Shoulder Stabilisation (Athletes)

Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

General Guideline:

If a patient appears to be regaining full range of motion too quickly (ie within the first 4 to 8 weeks) cease mobility work and concentrate instead on cuff and peri-scapular strengthening exercises

Week 0-2

Aims:

• Pain control
• Protect the shoulder stabilisation
• Allow the wounds to heal
• Maintain overall mobility
• Axilla/armpit hygiene

Suggested treatment:

• Ice
• Regular pain relief
• Elbow/wrist/hand and neck ROM exercises
• Sling most of the time, off for hygiene

Restrictions:

• No passive abduction
• No external rotation

Week 2-6

Aims:

• Wean out of sling
• Regain GH joint flexion
• Scapular control/stabilisation
• Minimal pain
• Return to light work/desk duties
• Functional activities at waist height

Suggested treatment:

• Work on flexion – start passive and active assisted and progress to active as comfort allows
• Scapular stability – peri-scapular strengthening
• Isometric rotator cuff exercises
• Maintain overall mobility

Restrictions:

• No passive ER beyond 20°
• No combined abduction and ER (active or passive)

Week 6-12

Aims:

• Increased ROM
• Aim 75% of other side
• ER till restricted to 50% other side
• Increased cuff activation
• Wean sling completely
• Good muscle control over an active range of motion

Suggested treatment:

• Continue working on ROM including flexion, extension and abduction
• Progress cuff strengthening
• From isometric to isometric at various ranges to isotonic if comfortable
• Proprioceptive exercises
• Normal movement patterning as range returns

Restrictions:

• No ER >20°
• No passive combined abduction/ER until weeks 8-12

Month 3-6

Aim:

• Regain full ROM (including abduction and ER)
• Aim 90% ER compared to contralateral side
• Progressively improve control in previously apprehensive positions
• Improve power/endurance of shoulder
• Good dynamic proprioception
• Fully rehabilitated for non-contact functional demands
• Gradual return to non contact sports

Suggested Treatment:

• Passive stretches in abduction/ER as possible
• Stretching and mobilisation if passive range of motion limited
• Progressive increase in resistance training
• Press ups if good shoulder control
• Overhead stability work
• Introduce plyometric exercises when range, strength and control allow
• Sports specific fitness and agility exercises

Restrictions:

• ER remains tighter on the operative side
• Do not encourage passive stretching in abduction and ER if any anterior apprehensive signs or symptoms

Month 6-12

Aims:

• Symptom free training
• Active ROM 90-100% contralateral side
• Endurance/strength and functional/sports specific movements
• Psychological preparation for unrestricted function including in contact sports

Suggested Treatment:

• Return to sport specific training
• Long term maintenance programme
• Non contact sports recommence approx. 6 months
• Contact sports recommence approx. 12 months.
• No restrictions

Some General Questions

What to expect after surgery:

• Most patients will stay a night post operatively
• After you wake up, you may notice your whole arm feels numb from the local anaesthetic applied to the nerves of your arm – this should wear off approximately 12 hours after surgery
• The next morning, you will be seen by the medical team and physiotherapists prior to your discharge
• You will be sent home with medications or a script to help with pain relief

Time in Sling:

• Generally your sling should be on at all times (except for hygiene) in the first 2 weeks
• From 2-6 weeks, you can wean out of the sling gradually using it less and less each day. You do not need to use your sling at night/sleeping
• From 6-12 weeks, you should not need to use your sling at all

Return to Activity

• Driving: when adequate range of motion and pain to allow safe control of the car and to react appropriately in an emergency. Both arms must be fully functional and on the wheel for this to occur. Usually dependent on time in sling.
  Return to driving from 6 weeks post op at earliest
• Work: desk based roles should be able to return once pain has settled – usually approximately 2 weeks after surgery. Those with more manual occupations may need specific recommendations and light duties are usually recommended

Criteria for Return to Sports:

There are many ways to assess whether an athlete is ready to return to sport. There are also lots of variables such as the type of overhead activity (eg throwing vs swimming) and contact vs non contact sports. In the literature, “time” is the most important factor, although not the only one. Generally 6 months is the earliest possible time for return to any sport, and 9 months for contact athletes.
Other variables to consider include comparison to the contralateral side for:

• Baseline strength >80% (eg weights lifted vs pre-injury)
• <20% reduction in ROM
• Psychological readiness for overhead activity

Sports Specific Recommendations:

• Swimming: water based exercise is very helpful after surgery. No swimming until the wounds have healed – usually 2 weeks post operatively. Breaststroke by 12 weeks and freestyle by 18 weeks.
• Golf: usually requires significant rehab and time before adequate protection of the stabilisation has occurred. Usually 4-6 months post op
• Non Contact Sports: or sports where patients have control of their arm/body and can minimise the chances of a fall onto their arm with body weight (pilates, yoga, swimming, running, cycling, racquet sports, gymnastics, fencing, rock climbing)
  Consider breaking down these sports into components and commence gradual return with increasing progression of difficulty from 6 months
• Contact sports: (eg hockey, football, rugby, martial arts, BMX riding)
  As with non contact sports but with increased force and impact – need to train for unexpected impacts and ability to respond
  Do not commence before 9 months

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

Patient information

• Arthroscopic Stabilisation (Bankart)

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.