REHABILITATION GUIDELINES TO IMPROVE DYNAMIC STABILITY

October 29, 2018

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