Posterior Stabilisation

Updated Evidence-Based Insights (2023–2024)

Sling & External Rotation Bracing
- External rotation bracing (ER brace) is often used in the first 4–6 weeks.
- Sling weaning begins after 4 weeks if stability and pain allow.
Avoiding Internal Rotation (IR) Early
- Active and passive IR should be delayed for at least 6–8 weeks to avoid stressing posterior capsule and labrum.
- Stretching IR only introduced after 8 weeks, if IR tightness persists.
Scapular & Proprioceptive Focus
- Emphasis on scapular neuromuscular control and proprioception > pure ROM gains early on.
- Joint stability is the goal, not early flexibility.
Strength Progression
- Isometrics → CKC → functional strength introduced by week 10–12.
- Return to overhead sports requires passing strength, neuromuscular, and apprehension tests (typically 20–24 weeks).

Phase	Timeline	Goals & Interventions	Avoid
Phase 1: Protection & Early Motion	0–2 weeks	– Sling (or ER brace if instructed) – Pendulums – Hand/elbow/wrist ROM – Patient education	– Shoulder IR – Shoulder flexion – Combined IR/flexion stretch
Phase 2: Protection & Control	2–6 weeks	– Continue sling use – Begin passive ROM in flexion/scaption (pain-free) – Avoid IR and cross-body adduction – Initiate scapular setting	– IR stretching – Active elevation against gravity
Phase 3: Controlled Motion	6–12 weeks	– Wean sling – Progress PROM → AAROM → AROM – Start IR stretching after 8 weeks if needed – Begin closed chain stability drills – Strengthen RC in neutral	– Resisted IR – Heavy lifting
Phase 4: Strength & Functional Control	12–16 weeks	– Isotonic RC + scapular strengthening – Dynamic balance & kinetic chain drills – Begin eccentric control – Start CKC + proprioceptive tasks (e.g., plank progressions)	– Overhead sports or heavy gym loading
Phase 5: Sport/Occupation Integration	16–24 weeks	– Return to full AROM – Begin throwing program or overhead work if stable – Ensure posterior cuff endurance and ER/IR ratio >80%	– Returning to sport without strength/control benchmarks