Rehabilitation for atraumatic shoulder instability in circus arts performers: delivery via telehealth

Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint

“…Correction techniques not only determine if there is a motor control pattern component of the patient’s presentation but assist in determining if the patient is likely to respond to rehabilitation and what exercise drills are best suited to commence the program. For example, if a patient’s symptoms improve with a scapular upward rotation correction, then they are likely to improve with rehabilitation that commences with exercises that restore that position of the scapula [ 7 , 8 , 9 ]. Similarly, if posterior correction of the humeral head improved an objective test, then the rehabilitation program should have a particular focus on activating muscles that limit the posterior humeral head translation [ 60 ].…”

“…One study [ 8 ] included 46 patients with MDI and demonstrated that completing 12 weeks of the WIP 1 significantly improved scapular upward rotation, muscle strength, movement variability and functional outcomes measures. The other study [ 7 ] included circus performers with atraumatic shoulder instability and was delivered exclusively via Telehealth. After a 12-week program, performers had significantly improved MISS and WOSI scores at 6, 12, and 24 weeks from baseline, and significantly improved scapular upward rotation and muscle strength at final follow-up (24 weeks).…”

“…Although this study was in a post-surgical population, the principles of ensuring adequate scapular and glenohumeral muscle strength for safe return to high-level activity still apply to a non-traumatic population. Previous MDI studies [ 7 , 8 , 9 ] have shown that group improvements in functional outcomes (including sporting and activity participation) are related to group improvements in muscle strength on a hand-held dynamometer. Shoulder strength testing with hand-held dynamometry has good inter and intra-rater reliability when performed by an experienced practitioner and the protocol used in MDI clinical trials has been published in detail [ 107 ].…”

“…Patients are likely to have a significant improvement in functional outcomes after 6 weeks of the WIP 1 program though scores of 80% of a normal shoulder are seen closer to 12 weeks [ 7 , 8 , 9 ]. The largest treatment effects are seen at 24 weeks post rehabilitation [ 9 ], which is when most overhead sporting patients may expect to recommence training.…”

“…In 2016, we published the details of an evidence-based program for MDI [ 5 , 6 ] that has been evaluated for efficacy in two single-group studies [ 7 , 8 ] and a randomised controlled trial [ 9 ]. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition [ 10 ].…”