Posterior Stabilisation Rehabilitation Guidelines

Posterior Stabilisation Rehabilitation Guidelines

Introduction

These guidelines provide a structured rehabilitation plan for patients following posterior shoulder stabilisation surgery. The program is designed to be individualized, with all exercises performed without pain. Any specific restrictions should be referenced in the post-operative instructions. If these are not available, the patient should contact the consultant’s secretary.

Rehabilitation should focus on protecting the repair, promoting soft-tissue healing, and addressing shoulder girdle control, core stability, and overall kinetic chain function.

Post-Surgery Rehabilitation Phases

Phase 1: 1-14 Days

Goals:

• Protect the Repair:
  • Wear the external rotation brace at all times, except when dressing, washing, or doing exercises.
  • Teach proper use of sling, dressing, and personal hygiene techniques.
• Pain & Inflammation Management:
  • Use analgesics, NSAIDs, ice, and proper posture to control pain and inflammation.
• Shoulder Control & Relaxation:
  • Focus on scapular retraction and depression.
• ROM & Exercise:
  • Begin Passive Range of Motion (PROM), specifically pendulum exercises in neutral rotation.
  • Start External Rotation (ER) from neutral outward.
• Upper Limb Mobility:
  • Perform hand, wrist, elbow, and neck ROM exercises as needed.
• Sleeping Position:
  • Advise sling use while sleeping. Place a pillow beneath the elbow if lying supine to prevent the shoulder from resting in extension.
• Prevent Muscle Atrophy:
  • Perform pain-free isometrics in neutral (less than 30% Maximal Voluntary Contraction).

Precautions:

• Sling Use: Typically for 3-6 weeks (follow post-operative instructions).
• Avoid:
  • Combined forward flexion (FF) and internal rotation (IR) for up to 6 weeks.
  • Lifting objects, excessive stretching, sudden movements, and supporting body weight with the affected arm.
• Driving: Not recommended for 3 weeks (right shoulder), 6 weeks (left shoulder).

Milestones at 2 Weeks:

• Pain, inflammation, and muscle inhibition are well-managed.
• Return to pre-operative sleep patterns.
• Good scapula setting and PROM: Elevation in neutral to 90°, IR to neutral.

Milestones at 6 Weeks:

• Minimal pain and inflammation.
• Pre-operative PROM (except IR and horizontal flexion).
• Passive IR: 25% of pre-operative range.

Phase 2: 15 Days - 6 Weeks

Goals:

• Protect Soft Tissue: Avoid overloading healing tissue.
• Continue managing pain and inflammation as in Phase 1.
• Begin scar massage once stitches are removed.
• Gradually restore PROM, progressing to Active Assisted Range of Motion (AAROM) and Active Range of Motion (AROM) (without pain).
• Focus on dynamic shoulder stability and scapular humeral rhythm (SHR).

Precautions:

• Continue avoiding combined forward flexion (FF) and internal rotation (IR) for up to 6 weeks.
• No lifting, excessive shoulder extension, sudden movements, or supporting body weight with the affected arm.
• Gradually wean out of the sling after 4-6 weeks (check post-op note).

Milestones at 6 Weeks:

• Pain, inflammation, and muscle inhibition are well-managed.
• Pre-operative PROM restored (except for IR and horizontal flexion).
• Good SHR with PROM.

Phase 3: 7 - 14 Weeks

Goals:

• Achieve Full PROM, with multi-directional stretching into end ranges as tolerated.
• Gradually restore AAROM and AROM, with focus on good scapular humeral rhythm (SHR).
• Strengthening:
  • Introduce scapular stabilisation exercises.
  • Gradually progress rotator cuff strengthening from isometrics to isotonic strengthening.
  • Start proprioceptive exercises and continue shoulder and upper limb strengthening.
• Functional Activities:
  • Gradually return to light, non-repetitive functional activities.
  • Begin light, early-stage sport-specific exercises.

Precautions:

• Avoid excessive shoulder loading:
  • No heavy lifting or prolonged, repetitive upper limb activities.

Milestones at 14 Weeks:

• Resolved pain, inflammation, and muscle inhibition.
• Full AROM with good SHR to 100% of pre-operative range.
• Passive IR to 75% of pre-operative range.

Phase 4: 3 - 6 Months

Goals:

• Maintain Full PROM with multi-directional stretching.
• Achieve Full Pre-operative AROM with good SHR.
• Continue strengthening exercises for rotator cuff and scapular stabilisation.
• Gradually progress to more functional activities and sport-specific exercises.

Precautions:

• Continue avoiding excessive loading of the shoulder, particularly:
  • No heavy, repetitive, or prolonged overhead activities.

Milestones at 6 Months:

• Full pain-free motion with restored rotator cuff strength.

Phase 5: 6 - 12 Months

Goals:

• Continue strengthening and functional rehabilitation.
• Gradual return to strenuous work and contact sports as required.

Milestones at 12 Months:

• Full return to pain-free motion and shoulder function, with sufficient strength for all activities.

Contact Information

• Consultant Secretary: 07810356433
• Sulis Hospital Physiotherapy: 01761 422388
• Circle Health Group Bath Clinic Physiotherapy: 01225 838767
• St. Joseph Physiotherapy: 01633 820321

Note: This rehabilitation plan focuses on ensuring a safe and progressive return to activity following posterior stabilisation surgery. It emphasizes the importance of maintaining joint integrity, controlling pain, and gradually rebuilding strength and functionality. Adherence to guidelines ensures optimal recovery while minimizing the risk of complications.

‍