Nathan WM. Skelley, M.D.

The program will vary in length for each individual depending on several factors:

1. Severity of symptoms

2. Chronicity of instability symptoms

3. Age and Activity Level of Patient

4. ROM/Strength Status

5. 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

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• 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