Shoulder Injuries: Labral Rehabilitation

The shoulder is a very mobile joint that has the ability to move in all the plane of motion and perform many different movements.  The shoulder can achieve this feat because of its complex structure that involves different muscles in various sizes performing different range of motions.  All these muscles are negatively affected during the course of a shoulder injury, which makes the shoulder a difficult part of the body to rehabilitate.  

After a shoulder surgery, an athlete  must follow a strict protocol to make sure that their shoulder heals properly and that they do not get re-injured once they return to their sport.  In a general protocol for a Superior Labrum Anterior to Posterior (SLAP) tear, the first three weeks of rehab will usually include passive range of motion (PROM) exercises, light wrist exercises, isometric exercises with postural awareness, and icing after exercises for the pain and swelling that the athlete will most likely have.  PROM occurs when the  joint moves with the assistance of someone or something else.  

The exercises that help accomplish this are shoulder pulley’s and codmans.  The pulleys involve a rope that is attached to a pulley system with handles at the ends.  The athlete will just grab each handle, and use their non-surgical arm to lift their surgery arm as high as they can tolerate.  To do the codmans the athlete will stand up, bend over at the waist, and use their body to move their arm like a pendulum.  For the shoulder isometrics, the athlete will bend the arm 90° and push their fist, their elbow, the back of the hand, and their palm of their hand into the wall to help activate those muscles without having to lift the shoulder.17

The next 3-5 weeks of rehab will include similar exercises, as well as active assistive range of motion (AAROM) exercises, some gentle open chain kinetic exercises in the supine position and manual therapy performed by a physical therapists.

AAROM occurs when the shoulder moves itself with the help of another object.  In most cases the athlete would most likely use a cane and then use their nonsurgical arm to move their surgery arm a couple of different directions.  

During manual therapy the athlete will lay down on a high table and a therapists will come and help take their shoulder to a greater, tolerable range of motion and will also do some stabilization exercises with the athlete.17  

   

In weeks 8-12 the athlete will begin to do some strengthening exercises that will involve the use of therabands to help build up the scapula stabilizers and rotator cuff muscles in addition to some of the previous exercises that they were doing before.  The athlete will also begin to do light weight exercises with therapeutic dumbbells within a tolerable range. .  

Between weeks 12 and 24 the athlete will increase the intensity of their current exercises and the therapists will continue to add new exercises that will further strengthen the shoulder and help get more range of motion in the shoulder.

Toward the end of the 12-24 week period the therapists will introduce  plyometric exercises to the athlete, which will help prepare them for the shoulder movements that they will encounter when they return to sport.  The athlete will also start to slowly work their way back into their team weight program by doing a few of the exercises and using light weights on the exercises that the therapists permits them to do.  At about the 5-6 month mark, the athlete should be ready to return to sport with no restrictions.17

References

16 SLAP Tears-OrthoInfo - AAOS. (n.d.). Retrieved February 28, 2016, from http://orthoinfo.aaos.org/topic.cfm?topic=A00627

17 Physical Therapy Rehab. (n.d.). Retrieved February 28, 2016, from http://www.orthoassociates.com/SP11Ca/