Plan of Care for Shoulder Strain

Acute Phase: PROTECTION PHASE

 Inform patient that the expected duration of symptoms may last 4 to 6 days. Tell patient to not
move their right arm too much. The patient must be told not stretch and use the right upper
extremity to carry things as that may aggravate the injury. The patient can use their right hand
for functional activities like writing and eating.
 Rest, Ice, Compression, Elevation, Massage for the first 2 days
 Protect (R) shoulder using shoulder brace
 Early mobilization (Grade 1/ gentle joint oscillations) on R Shoulder Joint.
 PROM – for proprioception on R shoulder, AROM for R arm and L UE (7 reps x 2 sets)
 Aerobic exercise on treadmill

Subacute Phase: CONTROLLED-MOTION PHASE

 The patient is informed that this stage may last for 3 weeks and that the injury is still fragile and
easily injured if overstressed but it can still be healed with proper caution. Therefore, the
patient is encouraged to do functional activities but recreational, sports, or work-related
activities should not be done yet. The patient is informed that they will feel discomfort as the
activities progress but this should not last longer for a couple of hours. The patient is given a
home exercise instruction.
 Shoulder Brace is removed
 AAROM or AROM on R Shoulder, AROM for R arm and L UE (7 reps x 3 sets)
 Multiple Angle Isometrics (MAI) on R Shoulder as tolerated (start with mild resistance)
 Submaximal Isometric Exercises
 Close Kinematic Chain exercises
 Proprioceptive exercise
 Aerobic exercise using treadmill is continued

HEI:

8 to 12 repetitions x 2 sets

Wand Exercises – while using both hands to hold a towel, curtain/metal rod, stick, broom move arms:

 Up and down (flexion)

 Side to side(abduction & adduction)
 Shoulder Rotation – arms at sides, elbows bent at 90 degrees, patient moves want side to side.

Chronic Phase: RETURN-TO-FUNCTION PHASE

 Patient is taught proper body mechanics, self-stretching, and instructed ways to not reinjure
their R shoulder again. For example, patient is instructed to wear backpacks using both
shoulders and avoid carrying them with only one shoulder.
  AROM for both UE (7 reps x 3 to 5 sets)
 PNF Stretching for both UE
 Submaximal to maximal resistance exercises are given
 Aerobic Exercise using treadmill is progressed

HEI:

Resistance Exercise

12 repetitions x 3 to 5 sets

 Using a water bottle or weights perform shoulder press, hold weight and push it up
 While holding weight on one hand, raise it sideways (side raise)
 Like the lucky cat, raise arm at 90 degree bend elbows at 90 degree, move it up and down
(Shoulder IR&ER)

Stretching

30 seconds hold x 2 to 3 sets

 Shoulder stretch
 Triceps stretch