Rehabilitation Principles for the Shoulder Joint

The overall objective of rehabilitation is to return the athlete to sport functionality with guiding the player to full recovery, noting the individual characteristics of the player and the nature of the injury. The final objective of rehabilitation is to have the player as fit as the pre-injury level, in as short a time as possible in a safe and scientific manner. In many cases this requires a multi-disciplinary team to achieve the player’s safe return to practice and subsequent to match readiness.

Principles:

• The shoulder is a complex joint, with a number of different injuries that may occur. Generic principles will be provided as a guide.
• Improve the range of motion(ROM)-reaffirm the normal ROM, which includes flexion, extension, abduction, adduction, internal and external rotation.
• Develop strength once the joint is pain free.
• Proprioception of the shoulder joint is essential in order to regain the injured muscle and joint to assess position in space.
• Flexibility and co-ordination, agility are important components that are required for full recovery.
• Aerobic and anaerobic fitness also needs attention. This is usually done once the player is pain free.
• The shoulder joint is prone to re-injury if the relative strength, range of motion and proprioceptive deficits are not fully re-conditioned.
• A player may only be allowed back to practice if the pre-existing fitness levels are achieved. This is why it is so important to have pre-season testing as a baseline of fitness levels are set.
• The shoulder joint should be free of swelling before rehabilitation commences.
• There is no recipe for rehabilitation of the shoulder joint, however a framework for rehabilitation can be drafted based on injury and the individual characteristics of the player, state of inflammation, healing rate of the individual and the psychological well-being of the player.

Unreasonable expectations to return to practice may cause re-injury and the rehabilitation may be delayed by a number of weeks or months.

Return to play is dependent on a number of factor, such as achieving full range of motion, good flexibility, muscular strength and endurance, agility, performing a range of skills related to the sport, following injury, illness or an extended layoff due to a number of factors.

• Return to training should be dictated by a number of tests that could be done, based on pre- testing baseline data.
• Full range of motion is required , a number of tests are available.
• Aerobic fitness is essential, as practically all sport requires a baseline of aerobic fitness. Arm ergometry testing could be done.
• Strength testing is essential, isokinetic testing is most accurate, however, there are simple strength testing that can be done in a gymnasium. The strength should be about 95% of pre-injury levels. Again the importance of pre-season testing is important.
• There should be a minimal difference in size between the injured versus non injured limb.
• Flexibility testing would be have to be done.
• There should be no pain or swelling or tenderness of the shoulder.
• It is possible to return to play if wearing a shoulder brace to limit overhead movements and extreme adduction and abduction.

It is thus important to follow guidelines for the rehabilitation programme, complete relevant testing, pain free with total range of motion. The player should reach at least 95 percent of pre-injury scores. The player’s pre-injury games skills should also be tested and only if close to pre-injury levels could the player return to practice.

1. Prentice, W.E. (2000) Rehabilitation Techniques in Sports Medicine. McGraw Hill. New York.
2. Mellion, M.B. (1994) Sports Medicine Secrets. Mosby.Boston.
3. Bruckner, P and Khan, K. (2007) Clinical Sports Medicine. McGraw Hill. New York.