 Sports Rehabilitation & Performance Center 
 Subacromial Decompression Guidelines© * 
 
 
The following subacromial decompression 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 
subacromial decompression emphasizes early mobilization and scapular stability.  
Strengthening exercises emphasize balance of the shoulder girdle musculature.  Care should 
be taken to avoid activities that increase pain and inflammation  
 
Follow physician’s modifications as prescribed 
 
 
 
POST – OPERATIVE PHASE I (DAYS 0-14) 
MAXIMUM PROTECTION PHASE  
 
 
 
 
 
 
 
GOALS:  
- Control post-op pain and swelling 
- Elevation in plane of scapula: to 150° 
- External Rotation to 75° 
- Independent with light activities of daily living, dressing 
- Independent home exercise program 
 
PRECAUTIONS: 
- Pain with exercises  
- Overhead activity 
- Carrying heavy objects 
 
TREATMENT RECOMMENDATIONS: 
- Codman’s/ pendulums, AAROM elevation in plane of scapula, cane ER in plane of scapula, scapular mobility 
and stability (sidelying, progressing to manual resistance, and Theraband resistance) sub-max deltoid 
isometrics in neutral, distal strengthening, modalities for pain and edema 
- Emphasize patient compliance to HEP and protection during ADLs 
- Other: _________________________________________________________________________ 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Controlled pain 
- Elevation in plane of scapula to 150° 
- External rotation to 75° 
- Independent home exercise program 
 
 
 
 
 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
Emphasize: 
- Avoiding overhead activities 
- Controlling pain and inflammation 
 
MODIFICATIONS TO PHASE I: 
 
 
POST – OPERATIVE PHASE II (WEEKS 2-6) 
GOALS:  
 
- Restore full ROM 
- Strength 4/5 throughout involved upper extremity 
- Independent with light ADLs  
- Normal scapulohumeral rhythm <90° elevation 
- Independent home exercise program 
 
PRECAUTIONS: 
- Avoid overhead reaching until appropriate ROM and strength have been achieved 
- Avoid painful ROM 
 
TREATMENT RECOMMENDATIONS: 
- ROM (active and passive), capsular stretching and joint mobilization, advance scapular strengthening below 
the horizontal, Initiate submaximal rotator cuff strengthening (begin with isometrics), progress deltoid 
strengthening, hydrotherapy, UE PREs, upper body ergometry, modalities, progress HEP 
- Other: _________________________________________________________________________ 
 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Minimal pain and inflammation 
- Full ROM 
- Strength 4/5 throughout involved upper extremity 
- Normal scapulohumeral rhythm <90 degrees elevation 

Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
 
Emphasize: 
- Avoiding overhead reaching until adequate  
 
ROM and strength 
- Overusing the shoulder 
- Avoiding heavy lifting 
 
MODIFICATIONS TO PHASE II:  
 
 
POST – OPERATIVE PHASE III (WEEKS 6-10) 
GOALS:  
- Full shoulder range of motion 
- Restore normal scapulohumeral rhythm throughout ROM 
- Upper extremity strength 5/5 
- Restore normal flexibility (equal to opposite side) 
 
PRECAUTIONS: 
- Avoid pain with therapeutic exercise and functional ADL 
- Avoid return to sport activities until adequate flexibility and strength have been established. 
 
TREATMENT RECOMMENDATIONS: 
- Continue ROM activities, flexibility exercises, joint mobilization, capsular stretching, advanced scapular and 
rotator cuff strengthening (overhead as appropriate), humeral head rhythmic stabilization, PNF diagonal 
patterns as tolerated, UE endurance (UBE), initiate flexibility exercises as needed, modalities prn, modify and 
advance HEP 
- Other: _________________________________________________________________________ 
 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Full PROM 
- Painfree AROM 
- Strength 5/5 throughout upper extremity 
- Good flexibility 
- Normal scapulohumeral throughout the ROM 
 
 
Patient Name: _______________________________________________ 
     
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
Emphasize: 
- Avoiding inflammation of rotator cuff 
- Establishing normal strength base 
MODIFICATIONS TO PHASE III: 
 
 
 Sports Rehabilitation & Performance Center 
 Subacromial Decompression Guidelines© * 

 
 
POST – OPERATIVE PHASE IV (WEEKS 10-14) 
GOALS:  
 
- Isokinetic testing to be >85% of the contralateral side (internal/external side) 
- Pain-free during all sport-specific drills 
- Functional strength, flexibility, and endurance to meet demands of the individual’s sport 
 
PRECAUTIONS: 
- Avoid pain with therapeutic exercise and functional ADL 
- Avoid return to sport activities until adequate flexibility and strength have been established 
 
TREATMENT RECOMMENDATIONS: 
- Full UE strengthening, sport-specific plyometrics, isokinetic training and testing, advanced neuromuscular 
training, begin sport-specific drills/ interval throwing program (surgeon-directed) 
 
CRITERIA FOR DISCHARGE/ RETURN TO SPORT: 
- Patient has met strength, flexibility, and endurance goals specific to his or her sport 
- Isokinetic IR/ER strength at least 85% of the unaffected side 
- > 66% Isokinetic ER/IR strength ratio 
- Pain-free during all sport-specific drills 
 

 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. Date: ___ /___ / _____ 
 
