Dislocated shoulder issue

[FooSai]

Hi guys I'm just looking for a bit of advice regarding my shoulder.

History:
Almost 4 years ago I dislocated my left shoulder after landing on my back from falling off a grind rail, skiing. Over the next year it dislocated a further 8 times, and so I had an operation to have it fixed (I think the muscle was tightened somehow, not too sure though). Since then I went through the rehab and physio with it, and aside from it being slightly weaker than my right shoulder have never had any issues with it until now.

Yesterday it dislocated again, and sounded like the muscle tore as well. I went to hospital to have it put back in and now am using the brace I had from my operation to immobilize it. The doctor suggested that I may have to think about surgery again, though I would rather avoid this if possible.

So onto my question...
I intend to keep my brace on for 3-4 weeks and then go through the physio process on my own with it, using the same methods as I was shown after my operation (isometric exercises, light stretching and then onto resistance bands). Would you suggest any sort of support I can use after I am done with my brace to help stabilize/support it without limiting movement too much? and also if there is anything else you would recommend to aid the healing process.

Thanks in advance
- Danny

P.S. sorry for the long post.

[Yarok]

hi
soft tissues healing process can be supported by different electothrapy and massage.ie magnetothrapy, ultrasound, cryotherapy, laser.
i heard as well about prolotherpy - thickening lax ligaments.
i would reccomend high impact exercises in safe, pain free range of a trunk, neck, shoulder girdle, elbow.

all the best

[Yarok]

hi

in theory i would do is

1.islolated strenthening/mass muscle building in dynamic safe range of motion of a trunk,shoulder. used pyramide gradual load folowed by eccentrics.(weights, mashines used)

2.global control/functional (prioproceptive neuromuscular facilitation)and exercises, look at this site can find article - "shoulder instability"

3. above mentioned massage and electrotherapy.

4. investigate any spinal and pelvic difunctions- if any treat it,
5.use supplementary nutrition ie protein etc, to speed up muscle growth

hope it'll help
thanks. good luck

[therapian]

Hi mate, bad news hey. Sorry to hear about the shoulder problem. Did you have any kind of MRI scan to confirm if any of the soft tissues in the shoulder were damaged or not? If the Doctor was happy to let you go without immediate surgery then immobilisation is one way to go but remember do NOT allow it to go stiff. 4 weeks of immobilisation does sound quite long?!?!?! Was this at the Docs advice?!

Within the joint structure of the shoulder is a capsule that will have a tendency to dry out if left to long and can cause joint stiffness. This can in turn lead to further, avoidable, rehab needs. Get assistance to facilitate some passive movements of the shoulder, For example: the will move your arms, within pain free range, 10 times in one plane of motion then in the other (horizontal and vertical). This is a VERY basic version of what is know as 'Passive physiological Movement'. This will help the joint prevent drying up and relube the joints if it does dry up. Soft tissue therapy (massage) would be good for the possible scare tissue build up of any muscle tears in the region and any other muscles in the area that have gone tight as a result of the injury. Once the physician gives the go ahead, start an aggressive rehab programme.

The key to successful rehab of any Musculo-Skeletal injury is:

Start with basic re-education of the muscles and movements (motor training). This is not weight training! Basic active movement without weight (or minimal weight)may be enough at 1st. Then you need to train strength, proprioception and flexibility.

Strength at first should focus on the rotator cuff muscles for approx 4 weeks before moving onto exercises that work the shoulder as a FULL FUNCTIONABLE UNIT.
While working the shoulders as a unit consider using proprioception aids such as doing push-ups on a BOSU or medicine balls. I think it's important only to start this kind of proprioception training once stability of the shoulder has been gained.
Along with this work on maintaining flexibility of the shoulder muscles.

With an injury history like yours treatment and rehab could take approx 6-8 weeks along with life long commitment to maintaining it, but hey, think of the Delts you'll gain!

Originally Posted by FooSai

Hi guys I'm just looking for a bit of advice regarding my shoulder.

History:
Almost 4 years ago I dislocated my left shoulder after landing on my back from falling off a grind rail, skiing. Over the next year it dislocated a further 8 times, and so I had an operation to have it fixed (I think the muscle was tightened somehow, not too sure though). Since then I went through the rehab and physio with it, and aside from it being slightly weaker than my right shoulder have never had any issues with it until now.

Yesterday it dislocated again, and sounded like the muscle tore as well. I went to hospital to have it put back in and now am using the brace I had from my operation to immobilize it. The doctor suggested that I may have to think about surgery again, though I would rather avoid this if possible.

So onto my question...
I intend to keep my brace on for 3-4 weeks and then go through the physio process on my own with it, using the same methods as I was shown after my operation (isometric exercises, light stretching and then onto resistance bands). Would you suggest any sort of support I can use after I am done with my brace to help stabilize/support it without limiting movement too much? and also if there is anything else you would recommend to aid the healing process.

Thanks in advance
- Danny

P.S. sorry for the long post.

[Canuck Physio]

I like the advice given so far, however, I would just like to add this bit.

Traditionally, to prevent injury or rehabilitate the rotator-cuff shoulder muscles, isolated movements are recommended. However, the results of one recent study showed that multi-joint movements appear to be just as effective at strengthening these muscles as well as preventing a reduction in functional strength—one important benefit that is not obtained from isolation exercises.

This study compared the effects of isolated and multi-joint exercises on rotator cuff strength. Thirty-nine males participated in this 6-week study. After initial isokinetic testing of internal and external rotation strength, the subjects were divided into 3 groups. The isolated-exercise group performed internal and external dumbbell rotation exercises. The multi-joint exercise group performed pull-ups, overhead presses, reverse pull-ups, and push-ups. A control group performed no exercises.

Both experimental groups showed an increase in rotator cuff strength. However, the multi-joint exercise group experienced significantly greater improvements in each arm.

The authors of the study do not recommend replacing isolated movements with complex movements to strengthen injured rotator cuff muscles. Instead, they recommend a combination of both methods.

Rehabilitation should begin with isolated movements to better stimulate the weak rotator cuff muscles, such as that mentioned below. This will help to increase local stability.
After basic strength has been restored, a switch to more complex, multi-joint exercises will provide greater synergistic recruitment of these muscle fibers that result in better improvements in functional strength. A progressive overload approach should always be incorporated to speed the recovery process.

Ref: Journal of Strength and Conditioning Research 18;1:144 – 148, 2004.

The key is to build up the local stability initially, and making sure that you arm has full available ROM. Thus, once local stability is gained, further improvements can be made by globally stabilizing and strengthening the supporting muscle groups of the shoulder.

[FooSai]

Thanks for the advice/info, you have been all been very helpful.

-FooSai

[therapian]

P.S. I'm not entirely sure about Yarok's advice.

[Yarok]

hi
therapian
which part are not you sure?
ask will be explained
that's the forum is for