Anterior Shoulder Stabilisation Rehabilitation Protocol

Restrictions:

  • Immobilisation of the shoulder joint in a broad arm sling for 6 weeks 24 hours per day.

  • Shoulder abduction and flexion to maximum 60 degrees, external rotation to 0 degrees in the first 6 weeks post operatively

    • All motion is done as active – No passive stretching.

    • Thigh to eye range as a guide.

  • Gentle passive range of motion may begin after 6 weeks

  • Light loading from 8 – 10 weeks post operatively

  • No strength training or heavy lifting for minimum 12 weeks postoperatively

  • Gradual return to sporting activity at 6 months post operative for contact and throwing sports

 

Patients should have a grasp of exercises and use of sling and simple ADL functions prior to discharge home

Aim to get early control of shoulder girdle and periscapular muscles

Light pendular and rotation exercises within range of motion limits

Circulation exercises

Do exercises 4 - 6 x per day

Aim for a relaxed exercises to avoid tension about the shoulder and neck

Cryotherapy for 20 minutes up to 4 x per day initially

 

At 2 and 6 week follow up

Wound review

Check pain levels

Observe simple ADLs

Range of motion in flexion, abduction and rotation should be measured

Check control of shoulder girdle and periscapular muscles

 

Phase 1: 0 - 6 weeks

Goal

Focus on gentle range of motion, good circulation, and posture

Action

  • Daily active exercises. Careful pendular exercises. Active elbow flexion and extension, hand circulation exercises and scapular muscle activation

  • Active range of motion exercises done gently with limits: abduction 60 degrees, flexion 60 degrees and external rotation 0 degrees until week 6

  • Scapular setting and control exercises

  • Use of cryotherapy for swelling reduction 20 minutes up to 4 x daily

  • Relaxation and posture exercises to reduce tension in the neck and shoulder girdle 

Criteria to move to the next phase

  • Near non tender, near pain free for all movements, achieve range of motion as stipulated above (60/60/0). Scapulohumeral rhythm control.

 

Phase 2 : From 6 weeks post-operatively up to 12 weeks

Goals

Increase range of motion (free range of motion within pain limits), scapulohumeral rhythm control, gradual increased activation of shoulder girdle musculature

Action

  • Active assisted shoulder range of motion exercises for flexion, abduction, internal and external rotation – focus on good quality motion

  • Scapular mobility exercises

  • Periscapular strengthening exercises

  • May begin gentle passive range of motion from 8 weeks post-operative

o   Strictly avoiding passive external rotation

  • Begin light isometric flexed elbow rotator cuff strengthening

  • Dynamic strengthening from 8 – 10 weeks post-operative

  • Active theraband exercises from week 10: check for good scapulohumeral rhythm

o   Eccentric strengthening first with Assisted concentric motion

o   Add in concentric training once good control achieved

Criteria to enter phase 3

  • Near full range of motion with good quality, little or no pain, good scapulohumeral rhythm and control

Phase 3: From 12 weeks onwards

Action

  • Can begin focused joint stretching and mobilisation from week 12 if range of motion is not optimal

o   Avoid passive external rotation stretching and external rotation in abduction stretching

-  If these ranges are suboptimal, please contact me for planning

  • Strength for scapulothoracic musculature and shoulder musculature

  • Aim for normal active and passive range of motion

  • Functional training and strengthening

o   Begin with focused retraining to sporting activities in low velocity manner

o   Strengthening throughout range

o   Open and closed chain exercises

  • Proprioceptive training under load 

Criteria for moving to next phase

  • Full active range of motion. Little to no pain, good scapulohumeral rhythm and muscular control

Phase 4: Approximately 4 - 6 months

Goals

Return to sporting activities

Action

  • ADLs, work and sports specific training

  • Increase muscle strength, power, and stamina

  • Maintain full range of motion

  • Sport specific exercises

  • Avoid contact and high velocity overhead exercises until power returns to 90 – 95% of contralateral side.

o   Functional and specific training in the interim to prepare for this activity

  • Recommend avoidance of contact and high velocity overhead activities until 6 months post operatively

Timeframes

  • Approximately 4 - 6 months with focused training for non-contact and non overhead sporting activities

  • Approximately 6 months for contact and overhead sporting activities

  • NB please consult with me if aiming for earlier sporting events than the above guidelines

Criteria for return to sport

  • Full range of motion. No pain with activity. Good muscular control.

  • Strength test 90% compared to uninjured side. 95% for contact and overhead / throwing sports

  • Constant score > 90% compared to uninjured side