SAD (Subacromial Decompression) Protocol

Phase I (post-op until week 2) Protective phase

‐ Slingusefor0‐7daysasneeded(orasdirectedbyMD)

‐ ElbowandhandROMandhandsqueezingexercises

‐ Passive,AAROM,andAROMexercisesassymptomsallow(startingwithPassive.

Patienttolerancewilldetermineprogression)

‐ Initiateshoulderisometricsandscapulothoracicre‐educationandstabilization

‐ Controlinflammationandpain

Phase II (weeks 2-6) Intermediate phase

Weeks 2-4

‐ ContinuewithROMexercises(PROM/AAROM/AROM)

‐ UseofpooltherapyifpossibleforROMandshoulderstrengthening

‐ Initiategentlestretchingexercises

‐ Normalizeshoulderandscapulothoracicarthrokinematics

‐ Continuewithisometricstrengtheningandbeginwithlighttotalarm,rotator

cuffandscapulothoracicstabilizerstrengthening

‐ Controlpainandinflammation

**Progression based upon: AROM = forward flexion 90 degrees +, abduction 70

degrees+, ER in scapular plane 30 degrees, tolerance of current exercises and ADL’s, and

patient compliance with home exercises and precautions

Weeks 4-6

‐ ContinuewithROMexerciseswithfocusonincreasingtofullROM

‐ Progresswithstretchingexercises

‐ Advancewithshoulderrotatorcuff,scapularstabilizersandtotalarm

strengthening(beginwithnoresistanceandprogressiontoweightsandtubing),

sidelyingER,andpronestrengthening,andfullcanscaption

‐ PNFwithlightmanualresistanceandrhythmicstabilization

‐ UBEforstrengtheningandendurancetrainingwithproperscapulothoracicand

shoulderpositioning

‐ Initiatejointmobilization(G/H,A/C,S/C,S/T)andposteriorcapsularstretching

‐ Avoidcompensatorypatternswithstrengthening(adjustasnecessarywithless

repsordecreasedresistance)

**Progression based upon: AROM = forward flexion 150 degrees +, abduction 140

degrees+, ER in scapular plane 40 degrees, tolerance of current exercises and ADL’s, and

patient compliance with home exercises and precautions

Phase III (Weeks 6-10) Strengthening Phase

‐ FullROM(AAROMandAROM)

‐ Continuewithstretching

‐ Continuetoprogresswithstrengthening(scapularstabilizers,rotatorcuff

musculature,flexionandabductionmovements,tricepsandbiceps)

‐ Openandclosedchainexercisesandperturbationtraining

‐ Rhythmicstabilization

‐ Lightinitiationtosportactivitiesasappropriateandpatienttolerates

**Progression based upon full pain free ROM to functional demands, strength deficits

less than 25%, good quality shoulder and scapulothoracic stabilization

Phase IV (Weeks 11+) Advanced Strengthening Initiation of Sport Activity

‐ Continuewithstretchingexercises

‐ Advancedstrengthening(includingoverheadstrengthening,isokineticER/IR

strengtheningat90degreesofabduction,increasedisotonictraining)

‐ Endurancetraining

‐ Rhythmicstabilizationinallrangesandpositions

‐ ManualPNFresistance

‐ Advancedclosedkineticchainexercises

‐ Sportspecifictraining

**Progression based upon pain free tolerance to training, strength deficits less than 10%

throughout, completion of training program, and confidence in shoulder

Last reviewed 1/1/2011