Clinical Orthopaedic Rehabilitation 2nd Edition s. Brent Brotzman, M.

210 Clinical Orthopaedic Rehabilitation Rehabilitation Protocol Non-operative Rehabilitation for Posterior Shoulder Instability Wilk This program is designed to return the patient/athlete to Initiate Eccentric (Surgical Tubing) Strengthening their activity/sport as quickly and safely as possible. The • External rotation (from 0 degrees to full external rota­ program will vary in length for each individual depending on severity of injury, ROM/strength status, and perfor­ tion). mance/activiry demands. • Internal rotation (from full external rotation to 0 degrees). Phase 1: Acute Phase Normalize Arthrokinematics of Shoulder Complex • Continue joint mobilization. Goals • Patient education of mechanics of activity/sport. • Decrease pain and inflammation. • Reestablish nonpainful ROM. Improve Neuromuscular Control of Shoulder Complex • Retard muscle atrophy. • Initiate PNF. • Rhythmic stabilization drills. Decrease Pain and Inflammation • Therapeutic modalities (e.g., ice, heat, electrotherapy). Continue Use of Modalities (As Needed) • NSAIDs. • Ice, electrotherapy modalities. • Gentle joint mobilization. Phase 3: Advanced Strengthening Phase Range of Motion Exercises • Pendulum. Criteria for Progression to Phase 3 • Rope and pulley. • Full nonpainful ROM. • L-bar • No palpable tenderness. • Flexion. • Continued progression of resistive exercises. • Abduction. • Horizontal abduction. Goals • External rotation. • Improve strength, power, and endurance. • Improve neuromuscular control. Strength Exercises • Prepare athlete for activity. • Isometrics Continue Use of Modalities (As Needed) • Flexion. • Abduction. Continue Anterior Capsule Stretch • Extension. • External rotation. Continue Isotonic Strengthening • Weight shifts (closed-chain exercises). Continue Eccentric Strengthening Note: Avoid any mot~ that may place stress on the poste­ rior capsule such as excessive internal rotation, abduction, Emphasize PNF (02 Extension) or horizontal adduction. Initiate Isokinetics Phase 2: Immediate Phase • Flexion-extension. • Abduction-adduction. Criteria for Progression to Phase 2 • Internal and external rotation. • Full ROM. • Horizontal abduction-adduction. • Minimal pain and tenderness. • \"Good\" MMT Initiate Plyometric Training • Surgical tubing. Goals • Medicine ball. • Regain and improve muscular strength. • Wall push-ups. • Normal arthrokinematics. Initiate Military Press • Improve neuromuscular control of shoulder complex. Phase 4: Return to Activity Phase Initiate Isotonic Strengthening • Flexion. Criteria for Progression to Phase 4 • Abduction to 90 degrees. • Full ROM. • External rotation. • No pain or tenderness. • Internal rotation (from full external rotation to 0 degrees). • Satisfactory clinical examination. • Supraspinatus. • Satisfactory isokinetic test. • Extension. • Horizontal abduction (prone). Goals • Push-ups. • Maintain optimal level of strength, power, and endurance. • Progressively increase activity level to prepare patient/athlete for full functional return to activity/sport. Continue All Exercises as in Phase 3 Initiate and Progress Interval Program