After the shoulder has been medically reduced (put back into place) and often immobilized for a period (e.g., in a sling), physiotherapy is crucial for rehabilitation. The goals are to reduce pain and swelling, restore range of motion, strengthen surrounding muscles, improve stability, and prevent future dislocations.

Phases of Rehabilitation

Acute Phase (Pain and Swelling Management, Protection):

• Rest and Immobilization: Following reduction, the shoulder is usually immobilized in a sling for a few weeks to allow soft tissues to heal.
• Pain and Swelling Control: RICE (Rest, Ice, Compression, Elevation) protocol, anti-inflammatory medication (as prescribed by a doctor).
• Gentle Passive Range of Motion (PROM): Initiating very gentle, pain-free movements within the safe range determined by the therapist, usually with assistance.
• Pendulum Exercises: Gentle, gravity-assisted swings of the arm.

Intermediate Phase (Restoring Range of Motion and Initial Strengthening):

• Active-Assisted Range of Motion (AAROM): Patient actively moves the arm with some assistance from the therapist or the other hand.
• Active Range of Motion (AROM): Patient actively moves the arm through its full available range.
• Rotator Cuff Strengthening (Isometric): Gentle contractions of the rotator cuff muscles without movement, to start building strength and stability.
• Scapular Stability Exercises: Strengthening muscles around the shoulder blade (scapula) to provide a stable base for arm movement.
• Proprioception and Neuromuscular Control: Exercises to improve the body’s awareness of joint position and muscle coordination.

Advanced Phase (Progressive Strengthening, Return to Function, and Sport-Specific Training):

• Progressive Resistance Training: Using resistance bands, light weights, and bodyweight to strengthen the rotator cuff, deltoid, biceps, triceps, and scapular stabilizers.
• Dynamic Stabilization Exercises: Exercises that challenge the shoulder’s stability during movement (e.g., throwing drills, plyometrics if applicable).
• Sport-Specific Rehabilitation: Tailoring exercises to the demands of the patient’s sport or activity.
• Return to Activity/Sport Testing: Functional tests to ensure the shoulder has regained sufficient strength, stability, and control before returning to high-risk activities.

Manual Therapy in Dislocated Shoulder Rehab

Manual Therapy refers to hands-on techniques performed by a physiotherapist to mobilize joints, manipulate soft tissues, and reduce pain. For a dislocated shoulder, once the acute pain subsides and healing begins, manual therapy can be very beneficial:

• Joint Mobilization: Gentle, controlled movements applied to the glenohumeral joint and surrounding joints (e.g., acromioclavicular, sternoclavicular, and scapulothoracic) to restore normal arthrokinematics (joint movement mechanics) and improve range of motion
• Soft Tissue Mobilization: Releasing tension, spasms, and trigger points in muscles around the shoulder, neck, and upper back that may be compensating or guarding.
• Myofascial Release:This technique focuses on releasing restrictions in the fascia (connective tissue) to improve flexibility and reduce tension in the broader shoulder girdle and surrounding areas.
• Active Release Technique (ART): A patented, hands-on soft tissue movement-based technique that treats problems with muscles, tendons, ligaments, fascia, and nerves. The therapist applies pressure to the affected tissue while the patient moves the body part through a specific range of motion. This can be effective for scar tissue, adhesions, and muscle imbalances after injury.
• Muscle Energy Technique (MET): A gentle manual therapy technique that uses the patient’s own muscle contractions to relax and lengthen shortened muscles and mobilize restricted joints. The therapist guides the patient through specific positions and isometric contractions to achieve relaxation and improved range of motion.