Bankart Repair: Movements, Activities, and Precautions to Avoid for Optimal Recovery

What to Avoid After Bankart Repair?

After a Bankart repair, strict adherence to post-operative precautions is crucial to prevent re-injury, promote optimal healing of the shoulder labrum, and ensure a successful return to function. Key avoidances include specific movements, premature loading, and neglecting structured rehabilitation.

Understanding Bankart Repair and Its Purpose

A Bankart lesion is a tear of the anterior (front) inferior glenoid labrum, often occurring after an anterior shoulder dislocation. This injury compromises the stability of the shoulder joint, making it prone to recurrent dislocations. Bankart repair surgery involves reattaching the torn labrum to the glenoid bone and tightening the stretched capsule, aiming to restore the anatomical integrity and stability of the shoulder. The success of this procedure heavily relies on a disciplined post-operative period to allow the repaired tissues to heal securely.

The Critical Post-Operative Period: Initial Restrictions

The immediate weeks following a Bankart repair are the most critical for protecting the delicate healing tissues. During this phase, the primary goal is to prevent stress on the reattached labrum.

• Avoiding Specific Movements:
  • External Rotation: This is the most dangerous movement and must be strictly avoided, especially when the arm is abducted (raised out to the side). Excessive external rotation can pull the newly repaired labrum away from the bone.
  • Abduction Beyond Prescribed Limits: Raising the arm out to the side too far, particularly when combined with external rotation, puts significant strain on the anterior capsule and labrum.
  • Extension Behind the Body: Reaching or moving the arm backward can also stress the anterior structures.
  • Combined Movements: Any combination of external rotation, abduction, and extension should be avoided, as these movements replicate the typical mechanism of anterior shoulder dislocation.
• Avoiding Weight-Bearing, Lifting, Pushing, and Pulling:
  • No Lifting: Do not lift anything, even light objects, with the operative arm.
  • No Pushing or Pulling: Avoid activities that involve pushing open doors or pulling objects.
  • No Weight-Bearing: Do not lean on the operative arm or use it to assist with standing or moving.
• Improper Sling Use:
  • Removing the Sling Prematurely: The sling is essential for immobilizing the shoulder and protecting the repair. Do not remove it unless specifically instructed by your surgeon or physical therapist for hygiene or prescribed exercises.
  • Allowing the Arm to Hang Freely: Always keep the arm supported in the sling, especially when walking or moving.
• Sleeping Positions:
  • Sleeping on the Operative Side: This puts direct pressure on the healing joint and should be avoided.
  • Sleeping Without Support: Many surgeons recommend sleeping on your back or in a reclined position with pillows supporting the operative arm to prevent unwanted movements during sleep.

Progressive Rehabilitation: Avoiding Premature Stress

As you advance through the rehabilitation phases, the restrictions gradually ease, but vigilance remains paramount. The focus shifts to controlled motion and gradual strengthening.

• Avoiding Over-Stretching or Forcing Range of Motion: While regaining motion is crucial, it must be done under the guidance of a physical therapist. Aggressive stretching or forcing the shoulder into painful ranges can re-injure the labrum.
• Avoiding Impact Activities:
  • Running, Jumping, or Bouncing: These activities can transmit forces up the kinetic chain to the shoulder, potentially stressing the repair.
  • Contact Sports: Absolutely no participation in contact sports (e.g., football, rugby, basketball) until full strength, stability, and clearance from your surgeon.
• Avoiding Heavy Lifting or Resistance Training (Early Stages):
  • Premature Loading: Do not engage in any form of resistance training (weights, resistance bands) without specific guidance from your physical therapist.
  • Progressive Overload: When resistance training is introduced, it must be highly controlled and gradually progressed to avoid overwhelming the healing tissues.
• Avoiding Repetitive Overhead Movements:
  • Sports-Specific Activities: Activities like throwing, swimming strokes (freestyle, butterfly), tennis serves, or overhead pressing should be avoided until significant healing and strength are achieved, and only with specific clearance.
  • Occupational Tasks: Be mindful of job-related tasks that involve repetitive overhead work and discuss these with your surgeon and employer.

Long-Term Considerations and Return to Activity

Even after the initial healing period, certain precautions and long-term strategies are necessary to maintain shoulder health and prevent future dislocations.

• Avoiding Sudden, Uncontrolled Movements: Especially those that mimic the initial injury mechanism (e.g., reaching quickly behind you, flailing your arm).
• Avoiding Ignoring Pain or Discomfort: Pain is a warning signal. If an activity causes pain, stop and consult your physical therapist or surgeon. Pushing through pain can lead to re-injury or chronic issues.
• Avoiding Neglecting Continued Strengthening and Stability Work: Rehabilitation is not just about the first few months. Ongoing exercises to maintain rotator cuff strength, scapular stability, and proprioception are vital for long-term shoulder health.
• Avoiding Premature Return to High-Risk Sports or Activities: Returning to sports or demanding physical activities too soon is a leading cause of re-dislocation. A structured, progressive return-to-sport protocol, often involving sport-specific drills, is essential and requires clearance from your medical team.

General Precautions and Lifestyle Adjustments

• Avoiding Poor Posture: Slumped posture can alter shoulder mechanics and increase stress on the joint. Maintain good upright posture.
• Avoiding Carrying Heavy Bags on the Affected Side: This can pull down on the shoulder and strain the healing tissues.
• Avoiding Falls: Take precautions to prevent falls, as landing on an outstretched arm can severely re-injure the shoulder.

The Role of Physical Therapy

Perhaps the most crucial "avoid" after Bankart repair is avoiding skipping or neglecting your prescribed physical therapy program. Physical therapy is non-negotiable for a successful outcome. Your therapist will guide you through each phase of rehabilitation, ensuring movements are safe, progression is appropriate, and strength and stability are optimally restored. They will provide tailored exercises, manual therapy, and education to help you regain full function and confidence in your shoulder.

Conclusion: Patience and Professional Guidance are Key

Recovering from a Bankart repair is a marathon, not a sprint. It demands patience, discipline, and strict adherence to medical and therapeutic guidelines. By understanding and diligently avoiding the movements and activities that jeopardize your recovery, you significantly enhance your chances of a successful outcome, reducing the risk of re-dislocation and enabling a safe return to your desired activities. Always prioritize professional medical advice and never hesitate to communicate any concerns with your surgeon or physical therapist.