Post-Operative Rehabilitation Protocol

Anterior Shoulder Instability

The physical therapy rehabilitation for anterior shoulder instability will vary in length depending on factors such as:

  1. Degree of shoulder instability/laxity
  2. Acute vs. chronic condition
  3. Length of time immobilized
  4. Strength/ROM status
  5. Performance/activity demands

The rehabilitation program is outlined in three phases.  It is possible to overlap phases (Phase I - II, Phase II - III) depending on the progress of each individual.

PHASE I

In all exercises during Phase I and Phase II, caution must be applied in an effort to prevent undue stress on the anterior joint capsule as dynamic joint stability is restored.

  • Apply modalities as needed (ice, heat, electrotherapy, etc.)
  • Perform range of motion exercises (passive, active-assist): avoid abduction, extension, and external rotation
    • Rope and pulley exercises
    • Finger walk exercises
    • Wand exercises
  • Manual stretching: avoiding stretching the anterior capsule
  • Posterior cuff stretch in supine position (cross arm adduction)
  • Functional behind the back stretch (IR towel stretch) if needed
  • Mobilization of posterior cuff if needed
  • Elastic resistance for IR/ER with arm at side and elbow at 90 degrees
  • Scapular strengthening (shrugs, rows, etc.)
  • UBE
  • DB
    • Supraspinatus: full and empty can in the scapular plane below shoulder level
    • Shoulder flexion
    • Shoulder abduction (pain free)
    • Shoulder extension in prone position: do not move the shoulder past the plane of the body
    • Shoulder rows in prone position
    • Shoulder shrugs in seated position
    • Serratus punch in supine position (push-up plus program)
  • Forearm/elbow strengthening
  • Rhythmic stabilization exercises: begin in the supine position and progress to functional planes of motion
  • PNF patterns with gentle manual resistance: progress by working in the dysfunctional plane of motion

PHASE II

In all exercises during Phase I and Phase II, caution must be applied in an effort to prevent undue stress on the anterior joint capsule as dynamic joint stability is restored.

  • Continue posterior cuff stretching
  • Continue strengthening exercises with free weights and elastic resistance: may progress planes of motion to the 90/90 position and emphasize eccentric work on the rotator cuff
  • Add lower trap pull downs with pulley system if available
  • Progress prone DB program by adding the following
    • Horizontal abduction
    • Retraction with ER
    • Extension with palm forward
  • Plyotoss chest pass: progress to overhead and single arm
  • Progress push-up program
    • Wall push-ups
    • Modified floor push-ups
    • Floor push-ups
  • Begin progressive throwing program as advised
  • Begin total body conditioning including a well-organized core stability program for overhead athletes
  • Begin skill development at a low intensity level
  • Continue with rhythmic stabilization exercises with resistance in the functional planes of motion
  • Continue PNF patterns

PHASE III

Phase III focuses on progressing exercises in preparation for returning to the prior activity level (sports, work, recreational activity, etc.).

  • Continue flexibility/mobility exercises
  • Continue strengthening exercises
  • Continue UBE
  • Continue progressive throwing program
  • Continue total body conditioning
  • Add overhead strengthening (military press)
  • Progress to bench program
    • Regular
    • Incline
    • Decline
  • Progress skill development at higher intensity
  • Begin sport-specific skill development (work hardening)