The treatment of posterior shoulder instability can be a frustrating experience for both the patient and the clinician. Although operative versus nonoperative treatment of this problem has been debated in the literature, and various surgical approaches presented, little specific information can be found regarding the components of an effective rehabilitation program. This paper presents an overview of the dynamics of posterior shoulder subluxation and the authors ' approach to conservative management, with particular emphasis on therapeutic exercise techniques and procedures.

J Orthop Sports Phys Ther 1989;10(12);488-494.

Anterolateral instability is a common lesion of the knee which can result in significant disability. Without treatment, this problem can typically cause recurrent meniscal tearing, increased joint laxity, progressive giving way, joint surface deterioration and restrictions of functional activities. Although surgery can be performed to improve static stability, many patients elect a nonoperative approach based on a knee rehabilitation program. The purpose of this paper is to discuss anterolateral knee instability and the authors' conservative management program. Two collegiate athletes are presented as case studies. Both had positive signs of anterolateral instability, but following arthroscopic surgery and rehabilitation, they were asymptomatic with no limitations in functional activity. One of the subjects discontinued rehabilitation prematurely and resumed sports with no recurrence of functional instability or synovitis, but continued with patellofemoral dysfunction. Nonoperative treatment can be effective in providing functional stability to the ACL-deficient knee with signs of anterolateral instability (i.e., positive pivot shift). More reports of similar cases and rehabilitation studies with long-term follow-up are necessary for comparison with surgical results, which are currently controversial and often disappointing.

J Orthop Sports Phys Ther 1989;11(6):237-244.

Techniques and procedures of proprioceptive neuromuscular facilitation (PNF) are well accepted for therapeutic exercise in rehabilitation of orthopaedic problems. Specific application for the treatment of knee ligament instabilities has not been documented in the literature. Spiral and diagonal PNF patterns emphasize rotatory components of joint function and can provide emphasis in selected musculotendinous structures of the knee. This article describes the application of therapeutic exercise techniques and procedures for anterior cruciate ligament (ACL) and resultant instabilities.

J Orthop Sports Phys Ther 1989;11(6):230-236.

Current concepts in postoperative anterior cruciate ligament (ACL) reconstruction management include participation in an "accelerated" rehabilitation program. There are no published reports examining the effects of accelerated or conservative rehabilitation on subjects with generalized ligamentous hyperelasticity. The purpose of this case study was to examine the effects of a conservative or "decelerated" rehabilitation program on the functional outcome of a hyperelastic female adolescent athlete following ACL reconstruction. The subject was a 15-year-old female basketball player who sustained a unilateral ACL tear and underwent subsequent ACL reconstruction using a patellar tendon autograft. The subject immediately began participation in a "decelerated" rehabilitation program in which the intensity and rate of progression was decelerated, emphasizing a prolonged period of maximum graft protection. Progress was objectively quantified with a battery of diagnosis-specific tests at scheduled intervals. Results at 52 weeks postoperative revealed normal range of motion, proprioception, balance, knee stability, quadriceps strength, hamstring strength, and subjective assessment values, and only a 4.0% deficit in functional scores. Our results suggest a "decelerated" rehabilitation program may be appropriate for the population with generalized ligamentous hyperelasticity by yielding excellent functional results without compromising the integrity of the graft and, ultimately, knee stability.

J Orthop Sports Phys Ther. 1997;26(1):29-34.

Key Words: anterior cruciate ligament reconstruction, rehabilitation, hyperelasticity

It is hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. The purpose of this study was to determine what effect shoulder muscle fatigue has on glenohumeral proprioception and to examine the relationship between arm dominance and shoulder proprioception. Eighty subjects without a history of glenohumeral pathology participated. Each was seated on an isokinetic dynamometer with a randomly selected shoulder positioned in 90° of abduction and elbow flexion. With vision blinded, the arm was passively positioned in 75° of external rotation for 10 seconds, then passively returned to the neutral starting position. Three trials each of active and passive repositioning (2°/sec) were recorded. Following a fatigue protocol, both active and passive repositioning were reassessed. Testing order was randomized. A significant difference was detected between pre- and post-fatigue scores. No significant difference was detected between dominant and nondominant extremities. No relationship between arm dominance and shoulder proprioception was established. It is concluded that shoulder proprioception is diminished in the presence of shoulder muscle fatigue, suggesting clinical rehabilitation protocols must emphasize increasing muscular endurance.

J Orthop Sports Phys Ther. 1996;23(6):348-352.

Key Words: proprioception, fatigue, dominance, shoulder