Physiotherapy first for shoulder instability?

Q: I have multidirectional shoulder instability from playing hockey as a kid. My surgeon has suggested I try some physiotherapy before thinking about surgery. Will this really help?

A: Patients are often sent to physiotherapy for strengthening when the shoulder joint is unstable. But physiotherapists don't prescribe the same exercise program for everyone. The therapist uses clinical skill, expertise, experience, and evidence-based information to decide which mode (type) of exercise to use. The same decision-making process is involved in determining a starting point for frequency, duration, and intensity of the exercises.

There are many variables for the therapist to consider. For example, does the patient have anterior instability (shoulder moves forward in and even out of the socket). Or is there posterior (backward) instability. Sometimes patients have multidirectional instability (the shoulder is unstable in more than one direction). Each one of these situations calls for an individual rehab program.

Then there is the scapula (shoulder blade) to consider. How well does it move? Is it moving in a coordinated rhythm with the shoulder? Scapular control is an important part of glenohumeral (shoulder joint) stability. Muscles must be evaluated for weakness, shortening, length-tension, and ability to generate as well as withstand forces needed for arm movement.

The therapist will also address proprioception (joint sense of position) with a physiotherapy program. Restoring these aspects of scapular and glenohumeral motion is vital. This concept is especially important for the athlete who depends on his or her arm for accuracy and strength in motion and function (e.g., think about the need for a baseball pitcher to deliver the ball exactly in the strike zone across the home plate).

The plan of care is designed by the physiotherapist for each specific patient. Progressively moving each person (particularly athletes) back toward full function for his or her daily activities and sports participation is often the direction therapy goes. This type of conditioning is called functional progression.

Nonoperative care under the direction of a physiotherapistcan save time, money, and avoid or delay surgery for many individuals. If your surgeon advised you to try this type of conservative care, it's likely there is a good chance for functional recovery for you. Give it your best and see what happens! Let us know.

Reference: Gregory N. Lervick, MD. Shoulder Rehabilitation in Glenohumeral Instability. In Current Orthopaedic Practice. January/February 2013. Vol. 24. No. 1. Pp. 79-83.

Eastwood Physiotherapy provides services for physiotherapy in Edmonton.