Bankart Lesion Exercises: Recovery Guide for Shoulder Labrum Tears

A Bankart lesion is a tear of the anterior-inferior labrum—the cartilage rim that deepens the shoulder socket. It typically occurs during a shoulder dislocation and is a major cause of recurrent shoulder instability. Whether you're managing conservatively or recovering from surgery, the right exercises are essential for recovery.

Understanding Bankart Lesions

What Happened

During anterior shoulder dislocation:

1. Humeral head (ball) forces out of glenoid (socket)
2. Labrum tears away from the bone rim
3. Capsular ligaments stretch or tear
4. Creates a defect that allows future dislocations

Types

• Soft Bankart: Labrum detaches from bone
• Bony Bankart: Piece of glenoid bone breaks off with labrum
• ALPSA: Labrum tears but stays attached (heals in wrong position)
• HAGL: Humeral avulsion of glenohumeral ligament

Why Rehabilitation Matters

Without proper rehab:

• High redislocation rate (90%+ in young athletes after first dislocation)
• Progressive instability
• Cartilage damage
• Early arthritis

With proper rehab:

• Improved dynamic stability
• Reduced redislocation risk
• Return to activity (with or without surgery)

Conservative vs. Surgical Treatment

Conservative (Non-Surgical)

Best for:

• First-time dislocators over age 30
• Lower activity demands
• Minimal bone loss
• Patient preference

Surgical (Arthroscopic Bankart Repair)

Best for:

• Young athletes (under 25)
• Contact/collision sports
• Recurrent instability
• Bony Bankart lesions
• High-demand shoulders

Note: This guide covers exercises for both pathways, with specific notes for post-surgical patients.

Phase 1: Protection Phase (Weeks 0-6)

Sling Use

• Conservative: 2-4 weeks
• Post-surgical: 4-6 weeks
• Remove for exercises only

Goals:

• Protect healing tissue
• Maintain elbow/hand mobility
• Gentle range of motion (within limits)
• Reduce pain and swelling

1. Pendulum Exercises

First movement after injury/surgery.

How to do it:

1. Lean forward, support yourself with good arm
2. Let affected arm hang relaxed
3. Gently sway body to create arm circles
4. Clockwise, counterclockwise, forward/back
5. 2-3 minutes, 3-4 times daily

2. Elbow, Wrist, and Hand Exercises

Maintain mobility in non-affected joints.

How to do it:

• Elbow flexion/extension: Full range
• Wrist circles
• Finger flexion/extension
• Ball squeezes
• Throughout the day

3. Scapular Squeezes

Early scapular activation without shoulder movement.

How to do it:

1. Sitting or standing
2. Squeeze shoulder blades together
3. Hold 5 seconds
4. Relax
5. 15-20 repetitions

4. Passive External Rotation (Limited)

Post-surgical: Start after 2-4 weeks, as directed by surgeon. Conservative: Start when acute pain subsides.

How to do it:

1. Lie on back, elbow at side, bent 90°
2. Use other hand or wand to rotate arm outward
3. Go ONLY to limit set by surgeon (often 20-30° initially)
4. Hold 5 seconds
5. 10-15 repetitions

CRITICAL: Do NOT push into pain. Follow surgeon's specific limits.

5. Passive Forward Flexion (Supine)

How to do it:

1. Lie on back
2. Use other arm to lift affected arm forward
3. Go to comfortable limit (often 90° initially)
4. Lower slowly
5. 10-15 repetitions

Positions to AVOID in Phase 1:

• External rotation beyond limit
• Arm behind back
• Combined abduction + external rotation
• Reaching across body
• Weight bearing on arm
• Any position that feels unstable

Phase 2: Early Mobility (Weeks 6-12)

Goals:

• Progress range of motion
• Begin active motion
• Continue scapular work
• Start light rotator cuff activation

6. Active-Assisted Forward Flexion

How to do it:

1. Stand or sit
2. Hold wand with both hands
3. Use good arm to help lift both arms forward
4. Progress range each week
5. 15-20 repetitions

7. Active-Assisted External Rotation

How to do it:

1. Hold wand with both hands, elbows at sides
2. Use good arm to push affected arm into external rotation
3. Progress range per surgeon guidelines
4. 15-20 repetitions

8. Wall Slides (Scaption)

Early active motion in safe plane.

How to do it:

1. Stand facing wall
2. Place forearm on wall at shoulder height
3. Slide arm up wall (like raising hand)
4. Lower with control
5. 15 repetitions
6. Progress away from wall support

9. Supine External Rotation (Active)

How to do it:

1. Lie on back, elbow at side, bent 90°
2. Actively rotate arm outward (no assistance)
3. Control the return
4. 15 repetitions
5. Progress by adding light weight (1 lb)

10. Prone Scapular Exercises

Prone I's:

1. Lie face down, arm at side
2. Lift arm toward ceiling, thumb up
3. Hold 3 seconds
4. 15 repetitions

Prone T's:

1. Lie face down, arm out to side
2. Lift arm toward ceiling, thumb up
3. Hold 3 seconds
4. 15 repetitions

Prone Y's:

1. Lie face down, arm at 45° angle
2. Lift arm toward ceiling, thumb up
3. Hold 3 seconds
4. 15 repetitions

11. Isometric External Rotation

How to do it:

1. Stand with elbow at side, bent 90°
2. Press back of wrist into wall or doorframe
3. Hold 5 seconds (no movement)
4. 10-15 repetitions
5. Light resistance only

12. Isometric Internal Rotation

How to do it:

1. Stand with elbow at side, bent 90°
2. Press palm into wall or doorframe
3. Hold 5 seconds
4. 10-15 repetitions

Phase 3: Strengthening (Weeks 12-20)

Goals:

• Full range of motion
• Progressive rotator cuff strengthening
• Scapular stability
• Closed kinetic chain exercises

13. Side-Lying External Rotation

Key rotator cuff exercise.

How to do it:

1. Lie on unaffected side
2. Affected elbow at side, bent 90°
3. Rotate forearm toward ceiling
4. Lower slowly
5. 15-20 repetitions
6. Add weight (2-5 lbs) as able

14. Standing External Rotation with Band

How to do it:

1. Anchor band at elbow height
2. Elbow at side, bent 90°
3. Rotate outward against resistance
4. Control the return
5. 15-20 repetitions

15. Standing Internal Rotation with Band

How to do it:

1. Anchor band at elbow height
2. Elbow at side, bent 90°
3. Rotate inward against resistance
4. Control the return
5. 15-20 repetitions

16. Rows (Cable or Band)

Scapular retraction and posterior shoulder.

How to do it:

1. Pull band/cable toward body
2. Squeeze shoulder blades together
3. Keep shoulders down (not shrugged)
4. Control the return
5. 15-20 repetitions

17. Wall Push-Ups

Closed kinetic chain strengthening.

How to do it:

1. Hands on wall at shoulder height
2. Lower chest toward wall
3. Push back
4. 15-20 repetitions
5. Progress: incline push-ups, then floor

18. Shoulder Flexion with Weight

How to do it:

1. Stand holding light dumbbell (3-5 lbs)
2. Raise arm forward to shoulder height
3. Thumb up position
4. Lower with control
5. 15 repetitions
6. Progress weight gradually

19. Scaption with Weight

How to do it:

1. Stand holding dumbbells
2. Raise arms at 30-45° from front (scaption plane)
3. Stop at shoulder height
4. Thumbs up
5. 15 repetitions

Phase 4: Advanced Strengthening (Weeks 20+)

Goals:

• Sport-specific preparation
• Plyometric training
• Return to activity

20. 90/90 External Rotation

More challenging position.

How to do it:

1. Arm out to side at 90°, elbow bent 90°
2. Rotate forearm back (external rotation)
3. Control the motion
4. Start without weight, add 2-5 lbs
5. 15 repetitions

Caution: This position is close to the instability position. Introduce carefully.

21. Push-Up Plus

Serratus anterior strengthening.

How to do it:

1. Standard push-up position
2. At top of push-up, push further (round upper back)
3. Feel scapulae spread apart
4. 15-20 repetitions

22. Prone Swimmers

Dynamic scapular control.

How to do it:

1. Lie face down, arms overhead
2. Lift arms off floor
3. "Swim" arms in circles
4. Keep shoulders down
5. 30 seconds

23. Plyometric Ball Tosses

For athletes returning to throwing.

How to do it:

1. Start with two-hand chest passes
2. Progress to one-arm tosses
3. Use light medicine ball (2-4 lbs)
4. Gradually increase intensity

Caution: Only for athletes cleared for throwing, typically 4-6+ months post-op.

Positions to Avoid Long-Term

Even after full recovery:

• The apprehension position: Arm at 90° abduction + 90° external rotation (like throwing position) should be approached gradually
• Behind-the-neck exercises: Lat pulldown behind neck, behind-neck press
• Sleeping on affected shoulder initially

Daily Exercise Program

Phase 1-2 (Weeks 0-12):

• Pendulums: 3-4x daily
• Range of motion exercises: 3x daily
• Scapular exercises: 2x daily

Phase 3 (Weeks 12-20):

Morning:

1. Range of motion warm-up
2. Rotator cuff exercises with bands
3. Scapular exercises

Evening:

1. Strengthening with weights
2. Closed chain exercises
3. Stretching if tight

Phase 4 (Weeks 20+):

• Full strengthening program 3-4x weekly
• Sport-specific training as cleared
• Maintenance rotator cuff work ongoing

Return to Sport Timeline

Conservative treatment:

• Non-contact activities: 3-4 months
• Contact sports: 4-6 months (with risk of redislocation)

Post-surgical:

• Non-contact activities: 4-6 months
• Contact sports: 6-9 months
• Throwing sports: 6-12 months

Criteria for return:

• Full pain-free range of motion
• Strength >85% of other side
• Negative apprehension test
• Sport-specific movements without symptoms
• Clearance from surgeon/PT

Warning Signs

Stop and consult your surgeon if:

• Feeling of instability or giving way
• Sudden onset of pain
• Decreased range of motion
• Catching or clicking
• Swelling or warmth

After surgery—seek immediate care if:

• Signs of infection (fever, redness, drainage)
• Severe sudden pain
• Numbness or tingling in hand

Key Takeaways

1. Respect healing time — Labrum needs 12+ weeks to heal to bone
2. Avoid the danger zone — Abduction + external rotation (throwing position) early
3. Rotator cuff strength is key — Dynamic stability replaces static ligament support
4. Progress gradually — Rushing increases redislocation risk
5. Long-term commitment — Shoulder strength is forever
6. Sport-specific prep — Don't skip the final phase before return

Bankart repair—whether surgical or conservative—requires patience and consistent effort. The shoulder can regain full stability and function, but it takes months of dedicated rehabilitation. Trust the process, follow your surgeon's guidelines, and don't rush your return to activity.