Clin North Am 2001 Jul;32(3):527-38
Shoulder rehabilitation strategies, guidelines, and practice.
Kibler WB, McMullen J, Uhl T.
Sports Medicine Center, University of Kentucky, USA.
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