🔑 About Bankart Repair
- The labrum (cartilage rim of the shoulder socket) has been reattached: it must heal before stress is applied
- The most dangerous position early on is arm raised + turned outward (abduction + external rotation): this stresses the repair directly
- No carrying objects for 12 weeks: even light bags stress the repair
- Sling for 6 weeks: sleep in sling for the full 6 weeks
- Cricket bowling, throwing, and contact sports require 4–6 months minimum
Phase 1
Immediate Protection: Sling Phase
Week 0 – Week 3🎯 Goals
- Protect the labral repair
- Control pain and swelling
- Keep elbow, wrist, and hand moving
- Begin scapular activation
- Gentle passive shoulder movement from Week 2
⚠️ Precautions
- Sling at all times including sleeping: for 6 weeks
- No active shoulder movement
- No lifting any objects (including bags, cups of tea with operated arm)
- No reaching behind back
- No supporting body weight with hands
- Avoid abduction + external rotation: direct stress on repair
- Shower with arm by side; no baths/pools until wound healed
Exercises
- Wrist flexion/extension and circles
- Finger bending and squeezing
- Ball squeezes
- Scapular retractions: in sling
- Pendulums (Week 2): arm hangs, small gentle sway only
- PROM flexion (Week 2): passive elevation to 90°
- PROM ER (Week 2): to 20° in scapular plane only
- Table slide: sit at table, slide arm forward
- Ice 4–5 times daily
✅ Ready for Phase 2 When:
- PROM shoulder flexion to 90°
- PROM external rotation to 20°
- Palpable scapular muscle activation
Phase 2
Protection Phase: Gradual ROM
Week 4 – Week 5🎯 Goals
- Continue protecting repair
- Increase PROM: flexion to 140°, ER to 45°
- Begin assisted shoulder movement
- Improve dynamic stability and balance reactions
Exercises
- PROM flexion to 140°
- PROM ER to 45° in scapular plane and at 90° abduction
- Cane-assisted elevation: sitting/standing
- Wall climbs: fingers walk up the wall
- Table slides: forward and sideways
- Pulleys
- Rotator cuff isometrics: submaximal ER, IR, flexion, extension
- Scapular row on physioball
✅ Ready for Phase 3 When:
- PROM flexion to 140°
- PROM ER in scapular plane to 45°
- PROM ER at 90° abduction to 45°
- Minimal substitution with assisted movement
- Pain less than 2/10
Phase 3
Intermediate Phase: Active Movement Begins
Week 6 – Week 8🎯 Goals
- Discontinue sling
- Independence with daily activities
- Begin rotator cuff strengthening
- Progress scapular strength
- Improve neuromuscular control
Exercises
- Active shoulder elevation: starting in lying, progress to standing
- PROM ER to 50–65° in scapular plane
- Side-lying ER with light weight
- Resistance band ER and IR standing
- Posterior capsule stretch: cross-body, sleeper stretch
- Scapular exercises: resistance band rows, push-up plus on knees, prone extension
- Rhythmic stabilisation: ER/IR at various angles
- Ball stabilisation on wall
⚠️ Precautions Phase 3
- No aggressive ROM or forced stretching of anterior shoulder
- Avoid push-ups and chest press movements: stress on anterior capsule
- No running or jogging on treadmill
- No lifting more than 5 kg
- No throwing, bowling, or overhead sport activities
✅ Ready for Phase 4 When:
- No signs of shoulder apprehension (fear of dislocation with arm raised and out)
- Shoulder flexion PROM to 160°
- PROM ER to 50–65° in scapular plane
- Pain less than 2/10
Phase 4
Transitional Phase: Progressive Strength
Week 9 – Week 11🎯 Goals
- Full passive and active ROM
- Progress rotator cuff and scapular strength
- Improve dynamic shoulder stability
- No carrying objects until Week 12
Exercises
- Full PROM and AROM: all planes
- Capsular stretching: continue cross-body and sleeper stretch
- Scaption and shoulder flexion to 90°
- Standing abduction
- Prone Ts and Ys
- Full push-up plus
- PNF diagonal patterns D1 and D2
- Biceps, triceps, shrugs
- Light resistance only until Week 12
✅ Ready for Phase 5 When:
- No signs of apprehension
- Full pain-free PROM and AROM
- Symmetric scapular mechanics
- Pain 0–2/10
Phase 5
Strengthening Phase
Week 12 – Week 16🎯 Goals
- Maintain full pain-free ROM
- Build shoulder strength to 5/5
- ER/IR strength ≥85% of other arm
- Begin restricted sport activities (light swimming)
Exercises
- ER and IR at 90° abduction with resistance
- Push-up progression: wall → counter → knee → full
- Lat pull-down
- Resistance band PNF patterns
- Body blade oscillations
- Upper limb on uneven surface
- Stretching: ER at 90° ABD, hands behind head
- Endurance training: light swimming half-strokes
- Progress weights up to 7 kg
Phase 6
Return to Sport
Month 4 – Month 6🎯 Goals
- Full pain-free ROM maintained
- Shoulder strength ≥85% of other arm
- Return to strenuous work
- Gradual return to sport and recreational activities
🏏 Sport Progression
- Month 4: Throwing program begins: short distances, easy pace
- Month 4–5: Progress throwing distance and pace
- Month 5: Overhead sport movements: cricket batting
- Month 5–6: Cricket spin bowling, badminton
- Month 6+: Cricket fast bowling, contact sports: surgeon clearance
- Avoid wide-grip bench press, military press, and lat pulldowns behind head: permanently high dislocation risk
Activity Guide
| Activity | Allowed? | When | Notes |
|---|---|---|---|
| Sling use | REQUIRED | 6 weeks | Day and night including sleeping; remove only for showering and exercises |
| Elbow/wrist/hand movement | YES | Day 1 | Keep distal joints moving at all times |
| Driving | WAIT | Week 6 | Surgeon clearance; off sling and strong painkillers |
| Two-wheeler | WAIT | Month 3+ | Risk of fall and sudden jerk stressing repair; confirm with surgeon |
| Office/desk work | CAUTION | Week 2–3 | In sling; operated arm resting; one-handed tasks only |
| Light housework (one hand) | CAUTION | Week 6 | No overhead reaching, no lifting with operated arm |
| Carrying objects | WAIT | Week 12 | No carrying anything in operated hand for 12 weeks: even a handbag |
| Swimming (gentle) | CAUTION | Month 3–4 | Half strokes, no overhead catch phase; surgeon clearance |
| Cricket batting | CAUTION | Month 4–5 | Gradual; avoid wild shots that externally rotate arm under stress |
| Cricket bowling (spin) | CAUTION | Month 5 | Surgeon clearance; progress throwing program first |
| Cricket fast bowling | WAIT | Month 6+ | Highest demand on anterior shoulder: surgeon clearance mandatory |
| Badminton / overhead racquet | WAIT | Month 5–6 | Surgeon clearance; overhead smash is high risk |
| Contact sports / kabaddi | WAIT | Month 6+ | Risk of re-dislocation with contact; surgeon clearance |
| Wide-grip bench press / military press | AVOID | Permanently | High risk of re-dislocation: avoid these specific exercises long-term |
🚨 When to Contact Us
🔴 Come to Hospital Immediately
- Shoulder appears out of position: feels or looks dislocated
- Sudden severe pain after a fall or contact
- High fever with wound redness or discharge
- Arm becomes cold, pale, or numb
🟡 Call Clinic Within 24 Hours
- New apprehension or fear when raising arm outward
- Wound not healing or looks infected
- Pain not settling with rest and ice
- Increasing stiffness despite physio
📅 Follow-up Schedule
🗓 Clinic Reviews
- 2 weeks: Wound check, suture removal
- 6 weeks: ROM, sling weaning
- 3 months: Strength assessment
- 6 months: Sport clearance
⚠️ Re-injury Prevention
- Always warm up shoulder before sport
- Continue rotator cuff programme 3x/week lifelong
- Avoid landing on outstretched arm
- Report any new instability or apprehension early
🏠 Daily Life Tips
- Sleep on back or non-operated side
- Dress operated arm first, undress last
- Avoid carrying heavy bags on operated shoulder
- Avoid sleeping on operated shoulder for 3+ months