Anterior Instability Rehab Protocol

Goal

• Reestablish full function of shoulder without stressing anterior capsule.
• May return to contact sports and weightlifting at 6 months; full recovery may take 1 year

Phase I – Protective / Early Range of Motion (0 to 3 weeks)

Goals

• Early range of motion to prevent stiffness
• Allow healing of repair

Exercise (perform exercises 3 times daily)

• Active assisted flexion with pulleys – progressively increase to 90º
• Pendulums
• AAROM shoulder ER to neutral (0º).  Use a cane or other hand.
• AROM of elbow (flex, extend, supinate, pronate), wrist, and hand (putty)
• NO ACTIVE ABDUCTION OR EXTERNAL ROTATION during first 6 weeks.
• Patient should wear sling .

Phase II – Recovery of Range of Motion (3 to 6 weeks)

Goals

• Improve range of motion
• Gentle strength

Exercise:  (Isometrics should be sub maximal, sub painful contractions)

• Isometric ER with elbow at side and forearm on stomach
• Isometric abduction with elbow at side
• Isometric biceps flexion
• Increase AAROM flexion with pulleys to 140º
• Begin adduction stretching, with arm pulled across body
• Discontinue sling use at 6 weeks.

Phase III – Advanced ROM (6 to 9 weeks)

Goals

• Increased ROM
• Continue gentle strength

Exercise:

• AAROM ER with elbow at side to 40º
• AAROM abduction to 90º
• IR stretching (towel behind back, slide cane up back, etc.)
• Increase flexion with pulleys to equal other shoulder

Phase IV – Strength (9 to 16 weeks)

Goals

• Approaching full range of motion
• Clinic and home based strength program

Exercise:

• Rotator cuff strength.  Progress as tolerated and as strength improves
• Upper Body Ergometer (UBE)
• Total Gym
• Lat pulls
• Seated Rows
• Plyoball rebounder
• Incline pushups
• Chair dips
• Increase active abduction to equal other shoulder
• Work on any focal deficits

Discharge (16+ weeks)

Goals

• Full active range of motion without pain

Exercise:

• Full, unrestricted activity
• Regular shoulder and rotator cuff strength as maintenance program