Evidence-based rehabilitation of athletes with glenohumeral instability

Knee Surg Sports Traumatol Arthrosc. 2016 Feb;24(2):382-9. doi: 10.1007/s00167-015-3940-x. Epub 2015 Dec 24.

Abstract

Purpose: To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability.

Methods: This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability.

Results: Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function.

Conclusions: This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete.

Level of evidence: Expert opinion, Level V.

Keywords: Exercise; Rehabilitation; Shoulder instability.

Publication types

  • Review

MeSH terms

  • Athletic Injuries / physiopathology
  • Athletic Injuries / rehabilitation*
  • Exercise Therapy / methods*
  • Humans
  • Joint Instability / physiopathology
  • Joint Instability / rehabilitation*
  • Range of Motion, Articular
  • Return to Sport
  • Rotator Cuff / physiopathology
  • Rotator Cuff Injuries
  • Shoulder Dislocation / physiopathology
  • Shoulder Dislocation / rehabilitation*
  • Shoulder Joint / injuries*
  • Shoulder Joint / physiopathology