Bankart Repair Rehabilitation Protocol

General Considerations:
- Use of a sling only as needed or prescribed - Okay to shower once dressings are changed (Day 1).
- Arm is restricted from these movements for 4 weeks: extension (backwards) past the plane of the body.
- External rotation (arm rotation outwards) greater than 0° (straight in front); extensive repairs may require more restrictions.
- For posterior repairs, avoid any internal rotation (turning in) past the body.
- No passive forceful stretching into external rotation/extension for 3 months following an anterior repair and into internal rotation for a posterior repair.
- Good posture is critical throughout the rehabilitation process to improve healing and decrease the risk of developing poor mechanics.
- Aerobic conditioning throughout the rehabilitation process.
- MD follow-ups Day 1, Day 8 - 10, 1 month, 4 months, 6 months and 1 year post-op.
- All active exercises should be carefully monitored to minimize substitution or compensation.

Days 1 - 5:
- MD visit (Day 1) to change dressings and review home exercise program.
- Home program to consist of: Icing shoulder as often as able for the first 3 - 5 days. Pendulums, elbow flexion/extension, wrist and forearm strengthening, gentle passive/active assistive exercises of the arm in flexion (front) keeping below the level of the shoulder, cervical stretches.
- Postural education and exercises.
- Stationary bike, stair machine, and elliptical without putting weight on involved arm.
- Sleeping semi-reclined is most comfortable.

Days 5 - 14:
- Clinic visit at 8 - 10 days for suture removal and check-up.
- Pain control (i.e. cryotherapy, massage, electric stim) - Gradual increase in passive and active assistive (AAROM) exercises as tolerated (from flexion out into the scapular plane) up to 90° unless otherwise indicated.
- Begin isometrics in all planes as tolerated.
- Soft tissue treatments to scars and surrounding musculature, scapular mobilizations.
- General conditioning as tolerated (include trunk flexion & extension exercises).

2 - 4 Weeks:
- Passive and AAROM flexion out to scaption (plane of the scapula) as tolerated.
- Isotonic wrist, forearm, and scapular exercises.
- Theraband resisted pull-downs from the front and the scapular plane; elbow flexion with high reps and low resistance; sub-maximal isometrics (as dictated by pain); active scapular elevation, depression, and retraction exercises; light weight bearing exercises.

4 - 6 Weeks:
- Resting pain should be notably diminishing. Continue with passive and AAROM exercises (cane exercises, wall walking, table slide) in flexion out to abduction as tolerated; maximal isometrics.
- Active exercises from flexion into the scapular plane against gravity as tolerated.
- No resistance until able to perform 30 reps at limb weight with perfect mechanics.
- Okay to add light resistance internal rotation exercises from 0° to the body only.
- UBE with light-to-no resistance only.
- Add proprioceptive training exercises. (Alphabet writing, fine motor skills, work/sport specific exercises).

6 - 8 Weeks:
- Continue to increase AROM exercises as tolerated (serratus anterior, upper, and lower trapezius); add eccentrics into protected ranges - Okay to begin LIGHT stretching into external rotation.
- Okay to begin LIGHT glenohumeral joint mobilization.
- Increase proprioceptive training (prone on elbows, quadruped position ("on all four's") for rhythmic stabilization.
- UBE with increasing resistance.
- Okay to begin jogging, road cycling, and standing arm resistance exercises in the pool.

8 - 12 Weeks:
- Emphasis on regaining strength and endurance - Light PNF patterns (proprioceptive neuromuscular facilitation).
- AROM exercises to include internal rotation and external rotation as motion allows, lateral raises and supraspinatus isolation, rower with a high seat, decline bench press, military press in front of body.
- Running, road or mountain biking, no activities with forceful, ballistic arm movement.

3 - 6 Months:
- Aggressive stretching; begin strenuous resistive exercises.
- Add light throwing exercises with attention to proper mechanics.

6 Months:
- Increase throwing program with focus on return-to-throwing sports as mechanics, conditioning, and strength allow.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.