Rehab for SLAP Lesions

Key Wellness / Rehab Strategies for Conservative Management of SLAP Shoulder Lesions (No Surgery)

1) Understand the Condition (What It Is)

• SLAP = Superior Labrum Anterior to Posterior tear (labrum tear), sometimes involving the biceps tendon attachment.
• Some SLAP types can be managed conservatively, while larger/more complex cases may require surgery.
• This rehab overview focuses on non-surgical management.

2) First Step: Relative Rest

• Decrease activities to a level that doesn’t worsen pain.
• Don’t completely stop all activity—reduce the movements that most aggravate symptoms.

3) Pain Control to Enable Rehab

• NSAIDs (e.g., ibuprofen/naproxen) may reduce pain so you can start exercises.
• Steroid (corticosteroid) injections
  • Usually held back unless truly necessary because steroids may interfere with healing of cartilage/biceps tendon.
  • Considered if pain prevents progress with rehab.

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Rehab Program Structure (3 Parts)

1) Range of Motion (ROM)

• Goal: restore full movement in all directions.

Early Phase Caution (First ~4 Weeks)

• Avoid movements that heavily involve the biceps tendon (especially if biceps involvement is part of the SLAP).
• Pain with shoulder flexion/abduction above ~90° can be normal early on—work short of the painful range and build gradually.

Adapt Exercises to Avoid Biceps Loading

Techniques mentioned include:

• Assisted or supported flexion (e.g., using a wall or assisting with the opposite hand)
• Side-lying flexion, where arm positioning reduces biceps involvement and emphasizes the deltoid

Address Posterior Shoulder Tightness (Especially for Overhead Throwers)

• Overhead sports can involve reduced internal rotation and posterior capsule tightness.
• Goal: stretch the posterior capsule, but do so carefully early.

Posterior Capsule Stretching Guidance

• Sleeper stretch may be prescribed for posterior capsule tightness, but:
  • Avoid forcing it in acute SLAP cases because it can be very painful.
• Better early options mentioned:
  • Gentler stretches that pull the shoulder across to target the posterior capsule
  • Ensure the scapula stays down during stretching to feel the capsule stretch

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2) Strength, Stability, and Endurance

• Suggested total rehab timeline in the video: around ~16 weeks (varies by person).

Early Rehab (~Weeks 0–4): Focus on Stability

Train muscles that stabilize:

• Scapula
  • middle traps
  • lower traps
  • serratus anterior
• Shoulder
  • rotator cuff

Training principles:

• Stable positions, low forces
• Slow, controlled movement
• High repetitions
• Emphasis on motor control / awareness
  • Know where the scapula is and how it moves during arm motion
  • Do control work even with minimal/no weight

Awareness drills mentioned:

• Repeat movements with eyes open vs. eyes closed
• Connect hand/arm position without relying on vision

Early Biceps Avoidance (First ~4 Weeks)

Avoid biceps-dominant positions such as:

• Flexion with the hand turned up
• Biceps curls
• Uppercut-style movements

Safer alternatives mentioned:

• Scapular stability work (e.g., side-lying/positioned exercises)
• Seated row / scapular control
• Serratus anterior “punching” variations
• Rotator cuff work in supported positions (example mentioned: ~90° flexion with support)

Mid Rehab (~Weeks 5–12): Gradually Reintroduce Biceps Loading

• Start involving the biceps, but avoid extreme/high-load positions immediately.
• Safer progressions suggested:
  • Shorter-lever biceps loading positions (e.g., “uppercut positions” referenced)
  • Gentle bicep curls with light weight to test tolerance
  • Progress toward less-supported positions as form improves

Gradually reintroduce speed/sport-like work:

• Start slow and light (e.g., foam ball)
• Progress with sport simulations (throwing/catching, wall/trampoline progressions)

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3) Sports-Specific Re-Integration (Finish Rehab With the Sport)

• Final stage should match the athlete’s demands.
• Example contrast:
  • Baseball pitcher vs. other field player (different arm positions and contact forces)

Ensure athletes can handle:

• Required velocity
• Required arm positions (often in/outstretched positions)
• Actual sport scenario demands—not only gym-based strengthening

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Whole-Body Contribution (Don’t Overload the Shoulder)

• In throwing sports, shoulder power depends on:
  • adequate hip strength
  • effective whole-body movement patterns
  • force transfer hips → torso → arm
• Coaches may help verify mechanics and reduce shoulder overload.

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Presenter / Source List

• Marika — Physiotherapist from Sports Injury Physio (Sports Injury Physio Calm/online physiotherapy assessment & treatment mentioned by the video)