What is the recommended home exercise program for a patient with recurrent shoulder dislocation?

Home Exercise Program for Recurrent Shoulder Dislocation

A structured neuromuscular exercise program performed at home is effective for recurrent shoulder dislocation, with exercises progressing from basic daily repetitions to advanced resistance training over 12 weeks, focusing on rotator cuff strengthening, scapular stabilization, and proprioceptive control. 1

Exercise Program Structure

Phase 1: Initial Strengthening (Weeks 1-4)

• Perform exercises twice daily, 20 repetitions per set 1
• Begin with low-intensity resistance using elastic bands 2
• Focus on rotator cuff activation in pain-free ranges 2
• Include scapular stabilization exercises to address motor control deficits 3

Phase 2: Progressive Resistance (Weeks 5-8)

• Transition to moderate-intensity strengthening exercises performed 3 times weekly 4, 1
• Progress to 2 sets of 10 repetitions with increased resistance 1
• Incorporate both aerobic and strengthening components at moderate intensity 4
• Add proprioceptive training exercises to improve joint position sense 1

Phase 3: Advanced Functional Training (Weeks 9-12)

• Advance to elite-level exercises: 2 sets of 10 repetitions, 3 times weekly 1
• Increase resistance progressively as strength improves 4, 2
• Include sport-specific or activity-specific movements 2
• Maintain scapular motor control emphasis throughout all exercises 3

Key Exercise Components

Rotator Cuff Strengthening

• External rotation exercises are critical for anterior instability 1, 2
• Internal rotation strengthening to balance muscle forces 2
• Perform in multiple shoulder positions to address functional demands 1

Scapular Stabilization

• Scapular motor control exercises improve active range of motion and reduce instability symptoms 3
• Focus on serratus anterior and lower trapezius activation 3
• These exercises are effective even when passive range of motion cannot be increased due to instability 3

Proprioceptive Training

• Neuromuscular exercises targeting joint position sense are superior to standard strengthening alone 1
• Include closed-chain exercises for enhanced proprioceptive feedback 1
• Progress from stable to unstable surfaces as tolerated 1

Expected Outcomes and Monitoring

Success Rates

• Atraumatic instability responds better to exercise (80% success rate) compared to traumatic recurrent dislocation (16% success rate) 5
• This distinction is critical: patients with traumatic recurrent dislocations may require surgical intervention if conservative treatment fails 5
• Neuromuscular exercise programs show superior outcomes compared to standard home exercises, with clinically meaningful improvements in shoulder function scores 1

Warning Signs Requiring Reevaluation

• Unremitting pain during the exercise program warrants immediate reassessment 6, 7
• Persistent instability symptoms after 12 weeks suggest need for surgical consultation 1
• Approximately 11% of patients performing structured neuromuscular exercises may still require surgery 1

Safety Considerations

Exercise Safety

• Exercise is safe for musculoskeletal conditions with very few adverse events reported 4
• Patients should be reassured that appropriately prescribed exercises will not worsen instability 4
• No serious adverse events were reported in controlled trials of shoulder instability exercise programs 1

Setting and Supervision

• Home-based programs are effective alternatives to supervised therapy for uncomplicated cases 6, 7
• Group or individual settings show similar efficacy, with slight benefit favoring group exercise 4
• Initial instruction by a healthcare provider ensures proper technique and progression 4

Common Pitfalls to Avoid

• Do not prescribe generic shoulder exercises without addressing scapular motor control and proprioception 1, 3
• Avoid excessive passive stretching that may increase instability 3
• Do not progress resistance too quickly before establishing neuromuscular control 1, 2
• Recognize that traumatic recurrent dislocations have poor response to exercise alone and may require early surgical referral 5
• Ensure exercises target all planes of motion, not just sagittal plane movements 2