Rehab Phase I:
The Sanford Health model suggests that in the acute Phase I stage the rehabilitation goals are:
- Reduce pain inflammation and guarding. A suggested invention for this is High Intensity PBMT (Laser)
- Protection of the anterior joint capsule. Restricting ER to 30 degrees while IR can be encouraged to FROM
- Minimise effects of immobilization including Muscle atrophy, reducd neuromuscular control and ROM loss. A proven intervention for this is NMES (Reinold 2008, Moroder 2017, 2020)
- Improved flexibility / ROM - passive mobilizations
- Improved muscle control activation and proprioception. This can be encouraged at a subconscious level using the Mi Action feature on the Chattanooga 4 Channel NMES device.
- Specific strengthening exercises:
- RC muscles using isometric contractions with NMES at 0 degrees abduction
- Active Flexion to 30 degrees and extension to neutral
- Isometric co-contraction progressing to isotonic contraction of biceps and triceps. Specific programmes available for this on Chattanooga 4 channel NMES devices
- Closed Kinetic chain Serratus Anterior strengthening combining NMES
- Lower Traps and Rhomboids strengthening combing NMES
- Closed Kinetic Chain Tabletop weight shifts - Ant/Post. Med/Lat.
- Supine IR/ER in 30 degrees scapula plane
- Side lying ER at 0 degrees abduction
7. Specific stretching gently and frequently
- Posterior capsule
- Elbow extensors
