The exercises that follow provide a rehabilitation programme for an anterior dislocation shoulder injury. The information is intended as a guide and refers to those people who have dislocated their shoulder for the first time. The rate of progression is dependent upon the healing process, which is affected by the age of the patient.
It is therefore not possible to be precise when indicating a prognostic timetable. Individuals will heal at different rates and therefore a pain-free range of movement is the best guide for progressing the stages of rehabilitation.
Protection Phase (0 – 6 weeks)
In younger patients, the shoulder should be immobilised in a sling for 3 to 4 weeks. In patients over 40 years of age, the sling should be discarded sooner to prevent secondary stiffening of the shoulder.
- No overhead arm movement or sporting activity should be undertaken for 6 weeks.
- Care should be taken at night, with some form of immobilizing device worn in bed.
Some active exercises can be started immediately. However, the extent of shoulder movement should be guided by pain, since over-stretching the healing tissues only delays the recovery. The exercises that follow should take place in the pain-free range.
- Use a grip strengthener for 10 minutes every couple of hours, in order to maintain wrist, hand and finger strength.
- Wrist and elbow bending and straightening should be practiced at least twice daily.
- The arm can be raised forward to the level of the shoulder (90 degrees) and out to the side to the level of the ribs (60 degrees).
Isometric exercises can be started once the arm is out of the sling:
Isometric contraction of the lateral rotator muscles of the shoulder.
This is achieved by pushing against a wall without any movement taking place.
More advanced strengthening of the lateral rotator muscles using a weight and pulley device.
Isometric contraction of the medial rotator muscles of the shoulder. This is achieved by pushing against a wall without any movement taking place.
More advanced strengthening of the medial rotator muscles using a weight and pulley device.
The range of movement in the shoulder can be gradually increased over the course of 2-4 weeks.
Functional Phase (6+ weeks)
Continue with the strengthening programme. Continue with range-of-movement exercises.
Use of resistance cord/band to strengthen the internal rotator muscles of the shoulder.
Use of Resistance Cord/Band to strengthen the external rotator muscles of the shoulder.
Self-assisted range-of-movement exercises for the shoulder (this shows the advanced stage).
The patient balances with the affected shoulder on a medicine ball for 1 minute at a time, followed by a rest period.
The medicine ball is replaced by a Wobble Board to make the exercise more difficult.
The difficulty is further increased by using a medicine ball and a Wobble Board!
The balancing task, and therefore proprioceptive ability, is further taxed by resting the legs on a Swiss Ball…
…and here’s one for all you break-dancers!