SLAP Tear Exercises: Rehabilitate Your Shoulder Labrum

A SLAP tear (Superior Labrum Anterior to Posterior) is an injury to the top of the shoulder's labrum—the ring of cartilage surrounding the socket. This injury commonly affects overhead athletes and can cause deep shoulder pain, clicking, and weakness. Whether treated conservatively or surgically, targeted exercises are essential for recovery.

Understanding SLAP Tears

Anatomy

The labrum is a fibrocartilage ring that:

• Deepens the shoulder socket (glenoid)
• Provides attachment for the biceps tendon (at the top)
• Improves shoulder stability

A SLAP tear occurs where the biceps tendon attaches—at the "12 o'clock" position of the socket.

Types of SLAP Tears

• Type I: Labrum frayed but still attached (degenerative)
• Type II: Labrum and biceps anchor torn from bone (most common)
• Type III: Bucket-handle tear, labrum hangs into joint
• Type IV: Tear extends into biceps tendon

Causes

• Repetitive overhead motions (throwing, swimming, tennis)
• Fall onto outstretched arm
• Direct shoulder trauma
• Heavy lifting
• Age-related degeneration

Symptoms

• Deep shoulder pain (hard to pinpoint)
• Pain with overhead activities
• Clicking, popping, or catching
• Decreased throwing velocity or control
• Pain with biceps activities (curls)
• Night pain

Conservative Treatment Approach

Many SLAP tears (especially Type I) respond to conservative treatment:

Goals

• Reduce pain and inflammation
• Restore range of motion
• Strengthen rotator cuff and scapular muscles
• Modify aggravating activities
• Improve shoulder mechanics

Who Should Try Conservative Treatment

• Type I tears
• Older patients with degenerative tears
• Those who can modify activities
• Non-overhead athletes

Phase 1: Pain Control and Mobility

Initial Management

• Rest from aggravating activities
• Ice 15-20 minutes, several times daily
• Anti-inflammatory medication if appropriate
• Avoid positions that stress the labrum

Pendulum Exercises

Gentle motion without loading:

1. Lean forward, support with uninjured arm
2. Let injured arm hang freely
3. Swing in small circles
4. Move forward/backward, side to side
5. Stay relaxed—let gravity do the work

Perform: 1-2 minutes, 3-4 times daily

Passive Range of Motion

Use other arm or therapist:

Assisted Forward Flexion:

1. Lie on back
2. Use other arm to lift injured arm overhead
3. Stay in pain-free range
4. Lower slowly

Assisted External Rotation:

1. Lie on back, elbow at side bent 90 degrees
2. Use stick or other hand to rotate forearm outward
3. Keep elbow pinned to side

Perform: 15-20 reps each, 2-3 times daily

Posterior Capsule Stretch

Often tight with SLAP tears:

1. Bring arm across body at shoulder height
2. Use other hand to pull elbow toward opposite shoulder
3. Feel stretch in back of shoulder
4. Hold 30 seconds

Perform: 3-4 reps, 2-3 times daily

Sleeper Stretch

1. Lie on injured side, shoulder and elbow at 90 degrees
2. Use other hand to push forearm toward floor
3. Keep shoulder blade flat on bed
4. Hold 30 seconds

Perform: 3-4 reps, 1-2 times daily (careful—some find this aggravating)

Phase 2: Strengthening

Scapular Exercises (Foundation)

Scapular Squeezes:

1. Sit or stand with good posture
2. Squeeze shoulder blades together and down
3. Hold 5-10 seconds
4. Relax and repeat

Perform: 15-20 reps, 3 sets

Prone Y, T, W

1. Lie face down on floor or bench
2. Y: Arms overhead, lift toward ceiling, thumbs up
3. T: Arms to sides, lift to shoulder height
4. W: Elbows bent, squeeze shoulder blades, lift

Perform: 10-15 reps each position, 2-3 sets

Sidelying External Rotation

1. Lie on uninjured side
2. Upper arm at side, elbow bent 90 degrees
3. Rotate forearm toward ceiling
4. Keep elbow pinned to side
5. Lower slowly

Perform: 15-20 reps, 3 sets

Low Rows

1. Use cable, band, or dumbbell
2. Pull elbows back, squeeze shoulder blades
3. Keep shoulders down
4. Return with control

Perform: 15-20 reps, 3 sets

Face Pulls

1. Band at face height
2. Pull toward face, elbows high and out
3. Externally rotate at end range
4. Squeeze shoulder blades

Perform: 15-20 reps, 3 sets

Resistance Band Internal/External Rotation

External Rotation:

1. Elbow at side, band anchored
2. Rotate forearm outward against resistance
3. Keep elbow fixed

Internal Rotation:

1. Turn to face opposite direction
2. Rotate forearm inward against resistance

Perform: 15-20 reps each direction, 3 sets

Phase 3: Advanced Strengthening

Rhythmic Stabilization

Build dynamic stability:

1. Partner or therapist applies gentle, random forces
2. Maintain arm position while resisting
3. Progress positions: at side, 90 degrees, overhead

Perform: 30-60 seconds, 3-4 sets

PNF Diagonal Patterns

Functional movement patterns:

D2 Flexion:

1. Start at opposite hip
2. Move arm up and out diagonally
3. Finish overhead, thumb back

D2 Extension:

1. Start overhead
2. Pull down toward opposite hip

Perform: 10-15 reps each direction, 2-3 sets

Prone Horizontal Abduction

1. Lie face down, arm hanging
2. Lift arm to side, thumb up
3. Squeeze shoulder blade back
4. Lower slowly

Perform: 12-15 reps, 3 sets

Push-Up Plus

1. Perform push-up (wall, incline, or floor)
2. At top, push extra (protract shoulder blades)
3. Feel stretch between shoulder blades

Perform: 10-15 reps, 3 sets

Post-Surgical Protocol

If surgery is performed, protocols are more restrictive:

Phase 1: Protection (Week 0-6)

Weeks 0-4:

• Sling wear as directed (typically 4-6 weeks)
• Passive ROM only
• Pendulums and assisted motion
• Elbow, wrist, and hand exercises
• No active biceps use

Weeks 4-6:

• Begin active-assisted ROM
• Continue passive stretching
• Initiate gentle isometrics

Phase 2: Early Strengthening (Week 6-12)

• Progress to active ROM
• Begin isometric rotator cuff exercises
• Scapular strengthening
• Avoid biceps loading
• No lifting greater than coffee cup

Phase 3: Progressive Strengthening (Week 12-16)

• Resistance band rotator cuff exercises
• Progressive scapular work
• Light biceps activity (with caution)
• Begin closed-chain exercises

Phase 4: Return to Function (Week 16+)

• Sport-specific training
• Interval throwing program (if applicable)
• Progressive loading
• Full return typically 6-9 months

Exercises to Avoid

With SLAP Tear (Conservative or Early Post-Op)

• Heavy biceps curls
• Pull-ups and chin-ups
• Dips
• Overhead pressing
• Behind-the-neck exercises
• Throwing or serving
• Heavy bench pressing

Position Caution

The position of most stress on SLAP lesion:

• Arm overhead and rotated back (like throwing position)
• Combined abduction, external rotation, and extension

Return to Throwing Protocol

For overhead athletes post-surgery:

Prerequisites

• Full, pain-free ROM
• Strength 85%+ of opposite side
• No pain with exercise progression
• Typically 4-6 months post-op minimum

Interval Throwing Program

Phase 1: 45 feet, 25 throws, 50% effort, every other day

Phase 2: 60 feet, 25-30 throws, progress effort

Phase 3: 90 feet, 30-35 throws

Phase 4: 120 feet (or max for position)

Phase 5: Flat-ground throwing, progress to mound

Each phase: 2-3 sessions before advancing

Sample Conservative Program

Monday/Thursday - Strength

• Prone Y, T, W: 2x12 each
• Sidelying external rotation: 3x15
• Low rows: 3x15
• Face pulls: 3x15
• Band IR/ER: 3x15 each

Tuesday/Friday - Mobility and Stability

• Pendulums: 2 minutes
• Posterior capsule stretch: 3x30 sec
• Assisted ROM: 15 reps each direction
• Rhythmic stabilization: 3x30 sec

Wednesday - Light Activity

• Scapular squeezes throughout day
• General fitness (avoid overhead)
• Core work

When to Consider Surgery

Surgery may be recommended for:

• Type II tears in young, active patients
• Failed 3-6 months of conservative treatment
• Overhead athletes wanting to return to sport
• Mechanical symptoms (locking, catching)

Key Takeaways

SLAP tear rehabilitation requires patience:

1. Conservative first - Many tears improve without surgery
2. Scapular stability is foundation - Supports rotator cuff function
3. Protect the biceps anchor - Avoid heavy biceps loading
4. Progress overhead work carefully - The vulnerable position
5. Return to throwing takes time - 6-9 months typical for athletes

Whether conservative or surgical, the principles remain: build stability, restore mobility, strengthen gradually, and respect the healing timeline.