Rehabilitation program of the shoulder: Difference between revisions
(New page: = Rehabilitation program of the shoulder = == Non-operative rehabilitation == When designing a rehabilitation program for patients with an unstable shoulder (glenohumeral joint instabili...) |
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= | = Non-operative rehabilitation = | ||
= | When designing a rehabilitation program for patients with an unstable shoulder (glenohumeral joint instability), it's important that the follow key factors should be considered: <ref name="Wilk">E. Wilk, K., C. Macrina, L., M. Reinold, M., 'Non-operative rehabilitation for traumatic and atraumatic glenohumeral instability', North american journal of sports physical therapy, VOL. 1 (2006), februari, nr. 1, p. 16-31</ref> | ||
*Onset of pathology | |||
*Degree of instability and the effect of their functions | |||
*Onset of pathology | *Frequency of dislocation (chronic versus acute) | ||
*Degree of instability and the effect of their functions | *Direction of instability (posterior, anterior or multidirectional) | ||
*Frequency of dislocation (chronic versus acute) | *Concomitant pathologies (Bankart lesion, [[Hill Sachs Lesion|Hill sachs lesion]], a reverse Hill sachs lesion...) | ||
*Direction of instability (posterior, anterior or multidirectional) | *End range neuromuscular control | ||
*Concomitant pathologies (Bankart lesion, [[ | |||
*End range neuromuscular control | |||
*Activity level | *Activity level | ||
When considering all of this seven key factors, each patient will have a different structure of the non-operative rehabilitation program. | When considering all of this seven key factors, each patient will have a different structure of the non-operative rehabilitation program. | ||
This rehabilitation program will be divided into two categories: traumatic and atraumatic. It's important to discuss about this traumatic and atraumatic dislocation protocol, to make it better. | This rehabilitation program will be divided into two categories: traumatic and atraumatic. It's important to discuss about this traumatic and atraumatic dislocation protocol, to make it better. | ||
<br> | |||
== Traumatic == | |||
This traumatic dislocation protocol will vary in length for each individual depending on the seven key factors and the arm dominance, desired goals and activities. <ref name="Wilk" /> | |||
This traumatic dislocation protocol will vary in length for each individual depending on the seven key factors and the arm dominance, desired goals and activities. <ref name="Wilk" /> | |||
<u>Phase 1 - The acute motion phase</u> | <u>Phase 1 - The acute motion phase</u> | ||
The goals of this phase are decrease pain, inflammation and muscular spasms; re-establish [[ | The goals of this phase are decrease pain, inflammation and muscular spasms; re-establish [[Shoulder Instability|dynamic stability]] and non-painful range of motion; retard muscular atrophy; improve proprioception and protect the healing capsular structures. To achieve this goals, following aspects will be implement: | ||
*decrease pain and inflammation | *decrease pain and inflammation | ||
*Range of motion (ROM) exercise: activo-passive, passive and active | *Range of motion (ROM) exercise: activo-passive, passive and active | ||
*Strengthening/proprioception axercises: isometrics performed with the arm at side | *Strengthening/proprioception axercises: isometrics performed with the arm at side | ||
*Rhytmic stabilization | *Rhytmic stabilization | ||
<u> | <u></u> | ||
<u>Phase 2 - Intermediate phase</u> | |||
Goals of this phase are enhance the proprioception, kinesthesia and dynamic stabilization; regain and improve muscular strength and the neuromuscular control; and normalize arthrokinematics. To achieve this goals, following aspects will be implement: | |||
*Progress ROM at 90 degrees abduction (painfree) | |||
*Initiate isotonic strengthening: emphasis on external rotation and scapular strengthening | |||
*Neuromuscular control of the shoulder complex: initiating proprioceptive exercise, rhytmic stabilization drills | |||
*As needed: continue use of ice, [[Current Concepts in Electrotherapy|eletrotherapy]] modalities | |||
<br> | |||
<u>Phase 3 - Advances strengthening phase</u> | <u>Phase 3 - Advances strengthening phase</u> | ||
Goals of this phase are to improve the neuromuscular control, strength, power and endurance; enhance the dynamic stabilizations; and prepare the patient or athlete for his activities. To achieve this goals, following aspects will be implement: | Goals of this phase are to improve the neuromuscular control, strength, power and endurance; enhance the dynamic stabilizations; and prepare the patient or athlete for his activities. To achieve this goals, following aspects will be implement: | ||
*As needed: continue use of ice or electrotherapy modalities | *As needed: continue use of ice or electrotherapy modalities | ||
*Continue isotonic strengthening, but now progressing resistance | *Continue isotonic strengthening, but now progressing resistance | ||
*Emphasize PNF (45,90 and 145 degrees) | *Emphasize PNF (45,90 and 145 degrees) | ||
*When working whit athletes: advanced neuromuscular control drills | *When working whit athletes: advanced neuromuscular control drills | ||
*Endurance training: increase the length of an exercise, more repetitions, more exercise periods throughout a day | *Endurance training: increase the length of an exercise, more repetitions, more exercise periods throughout a day | ||
*Initiate plyometric training | *Initiate plyometric training | ||
<u> | <u></u> | ||
<u>Phase 4 - Return to activity phase</u> | |||
Goals of this phase are increase the activity level (progressively) to prepare the patient or the athlete for functional return to his activity or sport. To achieve this goals, following aspects will be implement: | |||
*Exercise as in phase 3 | |||
*Progress the isotonic strengthening exercises | |||
*An interval sport program | |||
*consider a brace for contact sports (stabilizing the [[Glenohumeral Joint|glenohumeral joint)]] | |||
<br> | |||
<u>Follow up</u>: | <u>Follow up</u>: | ||
*Isokinetic test (external and internal rotation; ab- and adduction) | *Isokinetic test (external and internal rotation; ab- and adduction) | ||
*a progress interval training | *a progress interval training | ||
*Maintain the exercise program | *Maintain the exercise program | ||
<br> | |||
<br> | |||
== Atraumatic == | |||
= Post-operative rehabilitation = | |||
Revision as of 18:20, 11 April 2011
Non-operative rehabilitation[edit | edit source]
When designing a rehabilitation program for patients with an unstable shoulder (glenohumeral joint instability), it's important that the follow key factors should be considered: [1]
- Onset of pathology
- Degree of instability and the effect of their functions
- Frequency of dislocation (chronic versus acute)
- Direction of instability (posterior, anterior or multidirectional)
- Concomitant pathologies (Bankart lesion, Hill sachs lesion, a reverse Hill sachs lesion...)
- End range neuromuscular control
- Activity level
When considering all of this seven key factors, each patient will have a different structure of the non-operative rehabilitation program.
This rehabilitation program will be divided into two categories: traumatic and atraumatic. It's important to discuss about this traumatic and atraumatic dislocation protocol, to make it better.
Traumatic[edit | edit source]
This traumatic dislocation protocol will vary in length for each individual depending on the seven key factors and the arm dominance, desired goals and activities. [1]
Phase 1 - The acute motion phase
The goals of this phase are decrease pain, inflammation and muscular spasms; re-establish dynamic stability and non-painful range of motion; retard muscular atrophy; improve proprioception and protect the healing capsular structures. To achieve this goals, following aspects will be implement:
- decrease pain and inflammation
- Range of motion (ROM) exercise: activo-passive, passive and active
- Strengthening/proprioception axercises: isometrics performed with the arm at side
- Rhytmic stabilization
Phase 2 - Intermediate phase
Goals of this phase are enhance the proprioception, kinesthesia and dynamic stabilization; regain and improve muscular strength and the neuromuscular control; and normalize arthrokinematics. To achieve this goals, following aspects will be implement:
- Progress ROM at 90 degrees abduction (painfree)
- Initiate isotonic strengthening: emphasis on external rotation and scapular strengthening
- Neuromuscular control of the shoulder complex: initiating proprioceptive exercise, rhytmic stabilization drills
- As needed: continue use of ice, eletrotherapy modalities
Phase 3 - Advances strengthening phase
Goals of this phase are to improve the neuromuscular control, strength, power and endurance; enhance the dynamic stabilizations; and prepare the patient or athlete for his activities. To achieve this goals, following aspects will be implement:
- As needed: continue use of ice or electrotherapy modalities
- Continue isotonic strengthening, but now progressing resistance
- Emphasize PNF (45,90 and 145 degrees)
- When working whit athletes: advanced neuromuscular control drills
- Endurance training: increase the length of an exercise, more repetitions, more exercise periods throughout a day
- Initiate plyometric training
Phase 4 - Return to activity phase
Goals of this phase are increase the activity level (progressively) to prepare the patient or the athlete for functional return to his activity or sport. To achieve this goals, following aspects will be implement:
- Exercise as in phase 3
- Progress the isotonic strengthening exercises
- An interval sport program
- consider a brace for contact sports (stabilizing the glenohumeral joint)
Follow up:
- Isokinetic test (external and internal rotation; ab- and adduction)
- a progress interval training
- Maintain the exercise program
