Shoulder rehabilitation strategies, guidelines, and practice (Reprinted from Operative Techniques in Sports Medicine, October, 2000)

Shoulder rehabilitation can best be understood and implemented as the pract ical application of biomechanical and muscle activation guidelines to the r epaired anatomic structures in order to allow the most complete return to f unction. The shoulder works as a link in the kinetic chain of joint motions and muscle activations to produce optimum athletic function. Functional sh oulder rehabilitation should start with the establishment of a stable base of support and muscle facilitation in the truck and legs, and then proceeds to the scapula as healing is achieved and proximal control is gained. The pace of this "flow" of exercises is determined by achievement of the functi onal goals of each segment in the kinetic chain. In the early rehabilitatio n stages, the incompletely healed shoulder structures are protected by exer cises that are directed towards the proximal segments. As healing proceeds, the weak scapular and shoulder muscles are facilitated in their reactivati on by the use of proximal leg and trunk muscles to re-establish normal coup led activations. Closed chain axial loading exercises form the basis for sc apular and glenohumeral functional rehabilitation, as they more closely sim ulate normal scapula and shoulder positions, proprioceptive input, and musc le activation patterns. In the late rehabilitative stages, glenohumeral con trol and power production complete the return of function to the shoulder a nd the kinetic chain. In this integrated approach, glenohumeral emphasis is part of the entire program and is towards the end of rehabilitation, rathe r than being the entire program and being at the beginning of the program.