Shoulder injuries in the athlete: The Instability Continuum and Treatment

Abstract

The young athlete involved in overhand activity subjects the shoulder to extreme ranges of motion in a repetitious nature over a number of years. The biomechanics inherent to the overhand activity obviously offset the delicate balance of stability and mobility that are necessary for normal shoulder function. An instability continuum ensues.Treatment of overhand shoulder injuries focuses on the critical balance of stability and mobility. The instability must be stopped and the balance restored before anatomic damage occurs. The purpose of this article is to describe treatment that first strengthens the stability component, then progresses to the mobility component. It is called the treatment of the three Ps: (1) the glenohumeral protectors (rotator cuff muscles); (2) the scapulohumeral pivotors (scapular rotator muscles); and (3) the humeral positioners (deltoids, latissimus dorsi and pectoralis major). The protectors and pivotors are strengthened first. Once they demonstrate adequate synchrony of movement, the positioners are brought into play.This exercise program can be used for injury prevention or immediately following diagnosis. If anatomic damage has occurred and the program fails, the exercises can be used as a postsurgical rehabilitation program. If the exercises are effectively administered immediately following diagnosis, they are 95% successful in returning the athlete to his or her prior level of competition, without surgery. Of the 5% who do require surgery, 87% return to their prior level of competition, combining the anterior capsulo-labrum reconstruction (ACLR) surgical procedure with the effective and efficient exercise program described.