Welcome to Day 3 of the my “Injury Discussion” on Andrew Luck’s right shoulder. So after two boring posts on shoulder anatomy we’re now head on to his rehabilitation. I’m not a physical therapist, eventually I hope to be, but right now I am not. So while I do have experience in the post-operative setting in the acute stages following shoulder rehabilitation, a lot of the information I pull from physicals therapists and doctors who are well-versed in the field of shoulder rehabilitation. I don’t see patients who are acute post-operative. I recommend patients in the acute stages, to seek physical therapy measures while I can assist with the soft tissue work.
My role, in a team setting, is not to do the initial rehabilitation. My role in early stages is to help with range of motion (passive and active) and to help with “scar tissue” that’s been laying in the muscle. And in the later parts of the rehabilitation setting, is to make sure to keep pain levels to a minimum (and ideally zero) and maintain range of motion and then help with any accessory strength and stability work that may be needed. I want to help eliminate any compensations that could have developed in the rehabilitation stage and to make sure the athlete is moving like a well-oiled machine (Cliche).
After any surgery of the shoulder, instability in the initial is naturally going to occur. Mike Reinold, is someone who’s information I use a lot when rehabbing the populations I get to work with. He had a post that highlights items when rehabbing athletes with shoulder instabilities.
Post-Operative Phase I (Week 0): In terms of what I can help it, it’s a manual therapies component. Initially, there’s going to be more emphasis placed on adjacent joints. Cervical spine range of motion, elbow range of motion, and wrist range of motion. Since you’re in a sling most of the day and the week, maintaining the range of motion in other joints is very important and vital.
So assisting with range of motion (primarily passive) and reducing pain are going to priority in Phase 1. Towards the latter half of Phase 1 (3-4 weeks), reeducation of scapular movement is going to be very important:
Scapular Upward Rotation/Downward Rotation
Post-Operative Phase II (Week 4): The emphasis of phase II is to make sure the athlete can have full active mobility through all the different ranges of motion except internal rotation (internal rotation puts a lot of stress on the repaired posterior labrum).
Making sure that your athletes are able to stabilize their shoulder in neutral position is very important too (arm at the side of your body). Which means through phase II, you’ll have been strengthening the rotator cuff muscles initially through isometric work before advancing through limited range active range of motion and then hopefully full range active range of motion.
At this point, still most likely not cleared for any running or jumping exercises and certainly not throwing yet.
Post-Operative Phase III (Week 8): As you progress continue to progress, he is getting closer to throwing but still not cleared yet. As he continues to be more aggressive in the phase III, you won’t have back-to-back days if he feels any sort of soreness or discomfort. Manual therapy will continue to be a huge component throughout all of the phases of treatment to help with recovery and range of motion.
Exercises will start to incorporate multiple planes of movement instead of just working in a single plane. What I mean by that is, he no longer is just going to do flexion and extension, abduction and adduction, or internal rotation and external rotation, but he is going to combining those motions to create new motions; mainly diagonal patterns.
One of my favorite exercises right now for building rotator cuff stability throughout the entire range of motion is a banded pull-apart.
Post-Operative Phase IV (Week 12): And we’re allowed to jog and run! Which means he can theoretically begin to simulate dropping back, but that’s going to be more along the lines of his football-specific rehabilitation and comparisons to generally rehabilitation.
Up to this point, shoulder rehabilitation exercises have primarily focused on open-chain exercises. Open-chain exercises are exercises where the joint can freely move and is not anchored down to a fix surfaced. But in Phase IV, he can start to bear weight on his shoulder, with the expectations that he has progressed through the first three phases:
- Push-up holds
- Weight shifts on hands
- Scapular Push-ups
- Shoulder sliders
Post-Operative Phase V (General Physical Preparedness): He’s back to general strength and conditioning training. He will be brought through slowly making sure that if there’s any sort of pain or discomfort. Also it’s important that the team trainers, team doctors, and other team medical personnel all are on the same page in terms of the progression for Andrew Luck.
Exercise selection is really important even in the general preparation phase. There’s no need for him to do olympic lifts or box jumps. Some of the focuses of this phase is to eliminate any compensations that may have been developed (although should have been addressed during physical therapy), restore his fitness level, and prepare his mind and body for the rigors of the NFL Season.
He’ll be on a pitch count and not just in terms of total number of throws. He’ll be limited in all of the following:
- Number of days he throws over a 7 day period and eventually progressing to back-to-back days.
- if there is any sort of pain or discomfort the following day, he returns to rehab and doesn’t get work the next day.
- Number of days he still has to continually do shoulder rehabilitation when he’s in his throwing program.
- Total number of throws
- Distance of throws
- Routes he throws
- short to intermediate to long
- in breaking routes vs. out breaking routes
- Velocity at which he throws
- Who he throws to
- stationary targets
- moving targets
- Throwing 1-on-air
- Throwing 7-on-air
- Throwing 7-on-7s
- Throwing in team period without defenders
- Throwing in team period with defenders
- Throwing Live
- He will be heavily protected and not allowed to be touched in live period.