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PHASE 1: MAXIMAL PROTECTION Goals:

CRITERA FOR PROGRESSION TO PHASE 2

Decrease pain and inflammation

Restore passive mobility within ER limits (30°)

Pain-free restricted ADL using the sling

Exercises/Treatment: Abduction sling day and night

Waist level activity as tolerated e.g. keyboard

Regular cryotherapy

ROM: active hand, wrist and elbow.

PASSIVE shoulder ROM

LIMITED external rotation < 30°

Scapular mobility – avoid for two weeks with full thickness repairs. Then gentle introduction of scapula motions with SLING ON.

Isometrics: None weeks 0-3 for full tears. Afterwards sub-maximal and pain free isometrics in neutral e.g. rhythmic stabilization

• Manual Therapy: PROM, soft tissue work such as lymphatic drainage, NO mobilisation to glenohumeral joint •

Maximally protect the reconstruction via optimization of the environment for tissue healing e.g. avoid smoking, ensure stable blood glucose levels

Kinetic Chain Exercises: breathing, “Core” exercises in crook lying, focus on lower extremity movement e.g. stationary recumbent bike

“This paper reinforces the need for staged progression through rehabilitation in tandem with tissue healing phases.”

Pain less than 3/10 at rest Functional Tasks: 3 out of 5 1. Light meal preparation 2. Feed self-hand to mouth 3. Waist height ADLs 4. Less than 2 sleep disturbances per night 5. DASH score < 60 Passive ROM: Forward elevation 120̕, Abudction 90̕, ER 30̕ Able to perform active “scapular clock”

PHASE 2: MUSCULAR ENDURANCE Goals: • Careful progression to full active ROM (AROM) • Improvement of endurance ability and control of the shoulder complex • Normal use of arm during ADLs – apart from overhead lifts, jerking or repetitive actions • Discontinue sling Exercises – PROM > AAROM • Active assisted ROM (AAROM) 1 week before active ROM (AROM) • Light stretching until full passive ROM (PROM) • Low load, long stretches & joint mobilisations at 5-6 weeks post-op • Isotonic – no or low load + high repetition exercises • Gravity load is enough • MVIC of 15% or less e.g. table slides, pulley assisted elevation • Bar/stick or foam roller for ER AAROM in supine Exercises – AAROM > AROM • Fair isometric contraction + AAROM => AROM commences • Supine, side-lye or prone -> progress to standing • ROM exercises+ scapular control • Stepwise neuromuscular training e.g. rhythmic stabilization at various angles, diagonal PNF, open chain scapular exercises e.g. supine serratus punch

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kerr- hargrove  

kerr- hargrove