Shoulder injuries are one of the most common injuries that people suffer from, and the shoulder is therefore a very common joint to be treated by physiotherapists. Research shows that shoulder injuries are regularly affecting amateur and professional athletes (Schwank, et al., 2022). Debbie Cameron Physiotherapy aims to be constantly up to date with the latest academic research, making sure that as a practice we are treating patients with all the latest and current techniques as well as using the latest trusted protocols.
In 2019 a group of highly recognised and specialised medical professionals came together in Bern, Switzerland to discuss the latest ideologies and research regarding management of the shoulder. These individuals were all experts renowned for clinical or research-based contributions towards the management and rehabilitation of the shoulder (Schwank, et al., 2022). Together they have come up with the “2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels”. One of the topics covered is managing the Road to Recovery – here they have come up with 7 key principles for quality rehabilitation after shoulder injuries.
Regarding rehabilitation of the athlete’s shoulder, they stated that in general the rehabilitation programme needs to consider specific factors related to the athlete and their specific sport. This rehabilitation programme should aim to improve sport specific biomechanics as well as technique, increase the intensity of rehab to challenge the athlete to their capacity limit, it should aim to increase the individual’s resilience by increasing their capacity from a physiological as well as a psychological point. Throughout the programme the multi-disciplinary team (coach, manager, Doctor etc.) concerned with the athlete should always be in the loop (Schwank, et al., 2022). The Key Principles mentioned are as follows:
The Rehabilitation programme progression should be guided by irritability of the patient - this is irritability that is unique and specific to the patient and not to their pathology.
Shoulder Range of Motion (mobility) should be addressed using active exercise therapy - Shoulder Injuries can often present with limited range of motion or surprisingly they can also present with range of motion gain (e.g., Hypermobility). This needs to be managed with exercises, targeting the new range of motion so that the athlete can perform in this range and avoid future injury.
Rehab should address the Scapula but not necessarily screen for Scapular Dyskinesis (Anormal movement patterns) – Scapular dyskinesis is present in 53% of healthy individuals and in 61% of asymptomatic overhead or throwing athletes. Scapular dyskinesis could quite possibly be because of sport specific muscle imbalances and be asymptomatic. The scapula is to be considered as part of kinetic chain when rehabilitating the shoulder complex – thus the kinetic chain should be strengthened to improve the kinematics of the scapula.
Appropriate exercises need to be selected at the appropriate stages – As mentioned before the rehabilitation program needs to be sport and athlete specific, therefore everyone’s rehab process will be different. Although open chain and closed chain exercises need to be included – one athlete might start with a specific exercise earlier then another. End stage exercises nee to be guided specifically by the demands and performance level of the sport.
Plyometric Exercises should be included early – Plyometric exercises are very rapid and explosive like exercises – these exercises are crucial in preparation for the specific load of the athlete’s sport. Once again, this needs to be athlete and sport specific, initially low load exercises are introduced and then progressively the exercises will get harder and more advanced by adding resistance, increasing speed, or creating more sport specific positions.
‘Train the Brain’ – This principle focuses on the psychological aspect of the rehabilitation process. An injury can provoke changes in the brain which can outlast the injury itself. During rehab there is an important opportunity to make use of the brain’s capabilities and take advantage of the brains plasticity to reverse these changes – this is to assist removing any fear or misconceptions as well as to help re-train movement or regain motor memory.
Sport Specific Exercise – all the exercises in an individual’s rehabilitation program importantly need to be specific to their sport – this is the case whether its targeting strength, power, or endurance deficits. The athlete can’t return to sport and performance if they aren’t able to cope with the demands of their sport.
(Schwank, et al., 2022)
As mentioned previously, the physio team at Debbie Cameron Physiotherapy remain up to date with the latest principles and research to give our patients the best treatment and management so that you can get back to doing what you love. These 7 principles from the 2022 Bern Consensus are what the Debbie Cameron Physiotherapists will use to compile your specific shoulder rehabilitation plan that suits you and your unique demands or level of participation.
References
Schwank, A., Blazey, P., Asker, M. & Moller, M., 2022. 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. Journal of Orthopaedic and Sports Physical Therapy, 52(1).