Orthopaedic Surgeon
Shoulder Instability Nonoperative Rehabilitation
The program will vary in length for each individual depending on several factors:
-
Severity of symptoms
-
Chronicity of instability symptoms
-
Age and Activity Level of Patient
-
ROM/Strength Status
-
Desired Goals and activities
PHASE I - ACUTE MOTION PHASE
Goals:
Re-establish non-painful range of motion Retard muscular atrophy
Decrease pain/inflammation
** Note: During the early rehabilitation program, caution must be applied in placing the capsule under stress (i.e. stretching into Abduction, External rotation) until dynamic joint stability is restored.
• Decrease Pain/Inflammation:
o Sling for comfort as needed
o Therapeutic modalities (ice, electrotherapy, etc.) o NSAID’s
• Range of Motion Exercises:
o Gentle ROM only, no stretching o Pendulums
o Rope & Pulley
- Elevation in scapular plane to tolerance o Active-assisted ROM L-Bar to tolerance
- Flexion o
- Internal Rotation with arm in scapular plane at 30 o abduction - ExternalRotationwitharminscapularplaneat30 abduction
** DO NOT PUSH INTO EXTERNAL ROTATION OR HORIZONTAL ABDUCTION **
• Strengthening Exercises: o Isometrics
- Flexion
- Abduction
- Extension
- Internal Rotation (multi-angles)
- External Rotation (scapular plane)
o Rhythmic Stabilizations
- ER/IR in scapular plane
o Weight Shifts (Closed Kinetic Chain Exercises) o Joint reproduction proprioceptive drills
Continued
PHASE II - INTERMEDIATE PHASE
Goals: Regain and improve muscular strength Normalize Joint Motion
Improve neuromuscular control of shoulder complex
Criteria to Progress to Phase II:
1. Full Passive ROM (except ER)
2. Minimal Pain or Tenderness
3. “Good” Manual Muscle Testing of IR, ER, Flexion, and Abduction 4. Baseline proprioception and dynamic stability
• Initiate Isotonic Strengthening
• Emphasis on External Rotation and Scapular Strengthening o ER/IR Tubing
o Scapular motion with ER (Full Can)
o Abduction to 90 degrees
o Side lying external rotation to 45 degrees o Shoulder shrugs
o Prone Extension to Neutral
o Prone Horizontal Adduction
o Prone Rowing
o Biceps
o Table Push-ups
o Triceps
• Improve Neuromuscular control of Shoulder Complex
o Initiation of proprioceptive neuromuscular facilitation o Rhythmic stabilization drills
-
§ ER/IR at 90 degrees abduction o o
-
§ Flexion/Extension/Horizontal at 100 Flexion, 20 horizontal abduction
o Progress Closed Kinetic Chain exercises with rhythmic stabilizations o Wall stabilization on ball
o Static holds in push-up position on ball
o Push-ups on tilt board
• Continue Use of Modalities (as needed) o Ice, electrotherapy modalities
PHASE III - ADVANCED STRENGTHENING PHASE
Goals: Improve strength/power/endurance Improve neuromuscular control
Enhance dynamic stabilizations Prepare patient/athlete for activity
Criteria to Progress to Phase III:
1. Full non-painful range of motion
2. No palpable tenderness
3. Continued progression of resistive exercises
• Continue use of modalities (as needed)
• Continue isotonic strengthening (Progressive Resistive Exercises) o Continue all exercises listed above
o Progress to end range stabilization
o Progress to full ROM strengthening
o Progress to bench press in restricted ROM
o Program to seated rowing and latissimus pull down in restricted ROM
• Emphasize Proprioceptive Neuromuscular Facilitation
• Neuromuscular control drills (for athletes) o Ball flips on table
o End range RS with tubing
o Wall stabilizations on ball
o Push-ups on ball with rhythmic stabilizations Shoulder Instability Nonoperative – NWS – 1-1-17
Page 2
• Initiate plyometric training o 2-hand drills:
-
§ Chest pass
-
§ Side to side § Overhead
o Progress to 1-hand drills: § 90/90throws
§ Wall dribbles
** PRECAUTION IS AVOIDING EXCESSIVE STRESS ON CAPSULE **
PHASE IV - RETURN TO ACTIVITY PHASE
Goals: Maintain optimal level of strength/power/endurance
Progressively increase activity level to prepare patient/athlete for full functional return to
activity/sport
Criteria to Progress to Phase IV:
1. Full ROM
2. No pain or palpable tenderness 3. Satisfactory isokinetic test
4. Satisfactory clinical exam
• Continue all exercises as in Phase III • Initiate Interval Sport Program
• Continue Modalities (as needed) FOLLOW-UP
-
Isokinetic Test if available
-
Progress Interval Program
-
Maintenance of Exercise Program