SHOULDER INSTABILITY SHOULDER INSTABILITY – PART III
TREATMENT AND REHABILITATION OF SHOULDER INSTABILITY
By Jo Gibson, MCSP and Joanne Elphinston BPhty MA MCSP
INTRODUCTION Conventional strengthening programmes such as rotator cuff theraband exercises are ineffective in this patient group as gener- alised strengthening appears to reinforce the patterning. Similarly specific local con- trol strategies appear difficult to achieve due to impaired proprioception and domi- nance of the patterning muscle (24). Our experience mirrors that of the Stanmore group in that this patient group appear to respond much better to a more ‘normal movement’ approach to treatment aimed at restoring normal movement patterns.
Motor learning or relearning is key to establishing or restoring optimal movement patterns. When planning our rehabilitation approach we must appreci- ate the stages in motor skill acquisition. In the early stages tasks should be highly
cognitive, necessitate conscious attention and incorporate verbal and tactile cues to direct performance (Box 1). As practice continues the new learned behaviour becomes more automatic and there is an increase in the ease and efficiency with which the movements are performed. The patient can then perform other tasks simultaneously without losing or compro- mising the relearned movement pattern. Feedback is a key factor in this process and we need to consider both intrinsic and extrinsic factors. Intrinsic factors relate to feedback gained from ones own position or movement as a result of the somatosensory, vestibular, visual and auditory systems. Extrinsic factors include verbal cues, biofeedback, environment etc. By considering the different ways in