If you’ve had a posterior inferior capsular shift procedure to correct shoulder instability that has led to chronic dislocation, you need to take steps to protect your shoulder while it heals and work with your physical therapist to follow your surgeon’s recommended rehabilitation protocol. While your recovery is unique, each patient must complete four phases of rehabilitation before receiving final clearance from their surgeon.
The protection phase lasts for the first six weeks after your surgery and is separated into two stages. You need to take precautions throughout the entirety of the protection phase to safeguard your shoulder and prevent re-injury such as:
Your goals during the first part of the protection phase are to promote healing, start early protected range of motion with a therapist, prevent muscular atrophy, and decrease inflammation and pain.
During this stage, you and your physical therapist work on introducing some gentle exercises and small movements, including:
You can ice your shoulder after your therapy sessions and for up to 20 minutes every hour to reduce swelling and pain.
Your goals in the second stage of the protection phase include increasing your range of motion, normalize your joint function (arthrokinematics), improve your strength, and continue to reduce pain and swelling.
Your exercises in this stage include range of motion exercises and gentle joint mobilization.
Range of motion exercises
Gentle joint mobilization
Your physical therapist moves your arm and shoulder to normalize the function of different parts of your shoulder joint.
You can also work on a conditioning program for your trunk, legs, and general cardiovascular endurance.
At the end of the protection phase, when you’ve met all milestones, you can stop wearing your sling.
The intermediate phase of your rehabilitation lasts from weeks 6-12. Your goals during this stage of your recovery include:
You and your therapist work on range of motion and strengthening exercises, such as:
Throughout the intermediate phase, you can continue to apply ice to your shoulder for up to 20 minutes, especially after your physical therapy sessions.
The dynamic strengthening phase lasts from weeks 12-18. In order to start this phase of your rehabilitation, you need to have a full, nonpainful range of motion, no pain or tenderness, and regained 70% of your strength.
Your goals for the dynamic strengthening phase are to:
During this phase of rehabilitation, you focus on high-speed, high-energy strength exercises, diagonal pattern extensions, and eccentric training (lengthening of a muscle while it develops tension and contraction).
You will practice exercises, including:
You can start the final return-to-activity phase when you have a full range of motion with no pain or tenderness, and you have a satisfactory exam with your surgeon.
Your goal in the return-to-activity phase is to progressively increase your activities and return to unrestricted function.
During your physical therapy sessions, you continue to work on exercises, including:
You also progress to the Thrower’s ten protocol.
The Thrower’s Ten include:
