Exercises: • Ensure trunk stabilization -> shoulder linkages for force distribution • Plyometric exercises: double upper e.g. med ball throws to ground, side, overhead • Progress to single arm e.g. IR wall dribbles, IR throws against trampoline, supine 90-90 IR medicine ball toss • Can be performed at 90° abduction to improve IR/ER strength & throwing ability • Closed chain progressed e.g. suspension/TRX
CRITERA FOR PROGRESSION TO PHASE 5 ▲ ▲
MMT 5/5, HDD > 90% CONTRALATERAL SIDE ER90/IR90 > 70% PASS ON ALL FUNCTIONAL TESTS: 1. Med Ball Plyometric wall bounce: 2lbs x 60sec @ 165bpm 2. Single Arm Seated Shot-Put Test > 90% contralateral side 3. CKCUEST >21 touches in 15 seconds 4. UEY-Balance: total normalized excursion score >90% contralateral side
PHASE 5: RETURN TO SPORT PROGRAM Goals: • Full sports participation without compensation or risk of re-injury Guidelines: • Clinical and sport specific testing – mobility & strength-based criteria •
Simulated sport activity
Return to training
Playing lower level competition and less minutes until confident
If throwing sport - emphasis on late cocking and acceleration phase of throwing
Following successful completion of: •
Throwing Athletes: Throwing Progression
Golfers: Golf Progression Return to unrestricted activity/full sports participation
+ Study reference Altintas B, Bradley H, Logan C, Delvecchio B, Anderson N, Millett P (2019) Clinical Commentary: Rehabilitation Following Subscapularis Tendon Repair. The International Journal of Sports Physical Therapy, 14(2), doi: 10.26603/ijspt20190318
SUPPORTING REFERENCES 1.
Garavaglia G, Taverna E, Ufenast H. (2011).The frequency of subscapularis tears in arthroscopic rotator cuff repairs: A retrospective study comparing magnetic resonance imaging and arthroscopic findings. Int J Shoulder Surg.;5(4):90.
Katthagen JC, Vap AR, Tahal DS, Horan MP, Millett PJ.(2017).Arthroscopic repair of isolated partial and full thickness upper third subscapularis tendon tears: Minimum 2-year outcomes after single-anchor repair and biceps tenodesis. Arthroscopy;33(7):1286-1293.
Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox RB. (2016).The American Society of Shoulder and Elbow Therapists’ consensus statement on rehabilitation following arthroscopic rotator cuff repair. J. Shoulder Elb Surg. 225(4):521-535.
van der Meijden OA, Westgard P, Chandler Z, Gaskill TR, Kokmeyer D, Millett PJ. (2012). Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines. Int J Sports Phys Ther. ;7(2):197-218.
Decker MJ, Tokish JM, Ellis HB, Torry MR, Hawkins RJ.(2003) Subscapularis muscle activity during selected rehabilitation exercises. Am J Sports Med.;31(1):126-134.
Kokmeyer D, Dube E, Millett, PJ.(2016) Prognosis driven rehabilitation after rotator cuff repair surgery. Open Orthop. J.;10(Suppl 1: M10):339-348.