Recent studies highlight the importance of scapular stabilisation in ACJ rehabilitation. Incorporating exercises that focus on scapular control can improve outcomes by addressing muscular imbalances and enhancing shoulder biomechanics.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8169819/
A structured progression of strengthening exercises, starting with isometric exercises and advancing to isotonic and functional strengthening, is recommended. This progression helps in restoring muscle strength and endurance effectively.
https://www.gabriellaodemd.com/pdf/shoulder-ac-joint-reconstruction.pdf
Some protocols recommend initiating passive range of motion (PROM) exercises as early as 2 weeks post-surgery to prevent stiffness and promote healing. However, the exact timing should be individualised based on surgical specifics and patient response.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8129471
| Phase | Current Guideline Exercises | Additional Evidence-Based Exercises |
|---|---|---|
| Day 0 (Immediate Post-op) | – Pendular exercises – Neck/elbow/wrist/hand movements |
– Scapular Setting (activating lower traps & serratus anterior) – Passive Shoulder Flexion (using the non-operative arm or pulley) |
| 0-2 weeks (Early Phase) | – Closed kinetic chain – Proprioceptive exercises – Isometric Rotator Cuff |
– Table Slides (forward and lateral) – Scapular Clocks (hand on wall, move scapula in circular motions) – Isometric External Rotation (against wall or towel) |
| 2-4 weeks (Progressing to Active Movement) | – Progress RC & Scapula recruitment | – Wall Push-ups Plus (Modified) – Sidelying External Rotation (Low resistance) – Assisted Prone I’s, W’s and Y’s (on therapy ball or mat) – Resisted Band Upright Rows (light resistance) |
| 4-6 weeks (Strengthening & Neuromuscular Control) | – Progress RC & Scapula recruitment – Progress kinetic chain integration |
– 4 pt kneeling work – Dynamic Hug Exercise (serratus anterior strengthening) – Banded External Rotation with Scapular Retraction |
| 6-12 weeks (Functional Strength & Endurance) | – Restore optimal cuff & scapula control | – TRX Rows or Low Cable Rows – Landmine Press (controlled, light weight) – Overhead Medicine Ball circles (against wall for neuromuscular control) |
| 12 weeks+ (Return to Sport/Work) | (No specific recommendations) | – Overhead Kettlebell Carries (builds endurance and stability) – Plyometric Rebounder Throws (light ball for sports-specific training) – Push Press (light weight for strength and dynamic control)- Sports specific training encorporating explosive plyometric movements. |
✅ Better scapular stability & rotator cuff activation
✅ Early closed kinetic chain loading for joint stability
✅ Progressive neuromuscular control (TRX Rows, Landmine Press)
✅ Sports & work-specific functional training
