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AC Joint
Rehabilitation with 

Andrew Ryan
Handout

 AC Joint Rehab
Acromioclavicular (AC) joint injuries are the most frequent acute
shoulder girdle injuries in athletes, and require a structured
rehabilitation program to get your athletes back on the field into
contact situations. In this video on AC Joint Rehabilitation, Wallabies
Physiotherapist Andrew Ryan presents on the anatomy of the AC joint
and supporting ligaments, mechanisms of injury, how to assess,
diagnose and grade AC joint injuries. He then takes you through a
comprehensive rehabilitation program step by step, from the time of
injury on the field, right through to return to play and full contact. For
ease of viewing, this video is split into short segments.

Part 1 covers Anatomy of the AC Joint and ligaments, injury grading.

Part 2 - Timeframes for return to play, management of grade 3 injuries,

conservative or surgical management

Part 3 - Acute management and pain relief

Part 4 - Mechanism of injury, assessment of the AC joint and diagnosis

Part 5 - Taping for the AC Joint

Part 6 - Kinesio taping for the AC Joint

Part 7 - Early rehab guidelines

Part 8 - Early rehab exercises - rotator cuff

Part 9 - Early rehab exercises - standing, seated and side lying

Part 10 - Early rehab exercises - prone and supine

Part 11 - Intermediate rehab exercises - wall and ball

Part 12 - Intermediate rehab exercises - theraband and overhead

Part 13 - Advanced rehab exercises - pushup progressions


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Part 14 - Advanced rehab exercises - proprioception and combined
movements

Part 15 - Return to contact and summary

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Acromio-clavicular Ligament

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Coraco-acromial Ligament
 Coraco-clavicular ligament - Conoid portion

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Coraco-clavicular ligament - Trapezoid portion
 anatomy anatomy
• Articulation between clavicle and acromion of the scapula

• Joint capsule

• AC joint ligament:

• Acromioclavicular ligament

• Ligaments from coracoid process to underside of clavicle:

• Coracoclavicular ligament = conoid + trapezoid

anatomy - acromio-clavicular anatomy - coraco clavicular ligament

ligament - conoid portion

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anatomy - coraco clavicular ligament 6 grades of AC Joint sprain

- trapezoid portion (Rockwood)

http://www.physiotherapyassociates.com.au
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 grades 1-3 AC Joint sprain grades 4-6 AC Joint sprain
• Grade 1 • Grade 4
• Sprain of the capsule of the joint (2 weeks):
• Complete tear AC joint ligaments, + tear coracoclavicular ligaments (conoid + trapezoid)

• Characterised by local tenderness and pain on movement.

• greater soft tissue damage + coracoclavicular distance is up to 5x greater than the
uninjured side and involves posterior displacement.

• Grade 2
• Surgery indicated.

• Complete tear of the AC joint ligaments + sprain of the coracoclavicular ligaments (4-6
weeks). Characterised by localised tenderness and a palpable step deformity.
• Grade 5
• Grade 3 • As per 4 but involves superior displacement clavicle & surgery indicated

• Complete tear AC joint ligaments, + tear coracoclavicular ligaments (conoid + trapezoid) • Grade 6
(> 6 weeks). Conservative v Surgical Management

• As per 4 but involves inferior displacement clavicle (behind tendons of biceps and
• Tenderness + 25-100% greater coracoclavicular distance than the uninjured side. corocobrachialis) & surgery indicated

surgical intervention dysfunction

• loss of ‘strut’ function to stabilise the scapula, glenohumeral
joint

• may be considered for Type III and

beyond
• alteration in scapulohumeral mechanics

• some Type III injuries can have a good • distal clavicle rotation mechanics are altered – pain, loss of
result with conservative rehabilitation scapulohumeral movement

• Intact/functioning AC joint contributes 30 deg to

scapulohumeral movement.

acute management diagnosis

• Pain relief – analgesia/NSAIDS/CSI
• Mechanism of Injury ?

• Contact point of shoulder

• Sling – time depends on severity/Comfort

• Fall with outstretched arm

• Landing on elbow

• X - ray

• Palpation of the AC joint – crepitus/Pain

• Taping techniques – offload joint

• Palpation of the clavicle for potential #

• Observation for a ‘Step deformity’

• Ice/compression – Game Ready Unit

• Swelling/synovial thickening

• AROM limits: FF/ABD/ER/IR/HF

• Commence physio as pain allows

• Resisted Horizontal Extension

• Respect pain with activity • Active/Passive movements

 taping rehabilitation guidelines
• Pain free activation of shoulder/AC joint

• Rigid Tape, Fixomull 5&10cm, Tuf Skin, Skin Prep

• Limit overhead push/pull exercises

• Humeral Head elevation technique

• Bench press modification – close grip – not wide

• PA tape pull down over AC joint

• Incorporate scapulohumeral mechanics into rehab

• Kinesio tape options – cross the joint with 85% stretch – lay • Commence rehab ASAP within limits of discomfort/pain.

down edges.
• Move from Open to Closed Chain exercises

early rehab early rehab

• Cuff activation work:

• Respect pain & avoid aggravating positions:

• Classic ER/IR neutral + towel at axilla – theraband/tube

• Rows + Extension + Scap control – theraband/tube

• Overhead = military press, bench press, push ups

• Humeral head depression

• Pushing activities
• Dips

• Adduction/Abduction (and side lying ER/IR) – theraband/tube

• Contact

• Scap setting:
• Impact work e.g: running • Prone flutters – 0/45/90 + Crucifix/Superman

• Serratus Anterior - protraction/retraction + band

intermediate rehab working back to RTP 1

• Start to increase functional range:

• Swiss ball walk + push ups

• Wall climbs/slides + ball - proprio

• Push ups + dynamic – claps/walk up/down/along box +

• Work exercises up to 90 degrees shoulder FF/ABD 90
band around wrists

• Then work into overhead control – no pain AC joint

• Bench press BB/DB – alter grip as pain/progression allows,

• Overhead flutters – 0/45/90 – forwards/backwards + scap perform on floor

control – single arm/both

• Seated rows/bent over back rows/lateral flys

• Wall push ups
 working back to RTP 2 return to contact
• Deltoid flys – lateral/anterior/posterior
• Repetitive use of injecting local anaesthetic or pain killers and ignoring
symptoms with ongoing repetitive trauma on an AC joint that has not
settled may lead to osteolysis and long term issues with pain.

• Cable x-overs – low to high/high to low SA

• Return to contact plan:

• Body Blade prioprio – 90 deg/overhead – vertical/horizontal

blade position
• Walking into pads

• Jogging then running into pads

• Throwing weighted ball on tramp various heights

• Tackling a person

• Free Form Board slides/proprio

• Add speed and going to ground

• Swiss ball lie back – Shoulder ABD 90 – ER – weighted ball • Add getting off the ground

return to contact

• Protect the joint

• Padding or AC guard