Rehabilitation for multidirectional shoulder instability
Multidirectional instability (MDI) of the glenohumeral joint is a complex condition involving joint subluxation and/ or dislocation in multiple directions. The condition is often atraumatic and does not typically involve structural pathology.
This high quality RCT sought to compare 2 rehabilitation programs; the Rockwood and the Watson program.
The results of the trial suggest that, whilst both programs demonstrate significant improvement in a variety of measures, the Watson program resulted in the greatest long-term gains.
The Rockwood program focuses on concurrent global strengthening of the deltoid and rotator cuff muscles whilst the Watson program progresses through several phases, initially with scapular stability followed by rotator cuff/ deltoid strengthening and then into functional activities.
A total of 41 participants between the ages of 12-35 years (meeting strict inclusion criteria!) were randomly allocated to either the Watson or Rockwood program. Participants in each group attended a 30 minute session with a physiotherapist once a week for 12 weeks and were also prescribed exercises to complete at home.
The Melbourne Instability Shoulder Score (MISS) and Western Ontario Shoulder Index (WOSI) were the primary outcomes used in this study, with several other secondary measures also utilised.
The results indicate that participants in the Watson group demonstrated substantially greater functional gains according to the WOSI (at 12 and 24 weeks) and MISS (at 24 weeks). At 12 weeks, the proportion of participants who reported pain as being the limiting factor in abduction was also significantly less in the Watson group. Furthermore, pain scores at 24 weeks in the Watson group were also significantly lower than the Rockwood group.
Concluding, this direct comparison of rehabilitation programs for individuals with MDI suggests significantly greater functional gains and reduction in pain with the Watson program compared to the Rockwood program.
Expert opinion by Ann Le
This is a very high-quality study which provides strong support fo the Watson program.
However, it is important to note that the exercises in the Watson program are more complex than in the Rockwood program - this should certainly be taken into consideration when determining which program to implement on your specific client.
Interestingly, this study found that, whilst compliance in the Watson program was less than the Rockwood program, the participants in this group still attained the greater functional and pain outcomes.
> From: Warby et al., Am J Sports Med 46 (2018) 87-97. All rights reserved to The Author(s). Click here for the online summary.