Shoulder rehabilitation strategies, guidelines, and practice.

This framework for rehabilitation is consistent with the proximal-to-distal kinetic chain biomechanical model and applies current concepts of motor control and closed chain exercises. This framework approaches the final goal--glenohumeral motion and function-through facilitation by scapular control, and scapular control through facilitation by hip and trunk activation. This article supplies guidelines for rehabilitation and practices to implement the guidelines that have proved effective in our hands. Other protocols may be effective, as long as they adhere to several basic concepts of kinetic chain-based shoulder rehabilitation: 1. Functional shoulder rehabilitation requires that the muscle activations and joint motions follow a proximal-to-distal pathway along the appropriate kinetic chain. 2. Muscles around the shoulder function in an integrated fashion and should be rehabilitated in integrated patterns. Specific muscles may need isolated activation, but this activation should be facilitated by placing the proximal segments in a facilitating function. 3. Scapular control and coupled rotator cuff activation is vital to normal shoulder function. 4. Closed chain axial loading exercises are the primary means of early shoulder rehabilitation and are the mainstays of functional rehabilitation protocols.