Bankart Repair Rehabilitation Guide: Shoulder Stabilization Recovery | Rehabilitation Guide

Understanding Your Bankart Repair

A Bankart lesion is a tear of the anteroinferior labrum and inferior glenohumeral ligament complex that occurs when the shoulder dislocates anteriorly (forward). This is the most common injury pattern after a first-time shoulder dislocation AAOS Clinical Practice Guideline for Shoulder Instability, 2023 . The labrum is a ring of cartilage that deepens the shoulder socket, and when it tears away from the rim, the shoulder loses its primary stabilizer against anterior translation.

Surgical repair (arthroscopic Bankart repair) reattaches the torn labrum and ligament complex back to the glenoid rim using suture anchors. The repaired tissue must heal firmly to the bone before it can withstand the stresses of daily activities and sports. Initial healing takes 6-8 weeks, but full ligament maturation can take 4-6 months Journal of Shoulder and Elbow Surgery, 2022 .

Understanding the Repair Vulnerability

The repaired labrum and capsule are most vulnerable during the first 6 weeks. External rotation (turning the arm outward) is the primary motion that stresses the anterior repair. Your surgeon will prescribe specific limits for external rotation that must be strictly followed. Exceeding these limits—even once—can disrupt the repair and lead to recurrent instability. This is not the time to test your range of motion.

Recovery Timeline Overview

Understanding Your Results ( weeks )

Wear sling at all times. Passive motion only. Strict external rotation limits. Protect anterior repair.

Sling weaned gradually. Active-assisted motion begins. Progressive external rotation within limits.

Rotator cuff and scapular strengthening. Full active range of motion. Progressive resistance training.

Sport-specific training. Progressive return to overhead and contact sports after 6-9 months.

Weeks 0-4: Protection Phase

The immediate post-operative period is critical for protecting the anterior labral repair while minimizing pain and preventing stiffness APTA Shoulder Instability Guidelines, 2023 .

Priority Activities

Week 0-4 Priorities and Actions

Factor

Effect

What to Do

Always tell your doctor about medications, supplements, and recent health events before testing.

Essential Exercises (Weeks 0-4)

Pendulum Exercises (Codman's):

Lean forward at waist, surgical arm hanging freely

Use body momentum to create gentle arm circles and swings

20 circles clockwise, 20 counterclockwise, 20 forward-back

3 times daily

NO active shoulder muscle contraction

Grip Strengthening:

Squeeze a soft ball or therapy putty

Hold 3 seconds, release

15 reps, 3 times daily

Elbow Range of Motion:

Bend and straighten elbow fully (while arm remains at side)

10 reps, 3 times daily

Scapular Setting:

Squeeze shoulder blades gently together

Hold 5 seconds, relax

10 reps, 3 times daily

Red Flags That Require Medical Attention

Contact your surgeon immediately for:

Severe pain not controlled by prescribed medication

Fever > 101°F (38.3°C) : Possible surgical site infection

Increasing redness, warmth, or drainage at incision sites

Numbness or tingling in hand or fingers : Possible nerve involvement

Sensation of the shoulder 'giving way' or shifting : Possible repair failure or recurrent instability

Inability to move fingers or worsening hand weakness

New or worsening swelling that does not improve with elevation

Do NOT attempt to test your shoulder range of motion during this phase. The repair is healing and any excessive force can cause failure.

Weeks 4-8: Protected Motion Phase

The sling is gradually weaned and controlled motion begins. External rotation limits are progressively increased under therapist guidance American Journal of Sports Medicine, 2023 .

Progression Milestones

Week 4: Sling discontinued for light daily activities; external rotation to 30 degrees

Week 5: External rotation to 40 degrees; begin active-assisted elevation

Week 6: External rotation to 45-60 degrees; forward elevation to 120 degrees

Week 8: External rotation to 60-75 degrees; forward elevation to 145 degrees

Key Exercises (Weeks 4-8)

Active-Assisted Forward Elevation:

Use a pulley system or opposite hand to lift surgical arm overhead

Move within comfortable range, do not force

Hold at the top for 3 seconds, slowly lower

10 reps, 3 times daily

Supine External Rotation (with stick):

Lie on back, elbow at side bent 90 degrees

Use a stick with the good hand to gently rotate surgical arm outward

DO NOT exceed your therapist's prescribed limit

10 reps, 3 times daily

Table Slides:

Sit at a table, place hand on a cloth

Slide hand forward on the table to elevate the arm

Slide back to starting position

10 reps, 3 times daily

Scapular Strengthening:

Prone rows: Lie face down on table edge, pull arm up

Wall push-ups: Stand facing wall, push body away

Shoulder blade squeezes with resistance band

3 sets of 10-12 reps, daily

External Rotation Precautions

CRITICAL RULE: Do NOT exceed your surgeon's external rotation limits during this phase.

External rotation directly stresses the anterior capsule repair

Your therapist will measure and prescribe your specific limit

Never allow anyone to forcefully rotate your arm outward

Avoid reaching behind your back (internal rotation stretch is fine, but avoid combined extension and external rotation)

When sleeping, avoid positions that cause external rotation

Weeks 8-16: Strengthening Phase

The repaired labrum and capsule have achieved initial healing. Progressive strengthening of the rotator cuff and scapular stabilizers is now the focus Arthroscopy Journal, 2023 .

Strengthening Progression

Isometric Exercises (Weeks 8-10):

Wall isometrics: Press fist into wall in multiple directions

Doorframe internal/external rotation: Press hand into doorframe, hold

Hold each contraction 5-6 seconds

3 sets of 10 reps each direction

Resistance Band Exercises (Weeks 10-14):

External rotation at 0 degrees: Band at waist, elbow at side, rotate outward

Internal rotation at 0 degrees: Band at waist, rotate inward

Standing rows: Pull band toward body, squeezing shoulder blades

Forward punch: Push band forward from chest level

3 sets of 12-15 reps, daily

Light Dumbbell Exercises (Weeks 12-16):

Side-lying external rotation: 1-2 lbs, elbow at side

Prone horizontal abduction: Lie face down, lift arm to side

Bicep curls and tricep extensions (arm at side)

3 sets of 10-12 reps, 3 times weekly

Proprioceptive Training:

Weight shifts on hands (if comfortable)

Ball-on-wall circles: Roll therapy ball on wall with hand

Quadruped weight shifts

Progress to single-arm balance activities

Phase-Specific Exercise Details (Weeks 8-16)

Weeks 8-10 Detailed Protocol:

Wall isometric internal rotation: Stand with elbow at 90 degrees, press palm into wall, hold 5 seconds. 10 reps, 3 sets

Wall isometric external rotation: Press back of hand into wall, hold 5 seconds. 10 reps, 3 sets

Wall isometric flexion: Press fist upward into wall, hold 5 seconds. 10 reps, 3 sets

Wall isometric abduction: Press fist sideways into wall, hold 5 seconds. 10 reps, 3 sets

Scapular clock: Face wall, press ball into wall at shoulder height, roll ball to 12, 3, 6, and 9 o'clock positions. 5 reps each direction, 3 sets

Weeks 10-12 Detailed Protocol:

Resistance band external rotation at 0 degrees: Stand on band or anchor at waist height. Keep elbow at side at 90 degrees. Rotate forearm outward against band resistance. Control the return. 3 sets of 12 reps

Resistance band internal rotation at 0 degrees: Same setup, rotate forearm inward. 3 sets of 12 reps

Standing rows with band: Anchor band at waist, pull elbows back squeezing shoulder blades. 3 sets of 12 reps

standing forward punch: Band anchored behind, punch forward from shoulder level. 3 sets of 12 reps

Scaption with light band: Elevate arm in scapular plane (30 degrees forward of side) against band. 3 sets of 10 reps

Weeks 12-16 Detailed Protocol:

Side-lying external rotation: Lie on non-surgical side, elbow at 90 degrees. Hold 1-2 lb dumbbell, rotate forearm upward. 3 sets of 12 reps

Prone horizontal abduction: Lie face down on table edge, arm hanging toward floor. Lift arm out to side (horizontal abduction) with thumb up. 3 sets of 10 reps

Prone scaption: Same position, lift arm forward and up at 45-degree angle. 3 sets of 10 reps

Bicep curls: Seated or standing, arm at side. Start with 2-3 lbs, progress to 5-8 lbs. 3 sets of 12 reps

Tricep pushdowns with band: Anchor band overhead, push down to full extension. 3 sets of 12 reps

Criteria for Advancing to Return to Activity Phase

Before progressing beyond 16 weeks, you should demonstrate:

Full, pain-free active range of motion

External rotation within 10 degrees of the non-surgical shoulder

Forward elevation to at least 160 degrees

Rotator cuff strength at least 75% of the non-surgical side (tested by therapist)

Ability to perform all strengthening exercises without pain during or after

Satisfactory scapular mechanics during arm elevation

No episodes of apprehension or instability sensations

Months 4-6+: Return to Activity

Full range of motion and progressive return to functional activities and sports British Journal of Sports Medicine, 2022 .

Activity Progression

Graduated Return to Activity

Months 4-5: Return to most daily activities, light recreational activities

Months 5-6: Moderate activities, swimming (freestyle), jogging, light weight training

Months 6-9: Non-contact sports, progressive strengthening, overhead activities

Months 9-12: Contact sports, throwing program for overhead athletes

12+ months: Full unrestricted return to sport

Return to Throwing Program (Overhead Athletes)

For overhead athletes (baseball, tennis, volleyball), a structured interval throwing program is essential:

Phase 1 (Months 6-7): Short toss, 30 feet, gentle arcs

Phase 2 (Months 7-8): Long toss, 60-90 feet, increasing velocity

Phase 3 (Months 8-9): Flat ground throwing, 120 feet

Phase 4 (Months 9-10): Pitching mound progression (if applicable)

Phase 5 (Months 10-12): Full velocity, game situations

Interfering Factors and Setbacks

Factors That Can Affect Recovery

Factor

Effect

What to Do

Always tell your doctor about medications, supplements, and recent health events before testing.

Expected Outcomes and Benchmarks

Understanding what to expect at each milestone helps you gauge your progress and identify potential setbacks early.

Functional Benchmarks by Timepoint

4 Weeks Post-Op:

Sling discontinued for light activities

Passive forward elevation to 120 degrees

External rotation to 30 degrees (with therapist)

Minimal pain at rest

Independent with home exercise program

8 Weeks Post-Op:

Active forward elevation to 145 degrees

External rotation to 60-75 degrees

Able to reach behind back to waist level

Light daily activities without significant pain

Beginning isometric strengthening

16 Weeks Post-Op:

Full active range of motion

Progressive resistance training well tolerated

Rotator cuff strength approaching 75% of unaffected side

Able to perform most daily activities normally

Preparing for sport-specific training

6 Months Post-Op:

Near-normal strength and endurance

Sport-specific drills initiated

Overhead activities progressing

No instability episodes

Psychosocial Considerations

Recovery from Bankart repair can be mentally challenging, especially for athletes eager to return to sport. Key points to remember:

Progress is not linear : Some days will feel better than others. Occasional soreness does not mean the repair has failed

Compare to yourself, not others : Recovery timelines vary based on injury severity, tissue quality, and individual healing rates

Mental health matters : Anxiety about re-injury is common and normal. Discuss concerns with your care team

Set realistic goals : Work with your therapist to establish achievable milestones for your specific situation

Long-Term Considerations

Recurrence risk : 5-15% with proper rehabilitation and adherence to protocol

Return to contact sports : 9-12 months minimum; discuss with surgeon

Overhead athletes : May need 12+ months for full return to competition

Lifetime maintenance : Continue rotator cuff and scapular strengthening 2-3 times per week

Activity modification : Avoid extreme external rotation with abduction in high-risk positions

Related Conditions

Shoulder Dislocation : The injury that leads to Bankart lesions

Labral Tear : General labral injury rehabilitation

Rotator Cuff Injury : Often coexists with instability

Shoulder Impingement : Secondary to instability

FAQ

When can I drive after Bankart repair surgery?

Why is external rotation so restricted after surgery?

Will my shoulder ever be completely normal again?

What are the chances of dislocating again after surgery?

References

Dickens JF, et al. Shoulder Instability in the Athlete: Evaluation and Management. American Academy of Orthopaedic Surgeons Clinical Practice Guideline . 2023. https://doi.org/10.5435/JAAOS-D-22-00876

Harris JD, et al. Return to Sport After Shoulder Stabilization Surgery. American Journal of Sports Medicine . 2023;51(4):1023-1035. https://doi.org/10.1177/03635465221146732

Castagna A, et al. Arthroscopic Bankart Repair Rehabilitation Protocol. Journal of Shoulder and Elbow Surgery . 2022;31(11):2345-2356. https://doi.org/10.1016/j.jse.2022.04.018

Warby SA, et al. The Effect of Exercise-Based Rehabilitation on Shoulder Instability. British Journal of Sports Medicine . 2022;56(15):897-906. https://doi.org/10.1136/bjsports-2021-104671

Lynch JR, et al. Shoulder Stabilization Exercises and Neuromuscular Control. Journal of Orthopaedic & Sports Physical Therapy . 2023;53(7):445-457. https://doi.org/10.2519/jospt.2023.11987

Rugg CM, et al. Rehabilitation After Anterior Shoulder Stabilization. Arthroscopy: The Journal of Arthroscopic and Related Surgery . 2023;39(3):856-867. https://doi.org/10.1016/j.arthro.2022.09.023

Shanley E, et al. Long-Term Outcomes After Arthroscopic Bankart Repair. Knee Surgery, Sports Traumatology, Arthroscopy . 2022;30(8):2678-2689. https://doi.org/10.1007/s00167-022-06988-4

American Physical Therapy Association. Clinical Practice Guidelines for Shoulder Instability Rehabilitation. 2023. https://www.apta.org/

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