 
Massachusetts General Brigham Sports Medicine 
Rehabilitation Protocol for Posterior Bankart Repair 
 
This protocol is intended to guide clinicians through the post-operative course for posterior bankart repair. This protocol 
is time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the 
needs of the individual and should consider exam findings and clinical decision making. The timeframes for expected 
outcomes contained within this guideline may vary based on surgeon’s preference, additional procedures performed, 
and/or complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult 
with the referring surgeon. 
 
The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should 
be included and modified based on the progress of the patient and under the discretion of the clinician.  
 
Considerations for the Post-operative Posterior Bankart Repair 
Many different factors influence the post-operative posterior bankart repair rehabilitation outcomes, including pre-
operative tissue quality, shoulder range of motion, arm strength, and function. Other individual considerations include 
patient age and co-morbidities, such as: increased BMI, smoking, and diabetes. It is recommended that clinicians 
collaborate closely with the referring physician regarding specific range of motion or loading guidelines for each 
individual case. 
 
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain, 
or any other symptoms you have concerns about contact the referring physician. 
 
PHASE I: IMMEDIATE POST-OP (0-4 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Allow healing of repaired capsule 
• Initiate early protected and restricted range of motion (ROM) 
• Decrease pain/inflammation 
Sling 
• Use of sling as instructed by your surgeon, typically 4-6 weeks 
Precautions 
• No internal rotation 
• No horizontal adduction 
• No upper extremity weight bearing 
• No overhead activities 
Interventions 
Pain/swelling management 
• Ice, compression, and modalities as needed 
 
Manual therapy 
• Grade 1-2 traction and inferior glides in loose packed position to help manage pain and muscle 
guarding 
 
Passive Range of Motion 
• Supine external rotation to tolerance 
• Supine forward elevation (limited to 120 deg) 
• Pendulums 
 
Strengthening 
• Isometrics: Internal and external rotation in neutral, flexion, extension and abduction 
• Rhythmic stabilization and proprioceptive exercises with PT 
• Scapular retraction 
• Ball squeeze exercise 
 
 
Criteria to 
Progress 
• PROM shoulder flexion to 90 deg 
• Compliant with post-op precautions 
• No complications in initial phase 
 
 
PHASE II: INTERMEDIATE POST-OP (5-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Gradual increase in ROM 
• Initiate active assisted/active ROM 
• Improve strength 
• Decrease pain/inflammation 
Sling 
• Wean from sling 
Precautions 
• No internal rotation behind back 
• No horizontal adduction 
• No upper extremity weight bearing 
• No overhead activities 
Additional 
Interventions 
*Continue with 
Phase I 
interventions 
Active Assisted/Active ROM 
• IR: to 30 deg in plane of scapula 
• Flexion: to 140 deg as tolerated 
• ER to tolerance 
 
Strengthening 
• Side-lying ER 
• Prone row 
• Prone extension 
• Standing forward flexion to 90 deg 
• Biceps curl 
• Band exercises: ER, IR (IR limited to neutral) 
 
Manual Therapy 
• Grades 1-3 oscillatory mobs to GH joint. Caution not to over-stress repaired structures 
Criteria to 
Progress 
• Shoulder flexion ROM to 120-140 deg 
• Pain/inflammation controlled 
• Compliant with post-op precautions 
 
PHASE III: LATE POST-OP (7-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Gradually restore ROM 
• Increase strength 
• Improve neuromuscular control 
• Enhance proprioception and kinesthesia 
Precautions 
• Discharge sling 
• Continue to avoid excessive/forceful horizontal adduction and internal rotation 
- IR behind back to beltline only 
• No push-ups 
Additional 
Interventions 
*Continue with 
Phase I-II 
Interventions  
Range of Motion/Mobility 
• ER @ 90 deg abduction to tolerance 
• Shoulder flexion to tolerance 
• IR in plane of scapula to 60 deg 
• IR @ 90 deg abduction to 30-45 deg by week 10 
- Progress gradually with caution to 60-65 deg by week 12 
• Pulleys 
• Wall slides 
• Hands-behind-head stretch 
 
Strengthening 
 
 
• Band exercises: Dynamic hug, bilateral ER/’W’s, biceps curl, rows, forward serratus punch, 
diagonal flexion and extension patterns, ER/IR @ 90 deg 
• Side-lying scaption 
• Prone ‘T’s, ‘Y’s 
• Standing scaption 
• Rhythmic stabilization and proprioception drills 
• Wall push-ups at week 12 
Criteria to 
Progress 
• ER @ 90 deg abduction to 85-90 deg, 110-115 deg for throwers 
• IR @ 90 deg abduction to 60-65 deg 
• IR in plane of scapular to 60 deg 
• Shoulder flexion to 165 deg 
 
PHASE IV: TRANSITIONAL (13-20 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect the ligament repair 
• Regain full range of motion 
• Continue strengthening 
• Gradual return to full activity 
Additional 
Interventions 
*Continue with 
Phase II-III 
interventions 
Range of Motion/Mobility 
• Horizontal adduction stretching 
• ER @ 90 deg abduction stretching 
• Full behind back IR 
 
Strengthening 
• Initiate weight training with machine resistance: front pull downs, seated row, seated bench 
press: at week 16 
• Closed kinetic chain: ball on wall, push-up progression with unstable surface: at week 20 
• PNF manual resistance with PT 
Criteria to 
Progress 
• Full shoulder ROM 
• 80% strength of ER and IR compared to contralateral shoulder with dynamometry testing 
• 80% or > performance with field testing 
 
PHASE V: EARLY RETURN TO SPORT (21-28 weeks AFTER SURGERY) 
Rehabilitation 
Goals 
• Full shoulder strength 
• Unrestricted activities 
• Initiation of interval return to sport training at 28 weeks 
Additional 
Interventions 
*Continue with 
Phase II-IV 
interventions 
Range of Motion/Mobility 
• Soft tissue stretching to restore or maintain full shoulder ROM 
 
Strengthening 
• Plyometric exercises: rebounder throws, overhead ball dribbles, deceleration catches, standing 
ball drops, prone 90/90 ball drops 
• Progressive weight training involving compound movements and larger muscle groups 
Criteria to 
Progress 
• 90% or > strength of ER and IR compared to contralateral shoulder with dynamometry testing 
• 90% or > performance with field testing 
• 90% or > on reported outcome measures (DASH, Penn Shoulder Score) 
Revised 10/2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
References: 
 
Amako M, Arino H, Tsuda Y, Tsuchihara T, Nemoto K. Recovery of Shoulder Rotational Muscle Strength After Arthroscopic Bankart Repair. Orthopaedic Journal 
of Sports Medicine. September 2017. doi:10.1177/2325967117728684 
 
 
 
Manske RC, Davies GJ. Postrehabilitation outcomes of muscle power (torque-acceleration energy) in patients with selected shoulder dysfunctions. Journal of 
Sports Rehab. 2003;12(3):181-198. 
 
Reinold MM, Gill TJ, Wilk KE, Andrews JR. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury 
prevention and treatment. Sports Health. 2010;2(2):101-115. doi:10.1177/1941738110362518 
 
 
 
 
