TY - JOUR
T1 - Shoulder rehabilitation strategies, guidelines, and practice
AU - Kibler, W. Ben
AU - McMullen, John
AU - Uhl, Tim
PY - 2001
Y1 - 2001
N2 - Shoulder rehabilitation can best be understood and implemented as the practical application of biomechanical and muscle activation guidelines to the repaired anatomic structures in order to allow the most complete return to function. The shoulder works as a link in the kinetic chain of joint motions and muscle activations to produce optimum athletic function. Functional shoulder rehabilitation should start with the establishment of a stable base of support and muscle facilitation in the truck and legs, and then proceeds to the scapula as healing is achieved and proximal control is gained. The pace of this "flow" of exercises is determined by achievement of the functional goals of each segment in the kinetic chain. In the early rehabilitation stages, the incompletely healed shoulder structures are protected by exercises that are directed towards the proximal segments. As healing proceeds, the weak scapular and shoulder muscles are facilitated in their reactivation by the use of proximal leg and trunk muscles to re-establish normal coupled activations. Closed chain axial loading exercises form the basis for scapular and glenohumeral functional rehabilitation, as they more closely simulate normal scapula and shoulder positions, proprioceptive input, and muscle activation patterns. In the late rehabilitative stages, glenohumeral control and power production complete the return of function to the shoulder and the kinetic chain. In this integrated approach, glenohumeral emphasis is part of the entire program and is towards the end of rehabilitation, rather than being the entire program and being at the beginning of the program.
AB - Shoulder rehabilitation can best be understood and implemented as the practical application of biomechanical and muscle activation guidelines to the repaired anatomic structures in order to allow the most complete return to function. The shoulder works as a link in the kinetic chain of joint motions and muscle activations to produce optimum athletic function. Functional shoulder rehabilitation should start with the establishment of a stable base of support and muscle facilitation in the truck and legs, and then proceeds to the scapula as healing is achieved and proximal control is gained. The pace of this "flow" of exercises is determined by achievement of the functional goals of each segment in the kinetic chain. In the early rehabilitation stages, the incompletely healed shoulder structures are protected by exercises that are directed towards the proximal segments. As healing proceeds, the weak scapular and shoulder muscles are facilitated in their reactivation by the use of proximal leg and trunk muscles to re-establish normal coupled activations. Closed chain axial loading exercises form the basis for scapular and glenohumeral functional rehabilitation, as they more closely simulate normal scapula and shoulder positions, proprioceptive input, and muscle activation patterns. In the late rehabilitative stages, glenohumeral control and power production complete the return of function to the shoulder and the kinetic chain. In this integrated approach, glenohumeral emphasis is part of the entire program and is towards the end of rehabilitation, rather than being the entire program and being at the beginning of the program.
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U2 - 10.1016/S0030-5898(05)70222-4
DO - 10.1016/S0030-5898(05)70222-4
M3 - Article
C2 - 11888148
AN - SCOPUS:0035412094
SN - 0030-5898
VL - 32
SP - 527
EP - 538
JO - Orthopedic Clinics of North America
JF - Orthopedic Clinics of North America
IS - 3
ER -