|
Aims |
Potential Drills |
Dosage/Load |
Goals |
Considerations |
|
Develop scapular motor control to center the HH |
Scapular UR in standing
+/-elevation
+/- posterior tilt^ |
Motor control:
1-2 sets x 20 reps
5 sec holds
2 -3 x day
0-0.5-1.5kg in hand
+/- SR band
Endurance:
2 sets x 15 reps
5 sec holds
1 x day
2-3kg
+/- SR band |
Standing UR
2-3 sets x 20 reps 1-1.5 kg
+/- green SR band
(to move onto arc of motion phase)
Continue heavier load for scapula throughout program
1.5-2kg 2 sets x 15 reps
2-5kg+ 3 sets x 10-12 reps |
Side lying scapula drills if unable to do > 5 reps standing
Must have normal cervical spine strength to perform standing scapula drills
Care with posterior tilt as may encourage posterior translation of HH on retroverted glenoid |
| Arc of Motion Phase |
| Stage |
Aims |
Potential Drills |
Dosage/Load |
Goals |
Considerations |
| Stage 1: Coronal Plane 0° Abd |
Develop posterior HH control in
coronal plane
0° Abd |
ER/IR/Ext isometrics
Standing Ext to neutral with TB
Standing ER with TB
(0°-30-45° ER)
Standing IR with TB
(from 30-45° ER to 0°IR) |
Isometrics: 5-10 reps x 5 second holds (20-30 % MVC), 2-3 x day
TB drills:
1-2 sets x 15-20 reps, 2x day
Yellow-red-green TB (Double TB for Rows; ie: red+ green) |
Ext/ER/IR
1-2 sets x15-20 reps
Red-green TB |
Isometrics if arc cannot be controlled/drill is pain provoking
Ext/ER/IR =Short arc to larger arc of motion
ER initially from 0° to limit IR and possible posterior HH translation.
ER after Ext control established
IR after ER control established |
|
|
Side lying ER from a support (to prevent shoulder falling into IR) |
SL: 1-3 sets x 15-20 reps
2x day
0-0.5-1-1.5kg |
SL: 1-3 sets x 15-20 reps, 1-1.5kg |
Palpate posterior HH for unwanted posterior
translation when prescribing exercises |
|
|
Bent over row with weight |
BOR: 0.5-4kg
1 set x 20 – 2 x 15 reps
BOR: 5kg +
3 sets x 10 reps
3 x week |
BOR: 5 kg +
3 sets x 10 reps
3 x week |
If the patient can’t control the HH in any drill, return to scapular phase and improve endurance then strength |
|
|
Seated Row @ gym |
3 sets x 10-12 reps, 3 x week |
3 sets x 10-12 reps, 3 x week (appropriate strength load) |
|
|
|
Continue scapular UR drill from endurance to strength |
UR: 3-4kg,
2 sets x 15 reps
1 x day to
5kg+ 3 sets x 10-12 reps |
Scapular UR: 3-5 kg, 3 sets x 10-12 reps, 3 x week |
|
Stage 2: Coronal/
Sagittal Plane 0°-45° |
Develop posterior HH control in
coronal and sagittal plane plane
0-45° Abd |
Standing Ext Row with TB at 45° Abd
ER with TB at 45°
IR at with TB 45°
SL: progress load
BOR at 45° |
TB drills:
1-3 sets x 15-20 reps, 2x day
Yellow-red-green TB
SL: 2-2.5 kg
3 sets x 10-12 reps, 3 x week
BOR at 45°: 0.5-1-1.5kg, 2 sets x 15-20 reps
1 x day |
Ext at 45°: Green TB
ER at 45° TB: Red TB
SL: 2-3 kg
BOR at 45°: 1.5-3kg
IR at 45°: Red- green TB
2 sets x 15 reps, 1 x day or 3 sets x 10-12 , 3 x week depending on load |
Drills from Stage 1 can be progressed to a strength dosage with increased load
ER and IR to 45° may only be prescribed if required for patient function
IR after ER control established.
SL max recommended 2.5 kg female, 3.5kg male
Flexion commenced once Ext/ER /SL/BOR goals achieved |
|
|
Standing flexion in scapular to sagittal plane from 0-45° elevation
Continue UR drill with increased load |
Flexion:1-3 sets x 15-20 reps, 2x day
Yellow-red-green TB |
Flexion: sagittal plane red- green |
Scapular plane flexion typically safer to commence and work around into sagittal plane flexion as posterior HH control is gained.
Continue seated row at the gym. May introduce TRX row, may tolerate biceps/triceps drills |
Stage 3: Coronal/
Sagittal Plane 45°-90° |
Develop posterior HH control in
coronal and sagittal plane
45°-90° Abd |
Standing Ext Row with TB at 90°
ER with TB at 90°
supported to unsupported.
ER at 90° with weight
unsupported progressed from coronal plane to sagittal plane
IR at with TB 90°
supported to unsupported
BOR at 90° with weight |
TB drills:
1-3 sets x 15-20 reps, 2x day
Yellow-red-green TB
ER at 90° with weight: 1-2-3-4 kg (endurance to strength dosage)
BOR at 90°: 0.5-1-1.5kg- 2 kg
Motor control- endurance dosage
2kg + kg strength dosage |
Ext at 90°: Green TB
ER at 90°: Red-green TB
IR at 90°: Red- green TB
ER at 90° with weight: 3-4 kg in coronal plane 3 sets x 10 reps, 3 x week
BOR at 90°: 3-8 kg*
3 x sets 10 -12reps, 3 x week |
Drills from Stage 2 can be progressed to a strength dosage with increased load
Ext row at 90° performed before adding ER at 90
IR after ER control established.
Some patients may not require supported before unsupported ER/IR.
ER unsupported progressed into sagittal plane to prepare for flexion to 90° |
|
|
Standing flexion in scapular to sagittal plane from 45-90° elevation
Continue scapula drill with appropriate load for strength |
Flexion: 1-3 sets x 15-20 reps, 2x day
Yellow-red-green TB |
Flexion: sagittal plane Red- green TB, 2-3 sets x 15-20 reps |
Palpate posterior HH for unwanted posterior
translation especially when prescribing flexion exercises |
Stage 4:
Coronal/
Sagittal Plane >90°
and
Horizontal Flexion
Control |
Develop posterior HH control in
coronal and sagittal plane
>90° elevation
and HF control |
ER > 90- EROM
IR> 90-EROM
Flex> 90-EROM
With TB
Overhead press |
Recruitment/endurance (1-2 sets x 20 reps, 2, x day) to strength (3 sets x 10-12 reps) to ballistic (1-2 sets x 10+ reps) dosage depending on patients needs.
Yellow-red-green-blue TB*
Weight for overhead press: 0kg-0.5-1-2 * |
Dosage and load depend on patient's functional goals and ability to control movement.
Guide:
ER/IR: Red- Green
HF with TB: Red- Green
HF with weight 1-2.5+kg
Flex TB: Red- Green
Flex weight: 1.5-2-3-4+ kg
1-4 x 4-20reps depending on load, goals and patient control* |
Drills from Stage 3 can be progressed to a strength dosage with increased load
Flexion > 90° typically commences with TB in scapular plane moving around to sagittal plane.
Flexion weights typically commence after green flexion band in sagittal plane achieved.
*Dosage and load can be progressed from a recruitment and endurance dosage to a dosage and load functionally required and by the patient. Exercises may need to be progressed to blue or black bands or heavier weights if functionally required by the patient |
|
|
Horizontal Flexion Drill
With TB
With weight |
HF with TB: 1-3 sets x 15-20 reps Yellow-Red- Green*
HF with weight: 1-4 sets x 6-20reps
0.5-3kg* |
|
Horizontal flexion load progressed by having patient move torso around to commence drill in more HF
Once HF drills established, flexion drills in gym commenced (i.e., supine press, controlled bench press, overhead press with weights) |
| Stage 5: Sports Specific and Functional Stage |
Part practise of function and integration into sport/functional tasks |
Part Practice (example):
Acceleration phase of tennis serve
Whole Practice: Participation in training/sport/occupation |
Part practice dosage and load needs to mimic demands of task.
Whole practice progressed from small volume to larger volume |
Return to sport/occupation
/function |
Specific middle deltoid or anterior deltoid drills may need to be prescribed if atrophy or weakness remains
Integration of trunk stability and overall kinetic chain with shoulder drills needs to be considered.
Power/speed drills may need to be considered if required for function/sport
Weight bearing drills may be contra-indicated in posterior instability. Consider if weight bearing drills are functional for demands of patient. |