 Sports Rehabilitation & Performance Center 
 Anterior Shoulder Stabilization Guidelines© * 
 
* Developed by the HSS Rehabilitation Department Sports Rehabilitation and Performance Center 
 
The following anterior stabilization guidelines were developed by the Sports 
Rehabilitation and Performance Center staff at Hospital for Special Surgery. Progression is 
both criteria-based and patient specific. Phases and time frames are designed to give 
the clinician a general sense of progression.  The rehabilitation program following anterior 
shoulder stabilization emphasizes early, controlled motion to prevent contractures and to avoid 
excessive passive stretching later on.  External rotation and extension of the shoulder are 
progressed slowly to protect the repair of the labrum and to avoid excessive stretching of the 
anterior capsule.  The program should balance the aspects of tissue healing and appropriate 
interventions to restore ROM, strength, and function.  Overhead activities are progressed last. 
 
Follow physician’s modifications as prescribed 

POST – OPERATIVE PHASE I (WEEKS 0-3) 
MAXIMUM PROTECTION PHASE  
 
GOALS:  
- Promote healing :  reduce pain, inflammation and swelling 
- Elevation in plane of scapula: to 90° 
- External Rotation:  Arthroscopic to Neutral; Open to 30° 
- Independent home exercise program 
TREATMENT RECOMMENDATIONS: 
- AAROM elevation in plane of scapula, ER to neutral, scapular mobility and stability (sidelying, progressing to 
manual resistance) sub-max deltoid isometrics in neutral, modalities for pain and edema 
- Emphasize patient compliance to HEP and protection during ADLs 
- Other: _________________________________________________________________________ 
PRECAUTIONS: 
- Immobilizer at all times when not exercising 
- External Rotation and Extension limited to neutral (30° for Open) 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- External Rotation to neutral (30° for Open) 
- Elevation in plane of scapula: to 90° 
Minimal pain or inflammation  

Patient Name: _______________________________________________ 
 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
Emphasize: 
- PROTECTING SURGICAL REPAIR 
- Patient compliance with sling immobilization 
 
MODIFICATIONS TO PHASE I: 
 
POST – OPERATIVE PHASE II (WEEKS 3-6) 
GOALS:  
- Continue to promote healing 
- Arthroscopic: External rotation to 45°;  
 
 
- Elevation in plane of scapula to 120° 
- Open: External Rotation to 60°;  
 
- Elevation in plane of scapula to 145° 
- Begin to restore scapula and rotator cuff strength 
TREATMENT RECOMMENDATIONS: 
- D/C immobilizer (MD directed), AAROM FF and ER, scapular stabilization, sub-maximal isometrics ER/IR, 
modalities for pain and edema, progress HEP 
PRECAUTIONS: 
- Limit External rotation to 45° (arthrosopic) 
- Avoid excessive stretch to anterior capsule 
- Avoid rotator cuff inflammation 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Minimal pain and inflammation 
- Arthroscopic: External rotation to 45°; Elevation in plane of scapula to120° 
- Open: External rotation to 60°; Elevation in plane of scapula to145° 
- Internal rotation/ external rotation strength  4/5 
 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
Emphasize: 
- 
PROTECTING SURGICAL REPAIR 
- 
Avoiding excessive stretch to anterior capsule 
- 
Avoiding inflammation of rotator cuff 
 
MODIFICATIONS TO PHASE II: 
 
 
 Sports Rehabilitation & Performance Center 
 Anterior Shoulder Stabilization Guidelines© * 
   
POST – OPERATIVE PHASE III (WEEKS 6-12) 
GOALS:  
- Restore full shoulder range of motion 
- Restore normal scapulohumeral rhythm 
- Upper extremity strength 5/5 
- Restore normal flexibility 
- Begin to restore upper extremity endurance 
- Isokinetic IR/ER strength 85% of unaffected side 
 
TREATMENT RECOMMENDATIONS: 
- Initiate AAROM IR, progress isotonic and stabilization exercises for periscapular and RC muscles, humeral 
head rhythmic stabilization, PNF patterns as tolerated, UE endurance (UBE), initiate flexibility exercises as 
needed, modalities prn, modify HEP 
PRECAUTIONS: 
- Avoid rotator cuff inflammation 
- Continue to protect anterior capsule 
- Avoid excessive passive stretching 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Normal scapulohumeral rhythm 
- Minimal pain and inflammation 
- IR/ER strength 5/5 
- Full upper extremity range of motion 
- Isokinetic IR strength 85% of unaffected side 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
Patient Name: _______________________________________________ 
 
    Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
Emphasize: 
- PROTECTING SURGICAL REPAIR 
- Avoiding excessive passive stretching  
- Avoiding inflammation of rotator cuff 
- Establishing normal strength base 
 
MODIFICATIONS TO PHASE III: 
 
POST – OPERATIVE PHASE IV (WEEKS 14-18) 
GOALS:  
 
- Restore normal neuromuscular function 
- Maintain strength and flexibility 
- 
Isokinetic IR/ER strength at least equal to the unaffected side 
- > 66% Isokinetic ER/IR strength ratio 
- Prevent Re-injury 
PRECAUTIONS: 
- Pain free plyometrics 
- Significant pain with a specific activity 
- Feeling of instability 
TREATMENT RECOMMENDATIONS: 
- Full UE strengthening, ER/IR in 90/90 position (overhead athlete), initiate plyometrics, sport and activity 
related program, modify HEP 
CRITERIA FOR DISCHARGE: 
- Pain free Sport or Activity specific program 
- Isokinetic IR/ER strength at least equal to unaffected side 
- > 66% Isokinetic ER/IR strength ratio 
- Independent Home Exercise Program 
- Independent Sport or Activity specific program 
 
Patient Name: _______________________________________________ 
 
    Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
