Rehab Shoulder Multi-Directional Instability Protocol
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

Rehab Shoulder Multi-Directional Instability Protocol

Phase I: (0-4-6 weeks)

Goals:

  • Protect surgery
  • Decrease pain and inflammation
  • Initiate safe ROM while protecting anterior/posterior capsule
  • Patient education

Plan:

  • PROM limited to 90° of flexion and abduction: Do NOT stress or force internal and external rotation.
  • Elbow and wrist ROM
  • Modalities PRN
  • Pendulum and scapular activities
  • Light resisted activity to wrist

Phase II (4-6 weeks to 8-10 weeks)

Goals:

  • Decrease pain and inflammation
  • Achieve 50-80% of full ROM of flexion, extension and IR at end of phase

**This DOES NOT include abduction with ER or horizontal adduction w/ IR**

Plan:

  • Discontinue sling at 1 month
  • Begin increasing forward elevation (flexion in scapular plane) beyond 90°
  • Joint mobilization: avoid aggressive mobs/avoid inferior, anterior; and posterior directions
  • Use caution when performing passive range of motion into abduction with external rotation and internal rotation so as not to stress the healing capsule.
  • Scapular PNF
  • AAROM
  • Aquatic Therapy
  • Gentle rotator cuff strengthening (ER to neutral)

**Check with physician on rotation limitations**

Phase III (8-10 to 16-24 weeks)

Goals:

  • Near full ROM: EXCEPT ABDUCTION w/ EXTERNAL ROTATION and HORIZONTAL ADDUCTION with INTERNAL ROTATION
  • Good scapulo-humeral rhythm
  • 80-90% normal strength

Plan:

  • PROM (full range; ER near full-range):
  • **NO FORCE IN ABDUCTION/EXTERNAL ROTATION
    **NO FORCE IN ADDUCTION with INTERNAL ROTATION

  • Joint mobilization
  • Progressive scapular strengthening
  • Progressive rotator cuff ~strengthening
  • Begin machine weighted exercise
  • Gentle PNF, eccentric cuff strengthening
  • Biodex training if requested by M.D.

Phase IV (>24 weeks)

Goals:

  • Maximum ROM
  • Increase strength
  • Return patient to sport/activity

Plan:

  • Continue with progressive resistive exercises
  • Continue with machine-weighted program
  • Sport Specific Training