DR.

ANIL SOOD MANAGEMENT PROTOCOL FOR

SHOULDER DISABILITIES
Current rehabilitation programs for the shoulder should focus on restoration of
functional ability rather than focusing solely on resolution of symptoms. The
orthopedic surgeon and the physical therapist must identify and treat all of the
structures that are limiting this functional return. Rehabilitation is sometimes
difficult in the shoulder, whose complex function involves not only local anatomic
and biomechanical integrity, but also biomechanical and physiologic contributions
from distant body segments.

The distant segment contributions are key components of the sequential

activation of body segments that is necessary to accomplish any athletic activity.
The activation sequence is termed a kinetic chain.

Remember kinetic chain & proximal to distal sequencing

Keys points in shoulder rehabilitation are:

 Pelvis control over the planted leg (negative Trendelenburg sign)

 Effective hip and trunk extension(Core muscle strengthening

exercises)

 Scapular control, especially of retraction(Scapular setting,

strengthening)
  Normal glenohumeral rotation(Capsular stretches)

 Strengthen your rotators and advance to

 Plyometrics

 Ergotherapeutic exercises

 Gyrotonic exercises

Let’s begin
1. Trunk exercises
2. Hip / trunk rotation. Scapular protraction

3. Passive abduction & flexion

4. Medial low-row

5. Shoulder dumps with brace

6. Now let’s Swing the pendulum

7. Scapular clock-Retraction/Protraction
8. Isolated scapular depression & protraction

9. Don’t forget Rhomboids

10.Thumb down/ Thumb up(Infraspinatus & Supraspinatus)
11.Closed chain

12.Active rhomboids reinforcement

 When the patient is able to achieve a full glenohumeral active and passive
range of motion, the strengthening phase of rehabilitation can be started.
13.Salute the rotator cuff

14.Cross body adduction for posterior stretching/towel stretches

15.Stretch while you are going to sleep-sleeper stretches

16.Wall washes-axial loading with resistance

17.Hug the Bear widely with adduction(Bear hugging)

18.Posterior rotator cuff strengthening(do not forget medial elbow towel roll)
19.Thera band diagonal down(Coupled strengthening of Axial body & Rotator
Cuff)

20.Plyometrics
21.Plyometrics-Underhand & Overhand throws

22.Physical therapies

A. TENS- Transcutaneous electrical nerve stimulation (TENS) is a technique

used to relieve pain in an injured or diseased part of the body in which
electrodes applied to the skin deliver intermittent electrical stimulation
to surface nerves and block the transmission of pain signals. The two
most commonly used TENS in clinical practice are represented by the
high-frequency, low-intensity (conventional) TENS (HF-TENS) and by the
low-frequency, high-intensity (acupuncture-like) TENS (AL-TENS)
B. Laser Therapy- A laser is a device that emits light through a process of
optical amplification based on the stimulated emission of
electromagnetic. Low-level laser therapy (LLLT) significantly increases
microcirculation, activates angiogenesis, and stimulates immunological
processes and nerve regeneration. Moreover, it has an analgesic effect
through stimulating an increased production of endorphins radiation
 Absolute contraindications in using any kind of physical therapies are
presence of a pacemaker, recent neoplastic processes, and pregnancy.
Particular attention should be also given to those patients with acute
infective diseases, severe arrhythmias, seizures, and coagulation
disorders.

23. Aquatic therapy for Shoulder

24.Ergotherapeutic games
25.Gyrotonic (Neurophysiological Complex Therapy)
Gyrotonic training can incorporate movements of entire chains of muscles
and can be trained holistically and in three-dimensional sequences against
even gliding resistance. The joints are subject to a minimum axial load,
simultaneously developing of strength, coordination and agility. This
requires adequate joint and muscle stability.
26.Active reinforcement of the movement of internal rotation of the shoulder
with the aid of an elastic band

27.Scapular strengthening ( not to forget)

Horizontal scapular strengthening

 Vertical scapular strengthening

28.Keep playing
 What we need to understand is Sportsmetrics
1. Dynamic warm up
2. Pre-Conditioning
3. Perturbation training Balancing for unsuspected fall)
4. Plyometrics principles in rehabilitation
5. Neuro muscular training especially for >6 weeks

In case of any queries please feel free to contact me on dranilsood@rediff.com