Dr Mak Protocol™

SLAP Repair Rehabilitation Protocol

Criteria-Based Progressive Model

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Phase 1: Protection Phase

Week 0–4

Goals

• Protect labral repair

• Reduce pain and inflammation

• Prevent shoulder stiffness

• Maintain scapular activation

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Immobilization

• Sling: full-time (except exercises and hygiene)

• Sleep with sling

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Range of Motion (Passive only)

Week 0–2:

• Flexion: up to 90°

• Abduction: up to 60°

• External rotation: up to 20°

• Internal rotation: to abdomen

Week 2–4:

• Flexion: up to 120°

• Abduction: up to 90°

• External rotation: up to 30°

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Exercises

1. Pendulum Exercise

3 × 20 reps

Gentle, pain-free

2. Scapular Retraction

3 × 15 reps

3. Hand, Wrist, Elbow ROM

Full ROM

3 × 15 reps

4. Cervical mobility exercises

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Avoid

• Active shoulder movement

• Biceps contraction

• Lifting objects

• External rotation beyond limits

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Phase 2: Early Motion Phase

Week 4–8

Goals

• Restore passive ROM

• Begin active assisted motion

• Improve scapular stability

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ROM Progression

Week 4–6:

• Flexion: 140°

• ER: 45°

Week 6–8:

• Flexion: full

• ER: 60–75°

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Exercises

1. Active Assisted ROM

Stick or pulley

3 × 12 reps

2. Scapular strengthening

3 × 15 reps

3. Isometric exercises

External rotation

Internal rotation

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Avoid

• resisted biceps

• heavy lifting

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Phase 3: Strengthening Phase

Week 8–12

Goals

• Restore full ROM

• Improve strength

• Restore neuromuscular control

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Exercises

1. Theraband External Rotation

3 × 12 reps

2. Theraband Internal Rotation

3 × 12 reps

3. Scaption raises (light weight)

3 × 10 reps

4. Closed chain stability exercises

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Begin light functional activity

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Phase 4: Advanced Strength Phase

Month 3–5

Goals

• Restore full strength

• Improve dynamic stability

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Exercises

1. Dumbbell strengthening progression

2. Push-up progression

3. Plyometric preparation

4. Core strengthening

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Phase 5: Return to Sport Phase

Month 5–7

Goals

• Restore sport-specific function

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Exercises

1. Sport-specific drills

2. Throwing progression (if athlete)

3. Plyometric exercises

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Return to Sport Criteria

Patient must have:

• Full pain-free ROM

• ≥90% strength symmetry

• No instability

• Good neuromuscular control

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Expected Timeline

Daily activities: 6–8 weeks

Strength recovery: 3–4 months

Return to sport: 5–7 months

Overhead athletes: 6–9 months

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Dr Mak Clinical Insight (Important)

Protection of the biceps anchor during early healing is critical.

Premature activation of the biceps significantly increases the risk of repair failure.

Progressive scapular stabilization and rotator cuff strengthening are essential before return to

overhead activity.