SAD (Subacromial Decompression) Protocol
Phase I (post-op until week 2) Protective phase
Slingusefor07daysasneeded(orasdirectedbyMD)
ElbowandhandROMandhandsqueezingexercises
Passive,AAROM,andAROMexercisesassymptomsallow(startingwithPassive.
Patienttolerancewilldetermineprogression)
Initiateshoulderisometricsandscapulothoracicreeducationandstabilization
Controlinflammationandpain
Phase II (weeks 2-6) Intermediate phase
Weeks 2-4
ContinuewithROMexercises(PROM/AAROM/AROM)
UseofpooltherapyifpossibleforROMandshoulderstrengthening
Initiategentlestretchingexercises
Normalizeshoulderandscapulothoracicarthrokinematics
Continuewithisometricstrengtheningandbeginwithlighttotalarm,rotator
cuffandscapulothoracicstabilizerstrengthening
Controlpainandinflammation
**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
ContinuewithROMexerciseswithfocusonincreasingtofullROM
Progresswithstretchingexercises
Advancewithshoulderrotatorcuff,scapularstabilizersandtotalarm
strengthening(beginwithnoresistanceandprogressiontoweightsandtubing),
sidelyingER,andpronestrengthening,andfullcanscaption
PNFwithlightmanualresistanceandrhythmicstabilization
UBEforstrengtheningandendurancetrainingwithproperscapulothoracicand
shoulderpositioning
Initiatejointmobilization(G/H,A/C,S/C,S/T)andposteriorcapsularstretching
Avoidcompensatorypatternswithstrengthening(adjustasnecessarywithless
repsordecreasedresistance)
**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
FullROM(AAROMandAROM)
Continuewithstretching
Continuetoprogresswithstrengthening(scapularstabilizers,rotatorcuff
musculature,flexionandabductionmovements,tricepsandbiceps)
Openandclosedchainexercisesandperturbationtraining
Rhythmicstabilization
Lightinitiationtosportactivitiesasappropriateandpatienttolerates
**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
Continuewithstretchingexercises
Advancedstrengthening(includingoverheadstrengthening,isokineticER/IR
strengtheningat90degreesofabduction,increasedisotonictraining)
Endurancetraining
Rhythmicstabilizationinallrangesandpositions
ManualPNFresistance
Advancedclosedkineticchainexercises
Sportspecifictraining
**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