Anterior Stabilisation (Soft tissue procedures including Bankart Repair and Capsular Shift)

Updated Evidence-Based Insights (2023–2024)

  1. Sling Use
    • 4–6 weeks is still standard.
    • Wearing the sling at night beyond 4 weeks offers no additional benefit for most.
  2. ER Progression
    • Controlled ER to neutral (handshake position) is safe early on.
    • Full ER ROM should not be forced until 12+ weeks, especially for contact athletes.
    • Gradual ER progression leads to lower redislocation rates.
  3. Strengthening and Return to Activity
    • Isometric cuff and scapular muscle training can begin by week 6, once pain allows.
    • Return to overhead sports is safe from 16–20 weeks, with strength ≥90% of contralateral side and no apprehension.
    • Eccentric training improves neuromuscular control and reduces re-injury.
    • [Ref: ASES, ACSM, and Kluczynski et al.]
  4. Avoid Early Abduction + ER
    • Especially important in early phase (0–6 weeks) due to strain on anterior capsule.

Updated Anterior Stabilisation Rehab Protocol (2024)

Phase Timeline Goals & Interventions Avoid
Phase 1: Protection Phase 0–2 weeks – Sling (full-time except hygiene)
– Pendulums, hand/elbow/wrist ROM
– Passive ER to neutral (handshake)
– Patient education re: protection without fear		 – Active ER or IR
– ABD/ER combo
– Overhead motion
Phase 2: Controlled Passive Motion 2–4 weeks – Continue sling
– Supported flexion <120°
– Table slides, walk backs
– Scapular setting
– ER to neutral only		 – Combined ABD/ER
– Forced ER mobilisations
Phase 3: Assisted ROM & Early Strength 4–6 weeks – Wean off sling during day
– Active-assisted ROM
– ER to 30–45° gradually
– Initiate scapular and isometric cuff control		 – Sudden overhead or resisted ER
Phase 4: Functional Strengthening 6–12 weeks – Full AROM by week 10
– Gradual intro of supported ABD/ER
– Begin resistance (bands, light weights)
– Include CKC + proprioceptive drills		 – High-load/velocity activities
Phase 5: Sport-Specific & Dynamic Control 12–20 weeks – Eccentric and dynamic cuff training
– Progress kinetic chain drills
– Return to work/sport prep based on function (strength ≥90%)		 – Return to contact sports without clearance
Phase 6: Return to Sport 20+ weeks – Clearance testing
– Return to full training/sport if pain-free, full ROM, no apprehension
– Include reactive drills, throwing program if applicable		 – Ignoring signs of instability or fatigue

Progression Criteria Examples:

  • Full ROM pain-free
  • Strength ≥90% contralateral side
  • No apprehension during ER or overhead movements

Sport-specific skills can be performed without compensation

Aviva Cigna AXA PPP Proclaim Care WPA Healthcare

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