Shoulder Instability – Part III, Treatment And Rehabilitation Of Shoulder Instability

[physiobob]

INTRODUCTION:

Conventional strengthening programmes such as rotator cuff theraband exercises are ineffective in this patient group as generalised strengthening appears to reinforce the patterning. Similarly specific local control strategies appear difficult to achieve due to impaired proprioception and dominance of the patterning muscle (24). Our experience mirrors that of the Stanmore group in that this patient group appear to respond much better to a more ‘normal movement’ approach to treatment aimed at restoring normal movement patterns.

Motor learning or relearning is key to establishing or restoring optimal movement patterns. When planning our rehabilitation approach we must appreciate the stages in motor skill acquisition. In the early stages tasks should be highly...

Article Credit:

This article was kindly provided by sportEX medicine. To read more (3 page pdf document) download the entire PDF file that is attached below. You will need to register on this site first in order to download this file.

[reem101]

iam appreciate your great effort and hard work

[mikes100]

hi could you possibliy refer us to the previous 2 articles.
thanks

[physiobob]

Originally Posted by mikes100

hi could you possibliy refer us to the previous 2 articles.
thanks

They are posted in this same section under this one!

[mikes100]

thanks very much

[linbin]

hi sir
your posts are really useful and informative.please continue your good work

[shinydan]

good... but lots of doubt doubt on the techniques involving the swiss ball....any site to learn the basics regarding the motor relearning techniques....

[balrajsub]

Dear Physiobob
I have been treating shoulder instability problems on 3 step based approach
1. Selective activation of deep stability muscles, i.e. teaching HOH positioning with rotator cuff muscles activation & strengthening.
2. Progress to dynamic stability with activation and stregthening of Lower Trapezius and Serratus Anterior Muscles as described in -Mottram SL. Dynamic stability of the scapula.
Manual Therapy 1997;2(3):123-131
3. Progress to Scapular disassociation from the trunk while performing ADLs.

I have found better results with my patients with this approach. Am i doing it right or is this old school of managing shoulder problems?

[sharileedahl]

"Balrajsub" -
After reading through the attached article, I don't think you are off the mark at all. The only difference is that it appears that your 3 step approach stops at specific retraining and doesn't go on to "functional movement patterns" as referred to in the article.
I use alot of the same types of exercise ideas as you with shoulder rehab however I wouldn't go so far as saying I have a three step approach. It really just depends on what I am seeing with that individual client (i.e. not every shoulder injury is going to present with weak lower traps and s.a.).
I do use the ball quite a bit with shoulder rehab and love it. Rehab can be as challenging as you want to make it and I find they get a quicker functional recovery. I do however see the importance with many of my clients to spend some time on specific muscle recruitment first.

As for the question from "shinydan" re where to learn techniques....
I have picked up most from various courses and reading articles over the years.
One group that I took a course from re. the shoulder was the Kinetic Control group. From what I remember, the emphasis was more on how to recruit specific musculature and did not necessarily move on to "functional" exercises (it was about 5 years ago now though). Sarah Mottram was the instructor on the course that I attended, so I imagine the resource cited by "balrajsub"" would be useful. I have not done any Sahrmann courses however from what I know about the topics she covers, any resources by her would also be useful.

[gosee3263]

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