Physical therapy is the next step after surgery to help achieve a successful return to full, pain-free function.
The rehabilitationprogram consists of different phases that are both progressive and sequential. The key to successful rehabilitation is identification of the tissues involved, communication with the surgeon regarding the type of surgery performed, the patient's tissue quality, the quality of the repair, concomitant procedures performed, and patient understanding and compliance. The patient's goals and lifestyle desires must also be taken into consideration.
1. Acute Phase
2. Intermediate Phase
3. Advanced Strengthening
4. Return to Sports
Reduce pain and swelling Rehabilitation begins one to two weeks postoperatively. Passive range of motion, manual therapy, initiation of gentle rhythmic stabilization exercises, scapular stabilization exercises and modalities are utilized as needed to reduce pain and increase range of motion. Instruction in the use of a sling and modification of activities of daily living are reinforced to maintain and/or protect the integrity of the repair.
Initiate active range of action and activity tolerance Exercises are introduced to increase active motion while allowing for continued healing of soft tissue. Full passive range of motion is gradually restored during this phase. Manual therapy and modalities are used as needed to continue to reduce pain and inflammation. The use of a sling is gradually diminished, with instruction to not overstress the healing tissues.
Increase muscle strength and endurance The patient should have full passive and active range of motion. Shoulder exercises for strength and endurance are progressed here and more dynamic shoulder stabilization exercises are introduced. Exercises include eccentric contractions, proprioception and neuromuscular re-education, and multi-joint and multi-planar endurance exercises. Exercise selection is based on patient goals and activity/occupational demands. Manual therapy and modalities are used as needed.
Return to sport Advanced strengthening to increase muscle strength, power and endurance are performed so the patient can attempt to return to his or her previous level of sport participation. Maintenance of full, non-painful active range of motion and full strength are important. Plyometric activities and sports-specific loads are applied to the shoulder. Plyometric exercises enhance dynamic stability and proprioception and should be chosen individually based on sport-specific demands.