Rehabilitation Programme for the Best Outcomes Following Anterior Dislocation of the Shoulder

February 21, 2019


The literature is lacking consensus on what rehabilitation programme provides the best outcomes.   Ma et al., (2017) reminded us that rehabilitation following anterior shoulder instability is paramount in the injured or post-op shoulder, to protect healing and potentially minimizes recurrence risk through:
- Restoration of soft tissue mobility (passive GHJ mobilizations)
- Dynamic GHJ stability (Stability muscle activation and timing using NMES)
- Balance (early proprioceptive exercises)
- Muscle strengthening (superimposed with NMES)
Scheibel et al., (2017)

Explore sections below to learn more...

Rehab Phase I:

The Sanford Health model suggests that in the acute Phase I stage the rehabilitation goals are:

  1. Reduce pain inflammation and guarding.  A suggested invention for this is High Intensity PBMT (Laser)
  2. Protection of the anterior joint capsule.  Restricting ER to 30 degrees while IR can be encouraged to FROM
  3. 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)
  4. Improved flexibility / ROM - passive mobilizations
  5. 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.
  6. 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

Progression to phase II is determined by:

  • Minimal pain and inflammation
  • Static shoulder stability
  • Sufficient neuromuscular control below 100 degrees ROM

Supplementary Materials


1. Ma, R., Brimmo, O.A., Li, X. et al.  Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability.  Curr Rev Musculoskelet Med 10, 2017

2. Scheibel et al., Recommendations - Shoulder Post-op Rehabilitation Concept 2017

3. Reinold MM, et al., The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production After Rotator Cuff Repair Surgery, Am J Sports Med. Dec 36(12) 2008.

4. Moroder 2017, 2020 - The two Shoulder pacemaker refs in Shoulder Blog 1

Blogs about Shoulder Instability:

Management of Traumatic Dislocation of Shoulder - From POLICE to PEACE & LOVE

print pattern repeat

Rehabilitation Programme for the Best Outcomes Following Anterior dislocation of the shoulder

print pattern repeat

Product Brochures mentioned in above clinical evidence papers can be downloaded here:

Aircast Cryo/Cuff

Donjoy Ultrasling Pro

DJO Shoulder Post-Op Rehabilitation Concept

Chattanooga Lightforce

Continue Education:

Up to Date Reverse Shoulder Arthroplasty in the USA

presented by Dr. Thomas Bradley Edwards
Live Q&A and discussion with Dr. Sugaya and Dr. Matsumura in Postoperative Management and Posttreatment in Shoulder Arthroplasty - Apr 28th 2022

print pattern repeat

The Shoulder Series 2 of 3 – Too Loose (dislocation)

Dr. Chan Kin Yuen and Mr. Cliff Eaton shared their expertise and openly discuss about Shoulder dislocation with high recurrent rate, especially with young patients.

print pattern repeat

DJO Institute - Electrical Stimulation for Muscle RE-education & Strengthening

print pattern repeat

ACADEMY | Leading educational content and training for your clinic
Contact your
local distributor

Enovis Asia-Pacific Ltd.

Unit 1905 19/F, Tower 2,
Grand Central Plaza,
138 Shatin Rural Committee Road,
Shatin, Hong Kong 🇭🇰

General Enquiry

+852 3105 1415

Recovery Science
Ms Crystal Leung

+852 3105 3723

Ms Joe Cheung

+852 3105 1415

Business Inquiry
Mr Stephen Chung

   stephen.chung[@]

© 2023 Copyright Enovis. All Rights Reserved.