As with most orthopedic conditions, the rehab process involves settling the area down, then building back up. So once symptoms have settled, we need to reintroduce painful movements gradually, being guided by pain response after training.
With our resistance training, we want to ensure that we have an adequate balance between pushing and pulling exercises. This is essentially to avoid exposing the joint to excessive loading in each direction, and also to maintain strength balance around the joint. Initially we want to avoid exercises crossing the midline of the body, which tend to strain the AC joint. Pressing options such as a single arm floor press with rotation are great for this. Many athletes find that incline pressing (with dumbbells or cables) is more comfortable than flat bench press, due to the direction of the humerus aiming beneath the AC joint. Neutral grip bench using a safety bar, or dumbbells, may also be better tolerated in the early stages. As pain settles we can progress back into more demanding movements.
Scapular stability work focusing on posterior tilt and protraction (see clips) may be effective in optimising the ability of the shoulder muscles to buffer compressive loads.
With our skills training, we gradually reintroduce the previously painful techniques as tolerated, while closely monitoring volume of these strikes. If there were technical factors (e.g. poor elbow position in the hook, flaring elbows in body shot, overextending the jab, poor rotation in the cross) that may have led to the injury, these should be addressed in conjunction with the skills coach.
Finally, the athlete’s range of motion into hip and thoracic rotation should be assessed, and if there are significant restrictions in these areas which may be increasing the biomechanical load on the shoulder, these should be addressed in their exercise program.
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