 Sports Rehabilitation & Performance Center 
 SLAP Repair Guidelines© * 
 
The following SLAP Repair 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 SLAP repair emphasizes 
early, controlled motion to optimize healing and to avoid excessive passive stretching.  
Abduction and external rotation ROM of the shoulder, and biceps strengthening are 
progressed slowly to avoid excessive stretch to the labrum and traction to the long head of the 
biceps.  The program is based on the patient returning to sport-specific activities no earlier 
than 3-4 months post-surgery. 
 
Follow physician’s modifications as prescribed 
 
 
 
POST – OPERATIVE PHASE I (WEEKS 0-4) 
MAXIMUM PROTECTION PHASE  
 
 
 
 
 
 
GOALS:  
- Promote healing :  reduce pain and inflammation 
- Elevation in plane of scapula to 90° 
- External rotation: MD directed 
- Independent home exercise program 
 
PRECAUTIONS: 
- Immobilizer at all times, except when exercising or bathing 
- External Rotation and extension limited to neutral 
 
TREATMENT RECOMMENDATIONS: 
- Immobilizer; Gripping exercises; AAROM external rotation to neutral; AAROM elevation in PoS; AROM wrist/ 
elbow (supported to avoid biceps stress); scapular mobility and stability (sidelying, progressing to manual 
resistance); pain-free, submaximal deltoid isometrics; pain-free, submaximal RC isometrics; Modalities as 
needed; Home exercise program 
- Other: _________________________________________________________________________ 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- External rotation:  at least to neutral, MD directed  
- Elevation in plane of scapula to 90° 
- Minimal pain or inflammation 
 
 
 
 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
Emphasize: 
- PROTECTING SURGICAL REPAIR 
- Minimizing pain and inflammation 
- Patient compliance with sling immobilization  
 
MODIFICATIONS TO PHASE I: 
External Rotation to: ______° 
 
 
POST – OPERATIVE PHASE II (WEEKS 4-8) 
GOALS:  
 
- Continue to promote healing 
- Elevation in plane of scapula to 145° 
- External rotation to 60° 
- Begin to restore scapula and upper extremity strength 
- Restore normal scapulohumeral rhythm 
 
PRECAUTIONS: 
- Limit external rotation to 30° until 6 weeks 
- Avoid excessive stretch to the labrum and biceps 
- Avoid rotator cuff inflammation 
 
TREATMENT RECOMMENDATIONS: 
- Discontinue immobilizer (surgeon directed); Continue AAROM elevation (PoS): wand exercises, pulleys; 
Continue AAROM external rotation: limited to 30° until 6 weeks; Hydrotherapy as required; Manual scapular 
side-lying stabilization exercises; progress scapular strengthening in protective arcs; Physio ball stabilization 
exercises; Internal/External rotation isometrics (submaximal/pain-free) progressing to isotonic 
internal/external rotation strengthening at 6 weeks; begin humeral head stabilization exercises; scapular plane 
elevation (emphasis on scapulohumeral rhythm); begin latissimus strengthening, limited to 90° forward 
flexion; modalities, as needed; modify home exercise program 
 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Elevation in plane of scapula to 145° 
- External rotation to 60° 
- Normal scapulohumeral rhythm 
- Minimal pain and inflammation 
- Internal rotation/ external rotation strength  5/5 
 
 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
 
 
Emphasize: 
- PROTECTING SURGICAL REPAIR 
- Avoiding inflammation of rotator cuff 
- Normalizing scapulohumeral rhythm 
 
MODIFICATIONS TO PHASE II: 
  
 
POST – OPERATIVE PHASE III (WEEKS 8-14) 
GOALS:  
- Restore full shoulder range of motion 
- Restore normal scapulohumeral rhythm 
- Isokinetic IR/ER strength 85% of uninvolved side 
- Restore normal flexibility 
 
PRECAUTIONS: 
- Avoid rotator cuff inflammation 
- Avoid excessive passive stretching 
 
TREATMENT RECOMMENDATIONS: 
- Continue AAROM for elevation in scapular plane and external rotation; AAROM for internal rotation; 
aggressive scapular and latissimus strengthening; begin biceps strengthening; begin PNF patterns if 
internal/external rotation strength in 5/5; progress humeral head stabilization exercises; progress 
internal/external rotation to 90/90 position if required; general upper body flexibility exercises; upper body 
ergometry; Isokinetic training and testing; modalities as needed; modify home exercise program 
 
MINIMUM CRITERIA FOR ADVANCEMENT: 
- Normal scapulohumeral rhythm 
- Minimal pain and inflammation 
- Full upper extremity range of motion 
- Isokinetic internal/external rotation strength 85% of uninvolved side 
 

Patient Name: ______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. 
Date: ___ /___ / _____ 
 
 
Emphasize: 
- Monitoring ROM 
- Avoiding excessive passive stretching 
- Normalizing scapulohumeral rhythm 

POST – OPERATIVE PHASE IV (WEEKS 14-18) 
GOALS:  
 
- Restore normal neuromuscular function 
- Maintain strength and flexibility 
- Isokinetic IR/ER strength equal to the unaffected side 
- Prevent re-injury 
 
PRECAUTIONS: 
- Pain free plyometrics 
- Significant pain with a specific activity 
- Feeling of instability 
 
TREATMENT RECOMMENDATIONS:  
- Continue full upper extremity strengthening program and flexibility exercises; activity-specific plyometrics 
program; address trunk and lower extremity demands; continue endurance training; begin sport or activity-
related program; modify home exercise program 
 
CRITERIA FOR DISCHARGE: 
- Isokinetic IR/ER strength equal to unaffected side 
- > 66% Isokinetic ER/IR strength ratio 
- Independent home exercise program 
- Independent, pain-free sport or activity-specific program 
 
 
 
Patient Name: _______________________________________________ 
 
Physician’s Signature: ________________________________________ M.D. Date: ___ /___ / _____ 
Emphasize: 
- Monitoring symptoms 