Transcript Rehabilitation Program for Overhead Activities for Micro

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Rehabilitation Program for
Overhead Activities for
Micro-Instability
Phases in Rehabilitation
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Acute Phase
Intermediate Phase
Advance Phase
Return to Activity Phase
Goals
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ROM
Muscular Strength and endurance
Proprioception
Dynamic stability
Neuromuscular control
Acute Phase
• Immediately following injury
• Length amount of healing needed
Acute Phase - Goals
• Minimize pain and inflammation
• Normalize motion and muscle balance
• Restore baseline propioception and
kinesthetic awareness
ROM
• Normalize motion bilaterally
• IR and ER in restricted ROM
• Based on the theory that motion assists in
the enhancement and organization of
collagen tissue
• Stim of joint mechanoreceptors
Progressive applied loads
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Gentle passive ROM
Active assist ROM (Cane or L bar)
Flexion progress as tolerated
Shoulder rotation ROM is progressed from 0
to 30, 45 and 90 degrees of abduction
• Pendulum, rope and pulley exercises
Enhance Dynamic Stabilization
Activities
• Control anterior humeral head translation
• Restore flexibility of the posterior rotator cuff
muscles of the GH joint
• Against stretching of the anterior or posterior
GH structures
Posterior shoulder in thrower
• Eccentric contractions
• Soft tissue adaptation and loss of IR ROM
• Stretching - horizontal adduction stretch for
the posterior cuff muscles
Strengthening
• Submax painfree isometrics for shoulder
flexion, extension, abduction, ER,IR and
elbow flexion
• Isometrics are to reduce atrophy and restore
voluntary muscle control while avoiding
dynamic shoulder forces
• Isometrics should be preform at multiple
angles throughout the available ROM with
emphasize at the end of the ROM
Strengthening
• Manual rhythmic stabilization drills are
performed for the shoulder internal and
external rotators with the arm in the scapular
plane at 30 degrees and 45 degrees of
abduction.
• Alternating isometrics contractions facilitate
co-contraction of the anterior and posterior
cuff muscles
Rhythmic Stabilization
• Done with patient supine and the arm
position at 100 degrees of flexion and 10
degrees of horizontal abduction
• Humeral head compression forces at this
angle
Acute Phase
• Active ROM are started when adequate
muscular strength and balance have been
achieved
• Passively ROM in all planes and repositions it
with self repositioning
Closed vs Open Kinetic Exercises
Closed Kinetic Chain Exercises
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Axial compression exercises
Stress the joint in weight bearing position
Joint approximation
Stimulates articular receptors
Facilitates co-contraction of the shoulder force
couples
• Incorporates a combination of eccentric and
concentric contractions to provide joint stability
Acute Phase
• Initial exercises below shoulder level
• Weight bearing on a table while standing
• Weight shifts in anterior/posterior and medial
and lateral directions
• Rhythmic stabilization may be perform during
weight shift
Acute Phase
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Ice
High voltage stimulation
Iontophoresis
Ultrasound
NSAD
Intermediate Phase
• Begins when near normal passive motion
• Sufficient muscle strength of the shoulder
• Baseline proprioception, kinesthesia and
dynamic stabilization are needed
• Regain these sensory modalities throughout
the ROM
Intermediate Phase - Goals
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Enhance dynamic dynamic stability
Reestablish neuromusular control
Restore muscular strength and balance
Maintain full ROM
Intermediate Phase
• ROM – joint mobilization and self capsular
stretches
• Strengthening advance – tubing against
gravity, scaption exercises, emphasize on the
posterior cuff and scapular strengthening
exercises (Throwers Ten Program)
Throwers Ten Program
• Elicits muscles most needed to provide
dynamic stability on overhead athletes
Intermediate Phase
• Dynamic stabilization – eyes closed and at
the end of the ROM
• PNF patterns
Intermediate Phase
• Manual resistance ER – varying amount of
resistant throughout the ROM and
incorporate ecc and con contractions
• Scapular strengthening and dynamic
neuromuscular control (avoid fatigue)
Intermediate Phase
• Isotonic exercises for the scapulothoracic
• CKC exercises are advance
• Push up on the ball or unstable surface on a
tabletop
Intermediate Phase
• Lower extremity
• Core - Stabilization CKC
• Trunk strength abd crunches and pelvic tilts
• Double and single leg balances
Advance Phase
• Progressive and neuromuscular control
activities to return to activity
• Minimum pain and tenderness
• Full ROM Symmetrical capsular mobility
• Good strength and endurance
Advance Phase
• Full ROM and capsular mobility maintain
throughout the ROM
• Total motion is equal bilaterally
Strengthening
• Throwers Ten Program
• Exercises for the trunk and LE
• IR and ER tubing to eccentric and high speed
contractions
Aggressive Strengthening of the UE
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Bench
Isotonic machines
Seated row
Lats pull down
Plyometrics
• Train the UE to produce and dissipate forces
• Provide quick powerful movement involving
a prestretch pf the muscle
• Activate the stretch-shortening cycle of the
muscle tissue
• Stimulate throwing
• Increase neuromusular control and core
strength
Plyometrics
Stretch Shortening Cycle
• Prestretching of the muscle spindles and glgi
tendon to produce a recoil action of the
elastic tissues resulting in improve
performance by the combine efforts of the
stored elastic energy and the myotactic reflex
activation of the muscle
Return to Activity Phase
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Minimum complaints of pain and discomfort
Full ROM
Balance capsular mobility
Adequate pro, dynamic stabilization and
neuromuscular control
Isokinetic testing
• ER:IR strength ratio of 66 to 76% or higher at
180degrees/s
Isokinetic exercise?
• Exercise performed with a specialized
apparatus that provides variable resistance to
a movement, so that no matter how much
effort is exerted, the movement takes place
at a constant speed.
• Such exercise is used to test and improve
muscular strength and endurance, especially
after injury.
Summary
• Overhead thrower
• Pain due to anterior capsular micro-stability
and increase demands placed on the dynamic
stabilizers
• Focus on loss IR and weakness of ER and
scapular muscles
• Gradual return to throw program
• Emphasize on proprioception, neuromuscular
control and dynamic stability