Anterior shoulder dislocation is a common injury, especially for athletes and active individuals. It’s important for the injury to heal completely, but many times the patient will want to remain active during the progression process. One way to treat the injury yet still maintain fitness is through hydrotherapy.
Effective hydrotherapy exercises – anterior shoulder dislocation sample progression
Always consult a medical health care professional before performing any of the following interventions.
1. Active assisted range of motion – abduction
Achieving pain free and full range of motion (ROM) is the first step in a conservative approach to an anterior dislocation.
The following exercise is performed with 10 second holds at end range and no pain or feelings of instability should be felt. The client should feel a low level stretch, or up to a 3 out of 10 feeling of stretching discomfort.
Exercise: This exercise can be used with different parts of a pool, such as a ladder, bar, side of pool, step, etc. The client places one hand on stair and slowly walks away until a stretch is felt. They hold this position for 10 seconds and then walk back to the stair to rest for 10 seconds. This is repeated 10 times with slowly increasing the distance from the stair.
2. Scapular retraction
Once the capsule and ligaments are stretched the next line of defense to prevent the shoulder from dislocating is the rotator cuff and scapular muscles.
Activation of these muscles early on will help teach proper shoulder position in addition to providing stabilization of the shoulder joint.
Exercise: The client stands with their back against the wall. In addition to their back, they need to make sure that their head and posterior shoulders are touching throughout the exercise.
3. Rhythmic stabilizations in multiple positions
Rhythmic Stabilizations are a great tool used to activate the finer stabilizing muscles in the shoulder while keeping the joint in a safe position.
If you have progressed to Open Kinetic Chain stabilizations, a pool with a resistive current is a great way to work this.
Exercise: Stand facing the current with shoulder flexed to 90 degrees while holding a light weight medicine ball. Increase the current of the pool to a speed/strength that you can handle. The resistance of the current flowing over the medicine ball will give the perturbations needed to activate the muscles. This can be done in a still water pool by walking forward while holding the medicine ball out front in a flexed shoulder position.
4. Scaption with weight
Scaption or shoulder flexion with 45 deg of horizontal adduction, is one of the safest movements an unstable shoulder can perform. The reason for this is that the movement has the highest bone congruency, which supports the ball in the socket.
It is a very important exercise to perform early and often with an unstable shoulder to progress the strength to shoulder level.
Exercise: The client stands in the water up to their neck and performs the action of scaption while keeping the hand immersed in the water the entire time. A way of progressing this exercise is either increasing the speed that you move the arm and/or adding a hand weight. It is recommended to perform high repetitions with this exercise, therefore start at 3 sets or 10 reps then increase to 15 then 20 reps. Once the client is able to complete 3 sets of 20 reps then change one variable, aka increase speed or add a hand weight.
5. Sport-specific activity
An important goal for active individuals or weekend warriors is to be able to get back to the activity they love to play. A great way to progress back to any activity is to incorporate a sport specific motion into the rehabilitation process. For someone who enjoys playing tennis, an easy way to do this is to mimic a fore hand or back hand motion while holding a tennis racket in a pool. The benefit of an aquatic setting is that the water provides resistance through the entire swinging motion and the exercise will strengthen those functional swinging muscles.
~ Authored by Liz Lecomte
Download our Anterior shoulder dislocation sample progression hydrotherapy exercises infographic, (PNG, 1.25MB), compiled by senior physical therapist Jaeson Kawadler.