Tip - Protective phase, the Intermediate phase and the Late phase shoulder treatments

Protective phase, the Intermediate phase and the Late phase shoulder treatments.

Jo Gibson is a Clinical Physiotherapy Specialist at the Liverpool Upper Limb Unit based at the Royal Liverpool Hospital, UK.

Jo is an expert in shoulder rehabilitation and she recently took time out to discuss the latest advances in this rapidly developing specialty...

You identify three distinct phases following shoulder instability surgery: the Protective phase, the Intermediate phase and the Late phase. Could you briefly outline the typical goals of physiotherapy treatment during each phase?

"The initial protective phase essentially addresses restrictions imposed by the surgical procedure and aims to minimise the effects of any immobilisation period. Goals are to diminish pain and swelling, maintain passive range of motion (within surgical limits), improve proprioception    and optimise muscle recruitment with specific emphasis on the dynamic stabilisers (muscles which control the humeral head and shoulder blade). It is essential in avoiding compromise of the surgical procedure to consider the 'normal' healing response and identify factors that may affect it.

"The Intermediate phase aims to restore full active range