The Collision Shoulder A Progressive Approach to Rehabilitative - - PowerPoint PPT Presentation

The Collision Shoulder

A Progressive Approach to Rehabilitative Exercise

John Roche - Physiotherapist

A Rugby Perspective

The 2012 Canterbury team was surveyed for a Research project conducted by Khalid Mohammed:

Mohammed K et al Orthopaedics and Trauma [2015] http//doi.org/10.1016/j.mporth.2.014.12.007

• 56% had already had shoulder surgery [60% of forwards surveyed; 40%
• f backs]
• 2/3 of group had missed game-time because of shoulder injury
• All surveyed players had returned to rugby following injury/surgery

Surgical Cohort

Rehab Focus Areas

• Postural Awareness/ Control [Review neutral position
• f shoulder]
• Mobility [while avoiding over-stressing damaged

tissue]

• Scapula Control/ Stability [+core]
• Rotator Cuff Strength/ Co-ordination
• Functional Strength
• Return to Desired Activity Level

Pendular Exercises

• Can be useful for reducing

low level pain and maintaining joint mobility in early stages post injury

• 60 secs every 2-3 hours
• Consider cryotherapy for pain

Postural Control

• Neutral Position of Glenohumeral Joint = midway

position between protraction/retraction + elevation/depression

• Ensure patient doesn’t develop a “sick scapular”

PosturalControl

• Focus/ awareness on good posture through

lumbar/ thoracic spine and maintenance of good scapula position [NB: Difficult to maintain good scapula position with stiff thoracic spine]

• Think of how to provide feed-back: mirror;

family members; coaches etc

• Regular cues throughout day

Mobility

Don’t force ROM - should not be painful

• Active Assisted flexion
• Use stick/ pulley/ wall slide
• Rotations in supine with focus on scapula position
• Abduction in plane of the scapula
• Pool: water-supported/ resisted exercise
• Physio = joint mobilisation/ manual therapy +

exercise prescription

Scapula Stability Exercises

Prone scapula retraction

• Good scapula position
• Use lower traps/ rhomboids, not latissimus

dorsi

Scapula Stability Exercises

Bungee Row

Scapula Stability Exercise

4 point-kneeling with arm lift

Scapula Stability Exercise

• Side-on to wall
• Set scapula and rotate/ perform single-arm

press-up etc

Rotator Cuff Strengthening

• Theraband/ Tubing exercises: [focus on good scapula

“setting” and performing the exercise with control]

• Ext rot/ Int rot/ abd
• Start slow and controlled
• Progress load
• Progress speed/ eccentric load
• Consider sets/reps/resistance

progression

Dumb-bell Exercise

• Always focus on good scapula

control/position

• External rotation in side-lying
• Lateral raise in plane of scapular
• IR/ER with scapular control
• Other examples

Upper Body Strengthening

• Muscular Endurance Vs Strength Vs Power
• Consider resistance/ sets/ reps
• Consider athletes requirements for function
• “Pushing Exercise” [floor press/ bench

press/ shoulder press]

• “Pulling Exercise” [seated row/ bent-over

row/ lat pull-down]

Regaining Function

• Return to Play = 2 weeks full training
• Progress to this level via controlled coaching of

technique [collision/ tackle/ landing/ catching etc]

• Same philosophy with return to work

A Useful Resource

A Useful Resource