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REHABILITATION GUIDELINES TO IMPROVE DYNAMIC STABILITY

PHASE I – BASELINE STABILIZATION

Goals:

  • Diminish pain and inflammation
  • Improve posterior flexibility
  • Re-establish dynamic stability (muscular balance)
  • Re-establish muscular control
  • Improve scapula position, strength, and control

 

Treatment  Modalities:

  • Cryotherapy to posterior capsule/ cuff
  • Iontophoresis (Empi Hybresis)
  • Electrical stimulation

 

Flexibility:

  • Sleeper stretch
  • IR stretch @ 90° ABD
  • Horizontal ADD w/ IR stretch
  • Shoulder flexion and ER ROM (gentle stretch)

 

Exercises:

  • Emphasize muscle balance (unilateral muscle ratios)
  • Rotator cuff strengthening (esp ER)
  • Scapular strengthening exercises
    • Prone exercises on table and physioball
  • Dynamic stabilization exercises
    • ER/IR t-band w/ manual resistance and rhythmic stabilization
    • Manual resistance side-lying ER w/ end ROM rhythmic stabilization
    • Manual resistance prone rowing w/ end ROM rhythmic stabilization
  • Proprioceptive training
  • Closed kinetic chain
    • push-up position rhythmic stabilization at mid ROM
    • ball on wall in scapular plane w/ rhythmic stabilization
  • Monitored Rehabilitation System- ER/IR neuromuscular program
  • Seated neuromuscular control drill
  • Push-ups on plyoball w/ rhythmic stabilization / tilt board perturbations

 

PHASE II – INTERMEDIATE PHASE

Goals:

  • Progress strengthening exercises
  • Restore muscular balance (ER/IR)
  • Enhance dynamic stability
  • Maintain flexibility and mobility
  • Improve core stabilization

 

Flexibilty:

  • Control stretches and flexibility exercises
  • Sleeper stretch
  • Horizontal ADD w/ IR stretch

 

Exercises:

  • Progress strengthening exercises
  • Initiate core stabilization program
  • Implement LE strength program
  • Dynamic stability
    • Seated ER t-band on physioball w/ manual resistance and rhythmic stabilization @ end ROM
    • Prone scapular exercises on physioball w/ trunk extension (performed bilaterally)
    • Planks on plinth
    • Planks on physioball
    • Manual resistance rowing w/ rhythmic stabilization
    • Seated neuromuscular control drill on physioball and contralateral knee extension
    • Body Blade activities for endurance
    • Single leg stance on foam w/t-band ER/IR
    • Weighted cross motion while single leg stance on foam
    • PNF D2 flexion/extension w/ rhythmic stabilization @ 45°, 90°,145°
    • PNF D2 seated on physioball
    • Side-lying scapula neuromuscular control drill
  • Initiate 2 hand plyometrics
    • Chest pass soccer throw
    • Alternating over-head side-to-side
    • Side under-hand throw

 

PHASE III – ADVANCED STRENGTHENING

Goals:

  • Aggressive strengthening program
  • Progress neuromuscular control
  • Improve strength, power, endurance

 

Exercises:

Continue all exercises and stretches previously listed

  • Manual resistance
  • Dynamic stability drills
    • Seated physioball ER/IR t-band @ 0° ABD w/ manual resistance and rhythmic stabilization
    • Seated physioball ER/IR t-band @ 90° ABD w/ manual resistance and rhythmic stabilization
    • Planks on table
    • Bilateral UE support w/ rhythmic stabilization
    • Unilateral UE support w/ rhythmic stabilization
    • Unilateral UE support w/ LE movement and rhythmic stabilization
    • Continue Monitored Rehabilitation System for ER/IR
  • Plyometrics
    • Continue 2 hand drills
    • Initiate 1 hand drills
    • Wall dribble (30-60 sec bouts)
    • Plyometrics throw at 90°/ 90°
  • Stretch post exercise