 Sports Rehabilitation & Performance Center 
 Posterior Shoulder Stabilization Guidelines© * 
 
The following posterior 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 posterior 
shoulder stabilization emphasizes early, controlled motion to prevent contractures and to avoid 
excessive passive stretching later on.  Internal rotation and horizontal adduction are avoided 
early and then progressed cautiously to avoid excessive stress of the posterior capsule.  The 
program should balance the aspects of tissue healing and appropriate interventions to restore 
ROM, strength, and function.  Particular emphasis will be placed on the posterior glenohumeral 
and scapular musculature to further assist in protecting the posterolabral complex.  The 
program is based on the patient returning to sport-specific activities no earlier than 16 weeks 
post-surgery, with overhead activities and contact sports progressed last. 
 
Follow physician’s modifications as prescribed 
 
POST – OPERATIVE PHASE I (WEEKS 2-4) 
MAXIMUM PROTECTION PHASE  

GOALS:  
- Promote healing :  reduce pain, inflammation and swelling 
- Elevation in plane of scapula: to 90° 
- External Rotation:  to 30° 
- Initiate restoration of humeral head and scapular control 
- Independent home exercise program 
TREATMENT RECOMMENDATIONS: 
- AAROM elevation in plane of scapula to 90°, ER to 30°, scapular mobility and stability (sidelying, progressing 
to manual resistance), sub-max deltoid isometrics in neutral (3-4 wks), sub-max RC isometrics in neutral (3-4 
wks), elbow/ wrist AROM, gripping exercises, modalities for pain and edema, prn 
- Emphasize patient compliance to HEP and protection during ADLs 
- Other: _________________________________________________________________________ 
PRECAUTIONS: 
- Immobilizer at all times when not exercising 
- Internal Rotation and Horizontal Adduction limited to neutral  
MINIMUM CRITERIA FOR ADVANCEMENT: 
- External Rotation to 30°  
- Minimal pain or inflammation 
 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
Emphasize: 
- PROTECTING SURGICAL REPAIR 
- Limiting horizontal adduction and IR to neutral 
- Patient compliance with sling immobilization 
MODIFICATIONS TO PHASE I: 
 
POST – OPERATIVE PHASE II (WEEKS 4-6) 
GOALS:  
 
- Continue to promote healing 
- Elevation in plane of scapula to 90° 
- Internal Rotation to 45°  
- Begin to restore rotator cuff strength to 4/5 
TREATMENT RECOMMENDATIONS: 
- D/C immobilizer (MD directed), AAROM elevation in plane of scapular and ER, progress scapular 
strengthening protecting posterior capsule (modify closed chain exercises), sub-maximal isometrics ER/IR, 
sub-maximal deltoid isometrics, modalities for pain and edema, prn, progress HEP 
PRECAUTIONS: 
- Limit Internal rotation to 45° 
- Horizontal adduction limited to neutral  
- Protect posterior capsule 
- Avoid rotator cuff inflammation 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Minimal pain and inflammation 
- Elevation in plane of scapula to 90° 
- Internal rotation/ external rotation strength  4/5 

 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
Emphasize: 
- PROTECTING SURGICAL REPAIR 
- Monitoring ROM 
- Avoiding excessive stretch to posterior capsule 
- Avoiding inflammation of rotator cuff 
 
MODIFICATIONS TO PHASE II: 
 
 
POST – OPERATIVE PHASE III (WEEKS 6-12) 
 
GOALS:  
- Restore full shoulder range of motion 
- Restore normal scapulohumeral rhythm throughout ROM 
- Upper extremity strength 5/5 
- Restore normal UE flexibility 
- Isokinetic IR/ER strength 85% of unaffected side 
 
TREATMENT RECOMMENDATIONS: 
- Initiate AAROM IR, continue AAROM for ER and elevation on plane of scapula, continue progressive scapula 
strengthening, protecting posterior capsule, initiate IR/ ER in modified neutral, begin latissimus strengthening, 
begin scapula plane elevation when RC and scapula strength is adequate, humeral head stabilization 
exercises, PNF patterns if IR/ ER is 5/5, isokinetic training and testing, UE endurance (UBE), initiate flexibility 
exercises, modalities prn, modify HEP 
PRECAUTIONS: 
- Avoid rotator cuff inflammation 
- Continue to protect posterior capsule 
- Avoid excessive passive stretching 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Pain-free 
- Full upper extremity range of motion 
- Normal scapulohumeral rhythm 
- Normal upper extremity flexibility 
- IR/ER strength 5/5 
- 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 scapula and rotator 
cuff strength base 
 
MODIFICATIONS TO PHASE III: 
  
 
POST – OPERATIVE PHASE IV (WEEKS 12-18) 
 
GOALS:  
 
- Restore normal neuromuscular function 
- Maintain strength and flexibility 
- Isokinetic IR/ER strength ≥ 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 
- Avoid loss of strength and instability 
- Avoid overtraining 
TREATMENT RECOMMENDATIONS: 
- Full UE strengthening emphasizing eccentrics, UE flexibility program, advance ER/IR strength to 90/90 
position (overhead athlete), isokinetic training and testing, continue endurance training, initiate plyometrics, 
sport and activity related program, address trunk and LEs as required, modalities prn, 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: ___ /___ / _____ 
Emphasize: 
- Eccentric strengthening for overhead athlete 
- Elimination of strength deficits 
- Restoration of ER/IR strength ratio 
- Restoration of flexibility to meet demands of 
sport activity 
