Rehabilitation program of the shoulder
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: 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
Atraumatic[edit | edit source]
Post-operative rehabilitation[edit | edit source]
References[edit | edit source]
1. E. Wilk, K., C. Macrina, L., M. Reinold, M., 'Non-operative rehabilitation for traumatic and atraumatic glenohumeral instability', North amarican journal of sports physical therapy, VOL. 1 (2006), februari, nr. 1, p. 16-31