shoulder- instability- arthroscopic anterior shoulder plication in the overhead athlete
This document provides a detailed, phase‑based rehabilitation protocol for overhead athletes following arthroscopic anterior shoulder plication. It is organized into four sequential phases spanning weeks 0–32, each with specific goals, timelines, and exercise progressions. Phase I (Weeks 0‑6) is split into an Immediate Guarded Motion sub‑phase and a Maximum Protection sub‑phase, focusing on pain control, capsular healing, protection of repaired tissues, and early range‑of‑motion (ROM) and isometric work. Phase II (Weeks 7‑16) emphasizes controlled motion, gradual ROM expansion, dynamic stabilization, and the introduction of strengthening drills such as the Thrower’s Ten, closed‑kinetic‑chain (CKC) wall drills, and proprioceptive exercises. Phase III (Weeks 16‑23) advances strength, power, and endurance while initiating an interval throwing program. Phase IV (Weeks 24‑32) aims for unrestricted activity, completing the throwing program, and meeting objective return‑to‑play criteria (full painless ROM, satisfactory isokinetic testing, clinical exam, and physician clearance). The protocol also outlines modality use (cryotherapy in the first 7‑10 days), specific ROM limits for flexion, external rotation (ER), and internal rotation (IR) at each stage, and progressive loading guidelines (e.g., 1 lb weekly increments when pain‑free). The document concludes with explicit return‑to‑play benchmarks and reiterates copyright restrictions.
Topics
Phase I – Immediate Guarded Motion (Weeks 0‑6): Early Protection and Controlled Motion
Outlines the first two weeks of sling use, pain management, limited active‑assisted and passive ROM targets (flexion up to 90°, ER/IR limits), isometric and scapular stabilization exercises, and cryotherapy.
Phase I – Maximum Protection (Weeks 1‑6): Tissue Safeguarding and Early Strength
Details a parallel set of goals focusing on protecting healing tissues, maintaining ROM, preventing atrophy, and beginning light isotonic work (1 lb can, sidelying ER, CKC wall drills) while continuing proprioception drills.
Phase II – Controlled Motion (Weeks 7‑16): Expanding ROM and Dynamic Stabilization
Describes progressive ROM milestones (ER to 90‑115°, full 180° flexion), introduction of rhythmic stabilization, PNF, Thrower’s Ten, and incremental resistance increases, plus early plyometrics and CKC drills.
Phase III – Advanced Strengthening (Weeks 16‑23): Power Development and Initiating Throwing
Focuses on continued flexibility, self‑capsular stretches, advanced plyometrics, endurance and core drills, and the start of a structured interval throwing program (Phase I then Phase II).
Phase IV – Return to Activity (Weeks 24‑32): Full Functional Reintegration
Covers the final stage of unrestricted activity, continued progression of throwing, plyometrics, and strengthening, culminating in meeting objective return‑to‑play criteria.
Return‑to‑Play Criteria: Objective Benchmarks for Clearance
Lists the required outcomes for safe return to sport: full painless ROM, satisfactory isokinetic testing, clinical exam, completion of interval throwing program, and physician approval.
Exercise Progression Framework: From Isometrics to Plyometrics and Throwing Programs
Summarizes the systematic escalation of exercise intensity, from early isometrics and tubing work to weighted isotonic lifts, plyometric drills, and sport‑specific throwing protocols.