-18 Weeks 1. Resistive exercises as tolerated
2. Progress toward independent home program
3. Reinforce postural awareness, quality of exercise technique
and proper PRE progression
33 Sewall Street
Portland, ME 04102
(207) 828-2100
OPEN SMALL ROTATOR CUFF PROTOCOL
Post-op
0-2 Weeks Sling worn for comfort

2. PROM/AAROM (wand, pulley) within pain tolerance
4. Cryocuff/ice: days 1-2 as much as possible, then post activity for
pain.
2-6 Weeks Avoid active elevation (anterior deltoid) until 6 weeks

1. Progress AAROM/AROM within pain tolerance
2. Sub-maximal isometrics for shoulder musculature, except flexion
5. Gentle soft tissue mobilization and glenohumeral inferior glide
7. May initiate UBE after 4 weeks.
Goal: Involved shoulder AAROM grossly WNL by 6 weeks
6-12 Weeks 1. Progress AROM in all ranges

3. Strengthening exercises for scapular stabilizers and rotator cuff.
Emphasis of strengthening on high reps and low weight, with
postural awareness. May include PRE’s, theratube/band, PNF
and weight equipment
4. Progress to independent home program
Goal: AROM grossly WNL without shoulder hiking by 12 weeks

33 Sewall Street
Portland, ME 04102
(207) 828-2100

S.L.A.P. RECONSTRUCTION PROTOCOL
Post-op
0-3 Weeks PROM limited to: 90 flexion, 90 abduction, 0 external rotation and 0
extension. Avoid hyperextension of elbow. Sling worn at all times to
support glenohumeral joint.
1. PROM to tolerance within limitations
3. Sub-maximal isometrics for shoulder musculature-avoid forward
elevations
4. Theraputty and light resisted wrist isometrics
5. Soft tissue mobilization as tolerated
6. Ice/Cryocuff as needed
7. Cardiovascular exercises-stationary bike, treadmill with arm supported
3-6 Weeks ROM limited to: 120 flexion, 120 abduction, and 30 external rotation
Wean from sling-no active arm swing until after 4 weeks
1. PROM/AAROM (supine wand) to tolerance within limitations
2. Gentle manual resistance for scapula motions
3. Gentle rotator cuff strengthening
4. Gentle joint mobilization to scapula
6-8 Weeks ROM only limited to 60 external rotation

1. Progress PROM within limitations
2. AAROM/AROM within pain tolerance-seated wand, pulleys, UBE
3. Initiate light resisted elbow flexion and extension
4. Gentle open kinetic chain rhythmic stabilization exercises in supine
8-12 Weeks ROM limited to 60 external rotation

1. AROM with emphasis on quality of motion, avoid shoulder hiking with
elevation
2. Strengthening exercises for scapula stabilizers and rotator cuff
May include PRE’s, eccentric rotator cuff, PNF (avoid heavy resistance
in painful end ranges), and weight equipment
Emphasis of strengthening on high reps and low weight, with postural
awareness
3. Progress closed kinetic chain exercises as tolerated
4. Isokinetic at fast speeds blocking end ranges-avoid impingement
Goal: Full PROM (external rotation to 60) by 12 weeks
12-24 Weeks No ROM limitations

1. Progress to independent strengthening program
33 Sewall Street
Portland, ME 04102
(207) 828-2100

Reinforce postural awareness, quality of exercise techniques, and
proper PRE progression-frequency, duration and intensity
2. Coordinate sports specific training to begin return to normal function or
sport
Goals: 1. Full pain free AROM

2. Strength 95% of non-involved side
3. Return to full activity or sport without restriction by 24 weeks
33 Sewall Street
Portland, ME 04102
(207) 828-2100
ARTHROSCOPIC ACROMIOPLASTY PROTOCOL

Arthroscopic Acromio-Clavicular Excision
Arthroscopic Partial Thickness Rotator Cuff Debridement
Post-op
0-1 Week Sling worn for comfort

4. Cryocuff/ ice: days 1-2 as much as possible, then post activity
for pain

2. Sub-maximal isometrics for shoulder musculature
5. Gentle soft tissue mobilization
7. Therapist supervised UBE for motion, avoiding substitution or
Impingement
2-6 Weeks 1. Progress PROM and AROM as tolerated

(posterior
capsule stretching)
postural
awareness. May include PRE’s, theratube/ band, PNF and weight
equipment
Goal: Involved shoulder AROM grossly WNL without shoulder hiking
by 6 weeks
33 Sewall Street
Portland, ME 04102
(207) 828-2100

6-12 Weeks 1. Progress to independent strengthening program.
2. Reinforce postural awareness, quality of exercise techniques,
and proper PRE progression.
33 Sewall Street
Portland, ME 04102
(207) 828-2100
OPEN ACROMIOPLASTY PROTOCOL

Open Acromio-Clavicular Excision
Open Small Rotator Cuff Repair
Post-op
0-2 Weeks Sling worn for comfort

4. Cryocuff/ ice: days 1-2 as much as possible, then post activity
for pain.

1. Progress AAROM/AROM within pain tolerance
2. Sub-maximal isometrics for shoulder musculature, except flexion
5. Gentle soft tissue mobilization and glenohumeral inferior glide
7. May initiate UBE after 4 weeks.
Goal: Involved shoulder AAROM grossly WNL by 6 weeks
6-12 Weeks 1. Progress AROM in all ranges

postural awareness. May include PRE’s, theratube/ band, PNF
and weight equipment
4. Progress to independent home program.
Goal: AROM grossly WNL without shoulder hiking by 12 weeks

33 Sewall Street
Portland, ME 04102
(207) 828-2100
ARTHROSCOPIC BANKART REPAIR PROTOCOL
Post-op
0-2 Weeks Immobilization with sling/swathe on at all times, except

bathing
ROM limits to: 90 flexion, 45 abduction, 0 external rotation, 20
extension
2. Cryocuff/ice for pain
2-6 Weeks Sling must be worn while at school, in crowds, riding in a car,
and while sleeping. ROM limits to: 90 flexion, 90 pure
abduction, 30 external rotation at side, 20 extension
1. PROM and AAROM (wand pulley) within pain tolerance and
limits
2. Gentle rotator cuff strengthening
3. General soft tissue and joint mobilization
6-12 Weeks Discontinue sling

ROM limits to: 60 external rotation; full flexion, abduction, and
extension
1. Progress PROM and AROM as tolerated
3. Strengthening exercises for scapular stabilizers and rotator cuff
within pain-free ranges. May include PRE’s, PNF, and weight
equipment. Emphasis of strengthening on high reps and low
weight, with postural awareness.
12-24 Weeks 1. Range of motion-self-stretching program

2. Progress independent strengthening program
3. Reinforce postural awareness, quality of exercise technique,
and proper PRE progression
4. Coordination sports specific training to begin return to normal
Function
9 Months Possible return to full strength throwing and contact sport,

depending on strength and physician assessment
33 Sewall Street
Portland, ME 04102
(207) 828-2100
INFERIOR CAPSULAR SHIFT PROTOCOL

Post-op
0-4 Weeks Immobilization with sling on at all times, except distal arm
ROM and bathing
1. Elbow, wrist, and hand AROM 4x/day minimum
2. Cryocuff/ice for pain
4-6 weeks Decrease use of sling during the day except in uncontrolled
situations. Strict ROM limits to: 120 flexion, 90 abduction, 30
external rotations.
1. PROM, AAROM (wand, pulley), and AROM within pain tolerance
and limits
2. Supervised UBE within shoulder AROM within pain tolerance
and limits
4. Gentle soft tissue and joint mobilization
6-12 Weeks Discontinue sling at night

1. Progress AAROM and AROM as tolerated
2. Joint mobilization of scapula (gentle glenohumeral as indicated)
3. Strengthening exercises for scapula stabilizers and rotator cuff
within pain free ranges May include PRE’s, PNF, and weight
equipment Emphasis of strengthening on high reps and low
weight, with postural awareness
4. Progress toward independent strengthening program. Reinforce
postural awareness, quality of exercise technique, and proper
PRE progression.
Goal: AROM>90 percent of normal range for the involved
shoulder by 12 weeks
6 Months Begin functional throwing program

1. Continue with independent program-strength, stretch, and sports
specific drills.

33 Sewall Street
Portland, ME 04102
(207) 828-2100

9 Months Possible return to full strength throwing and contact sports
depending on strength and physician assessment

33 Sewall Street
Portland, ME 04102
(207) 828-2100

TOTAL SHOULDER ARTHROPLASTY
Includes Treatment for:
Hemi-Arthroplasty with intact rotator cuff
Post-op
0-3 Weeks ROM limited with external rotation to 45
Day 1 1. Pendulum exercises 3x/day minimum-taught at hospital

and reviewed in outpatient setting
2. PROM all ranges
Day 2 Phase I 1. Pulley and wand exercises

2. Manual resisted scapular motions
3. Modalities as indicated
3-4 weeks 1. Progress AAROM/AROM as tolerated

2. Isometrics for shoulder musculature
3. Scapular stabilizing exercises
4-6 Weeks Phase II 1. Initiate Theraband exercises

2. Emphasis on quality of exercise with postural
Education
DISCHARGE TO INDEPENDENT PROGRAM WHEN ROM PLATEAU

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33 Sewall Street

ROTATOR CUFF HOME PROGRAM

LARGE ROTATOR CUFF REPAIR PROTOCOL

Includes Treatments for:

0-2 Weeks Sling/swathe at all times, except for exercises

2-6 Weeks Sling/swathe at all times, except for exercises, bathing, or

12-18 Weeks RESISTIVE EXERCISES HELD AS PER SURGEON’S

MEDIUM ROTATOR CUFF REPAIR PROTOCOL

Includes Treatment for:

0-2 Weeks Sling/swathe at all times, except for exercises.

6-12 Weeks Discontinue sling at night. No ROM limits

Goal: Involved shoulder AROM grossly WNL by 12 weeks

OPEN SMALL ROTATOR CUFF PROTOCOL

0-2 Weeks Sling worn for comfort

2-6 Weeks Avoid active elevation (anterior deltoid) until 6 weeks

Goal: Involved shoulder AAROM grossly WNL by 6 weeks

6-12 Weeks 1. Progress AROM in all ranges

Goal: AROM grossly WNL without shoulder hiking by 12 weeks

6-8 Weeks ROM only limited to 60 external rotation

8-12 Weeks ROM limited to 60 external rotation

Goal: Full PROM (external rotation to 60) by 12 weeks

12-24 Weeks No ROM limitations

Goals: 1. Full pain free AROM

ARTHROSCOPIC ACROMIOPLASTY PROTOCOL

Includes Treatments for:

0-1 Week Sling worn for comfort

1-2 Weeks Avoid active elevation (anterior deltoid) until 6 weeks

2-6 Weeks 1. Progress PROM and AROM as tolerated

OPEN ACROMIOPLASTY PROTOCOL

Includes Treatments for:

0-2 Weeks Sling worn for comfort

2-6 Weeks Avoid active elevation (anterior deltoid) until 6 weeks

Goal: Involved shoulder AAROM grossly WNL by 6 weeks

6-12 Weeks 1. Progress AROM in all ranges

Goal: AROM grossly WNL without shoulder hiking by 12 weeks

ARTHROSCOPIC BANKART REPAIR PROTOCOL

0-2 Weeks Immobilization with sling/swathe on at all times, except

6-12 Weeks Discontinue sling

12-24 Weeks 1. Range of motion-self-stretching program

9 Months Possible return to full strength throwing and contact sport,

INFERIOR CAPSULAR SHIFT PROTOCOL

6-12 Weeks Discontinue sling at night

6 Months Begin functional throwing program

0-3 Weeks ROM limited with external rotation to 45

Day 1 1. Pendulum exercises 3x/day minimum-taught at hospital

Day 2 Phase I 1. Pulley and wand exercises

3-4 weeks 1. Progress AAROM/AROM as tolerated

4-6 Weeks Phase II 1. Initiate Theraband exercises

DISCHARGE TO INDEPENDENT PROGRAM WHEN ROM PLATEAU

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