Early rehabilitation should focus on the reduction of:
Pain.
Inflammation.
Swelling.
Restoring normal ROM.
In a painful shoulder, studies have demonstrated a decrease in electromyographic activity by 23% with a corresponding reduction in external rotation force production by 32%.
This finding suggests the importance of early pain reduction such that the athlete can begin a progressive strengthening program.
This can be accomplished using both local physical modalities in addition to manual therapies.
The athlete should also avoid activities which reproduce symptoms. .
Manual therapies such as joint mobilization and passive ROM can help restore normal joint kinematics and improve shoulder ROM
Grade I and grade II glenohumeral joint mobilization techniques can be performed to reduce pain, decrease muscle guarding and improve ROM.
Indeed, Codman’s pendulum exercise is safe and
[restrict] can reduce stiffness and improve ROM.
ROM exercises can be progressed to active-assisted, followed by active-unassisted exercises. .
Elite athletes with injuries to the rotator cuff may demonstrate limitations in glenohumeral range of motion that include GIRD and other deficiencies.
A recent randomized controlled trial demonstrated that dry needling had therapeutic effects on supraspinatus lesions and improved shoulder range of motion.
Internal rotation limitations in overhead athletes, are commonly related to chronic tightness of the posterior rotator cuff and shoulder musculature caused by poor position of the scapula, or the posterior joint capsule.
[A] :The modified sleeper stretch can effectively increase shoulder internal rotation. .
[B]: the modified cross-body stretch can effectively increase horizontal adduction and posterior capsule flexibility.
Stretching the pectoralis minor may also help improve scapular mechanics and overall shoulder function.
Neuromuscular electricalstimulation(NEMS) can assist with neuromuscular re-education and reducing muscle inhibition.
NEMS improve external rotation force production when applied to the infraspinatus following rotator cuff repair
Isometric exercises are also a safe and effective way early in the rehabilitation process to promote muscle activation and lead into more advanced isotonic strengthening exercises.
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3. Intermediate Phase
4. Advanced/Late Stage Rehabilitation
5. Future Directions and Conclusions
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Referqmce:
Weiss et al. 2018. Management of Rotator Cuff Injuries in the Elite Athlete.
