SLING DURATION | WHEN DO I START PHYSIO? | WHEN CAN I START DRIVING? |
4 weeks. | You will begin physiotherapy two weeks after your operation. | In approx 4-6 weeks, when you’re no longer using the sling and have full control of the vehicle. |
Acute phase (0-4 weeks)
Goals
- Reduce pain
- Protect the integrity of the repair
- Optimise tissue healing
- Maintain/regain range of movement
- Minimise muscle inhibition
Rehabilitation
- *Safe zone: commence with passive range of movement to 90° elevation, 20° external rotation
- Progress to active assisted & active supported mobilisation within that zone
- Elbow, wrist and hand exercises
- Simple scapular mobilisation exercises
- Closed kinetic chain/proprioception exercises – low load and ensuring congruency scapula on thorax
- Gentle isometrics rotator cuff
Criteria for progression
- Control of pain
- Range of movement
Intermediate phase (4-8 weeks)
Goals
- Discard use of sling
- Preserve integrity of surgical repair
- Restore functional range of movement including full elevation
- Re-educate cuff recruitment and scapular control through range
- Re-educate sensorimotor/proprioceptive function
Rehabilitation
- Progress range of movement to restore functional range
- No forced end range mobilisation
- Begin active range of movement exercises from 6 week mark
- Mobilise capsular restriction if necessary
- Progress cuff and scapular recruitment through range
- Progress kinetic chain integration
- Increase functional emphasis movement pattern correction
- Closed kinetic chain work to enhance co contraction
- Hydrotherapy permitted
Criteria for progression
- Pain free functional range of movement
- Good control of rotator cuff and scapular musculature through functional range through functional range
Late phase (>8 weeks)
Goals
- Restore full active range of movement
- Establish optimal neuromuscular control of shoulder girdle musculature
- Restore optimal cuff and scapula control through range and under load
- Optimise function specific power, strength and endurance
- Transference movement pattern correction and cuff/scapula control to functional tasks
- Return to work/sport and recreational activities
Rehabilitation
- Progress active range of movement
- Regain optimal range of movement into combined positions
- Enhance neuromuscular control through range and incorporated with kinetic chain
- Closed kinetic chain exercises with increased load
- Functional specific strengthening and endurance exercises
- Sports/functional specific rehab
Guidelines for return to functional activities
LIFTING | SWIMMING | GOLF |
Light lifting at 6 weeks. Avoid heavy lifting until 6 months. | Breaststroke 6 weeks, freestyle 12 weeks. | 3 – 6 months. |
