Six-week physical rehabilitation protocol for anterior shoulder dislocation in athletes

Abstract

Anterior shoulder dislocations are common in young athletes. The mechanism for the first or primary shoulder dislocation may involve a collision or a fall typically with the arm in an abducted and externally rotated position. The aim of this study was to design a physical rehabilitation program using the elastic band and resistive exercise to improve joint strength and range of motion in individuals diagnosed with a first-time shoulder dislocation. Twelve physically active males with a first-time acute shoulder dislocation were asked to volunteer. Participants began a physical rehabilitation program 2 weeks after the shoulder dislocation, which was confirmed by a referring physician. The rehabilitation program was 6 weeks in duration and required the participants to engage in progressive resistive loads/duration using elastic bands and weights 5 days per week. Pretest and posttest measures included shoulder strength and range of motion. All outcome measures were compared between the injured and uninjured shoulder, which served as the control condition in this study. There were statistically significant differences between the injured and uninjured shoulder for measures of strength and range of motion during pretests (P<0.01) but not post-tests (P<0.53). Finally, there were no differences between shoulders in regards to the volume measure suggesting that any changes in muscle atrophy or swelling were not detected. The physical rehabilitation program proposed in this study was effective at improving strength and range of motion in the injured shoulder as evidenced by the similarity in posttest values between the injured and uninjured shoulder.

Hill-Sachs Deformity

“…4 Physiotherapy regimens have shown success in decreasing frequency of dislocations by improving general joint stability. 5 Treatment of Hill Sachs deformities are based on the percentage of humeral head articular surface involved in the lesion. Lesions involving <20% are treated non-operatively while those >40% are managed with arthroplasty.…”

A Review of Common Shoulder Injuries

“…After the injury has been assessed by a physician, rehabilitation and reconditioning should begin as early as possible to limit atrophy of the surrounding muscles (Gaballah et al, 2017). Initially, isometric strengthening exercises should be performed to strengthen muscles that function to internally and externally rotate the shoulder.…”

“…Initially, isometric strengthening exercises should be performed to strengthen muscles that function to internally and externally rotate the shoulder. While these exercises are done, the shoulder should rest in a sling comfortably in a fixed position that is relaxed, adducted, and internally rotated (Athwal & Elliott, 2017;Gaballah et al, 2017). An example of isometric shoulder rotation exercises includes using a doorway as an immovable surface with the elbow bent to 90 degrees exerting force into the wall.…”

“…(Miller & Armfield, 2019). Gaballah et al (2017) examined several athletes with anterior shoulder dislocations and their rehabilitative techniques. The study utilized elastic bands to produce resistive loads and found that "the physical rehabilitation program proposed… was effective at improving strength and range of motion in the injured shoulder" (Gaballah et al, 2017, p. 357) and athletes were cleared to gradually return to play in six weeks.…”

“…The group concluded that "the immobilizer achieves the goal of preserving joint stability in the movements that are at risk of dislocation" (Dellabiancia, et al, 2019, p. S159) after observing reduced range of motion when the brace was worn. The previous discussion emphasizes that a suitable method of prevention for recurring anterior glenohumeral dislocations is proper rehabilitation which reduces risk of injury by restoring both range of motion and strength (Miller & Armfield, 2019;Gaballah et al, 2017;Vavken et al, 2014). Improper rehabilitation can exacerbate the likelihood of re-injury to the joint that has already naturally healed in a stretched and weakened position (Provencher et al, 2010).…”