Ac joint re

Jonathan Watson, MD
REHABILITATION PROTOCOL- Nonoperative AC joint sprain

The rehabilitation guidelines are presented in a criterion based progression program. Individual patients will progress at
different rates depending on their age, associated injuries, pre-injury health status, rehab compliance, tissue quality and
injury severity. Specific time frames, restrictions, and precautions may also be given to protect healing tissues and the surgical
repair/reconstruction. The therapist should consult the referring physician with any questions or concerns.
INDIVIDUAL CONSIDERATIONS
_________________________________________________________________________________
_________________________________________
PHASE 1 (~0-2 weeks)
REHAB GOALS 1. Protection of the shoulder
2. Gradual restoration of ROM
3. Minimize swelling & pain
PRECAUTIONS 1. Sling immobilization as needed until pain controlled (usually grade 1-
little/none, grade 2-1 week, grade 3-2-3 weeks)
2. ROM precautions: Avoid behind back IR, cross body adduction, end
range elevation.
3. Ice as needed for pain
4. No lifting or carrying objects
RANGE OF o Active & passive elbow, wrist, hand ROM, ball squeeze, gripping
o Low load active assist ROM
MOTION o No stretching at this time. Soft tissue mobilizations/techniques as
EXERCISES tolerated
o Table slides, wall slides, progress reclined flexion to upright
o Supine flexion & pulleys
SUGGESTED o As above
o LE and core activities when pain tolerates. Non wt bearing to UE
THERAPEUTIC
o Closed chain- scapular exercises
EXERCISES o Scapular clocks
CARDIOVASCULAR Stationary bike with sling as pain tolerates
EXERCISE
PROGRESSION o Full passive ROM
o Out of sling
CRITERIA
PHASE 2 (~3-6 weeks)

REHAB GOALS 1. Achieve ROM goals
2. Normalize rotator cuff guarding & neuromuscular control
3. Minimize pain and swelling
PRECAUTIONS 1. ROM precautions: Avoid cross body adduction
2. Ice as needed after activity
3. No lifting or carrying objects
RANGE OF o Continue phase 1 exercises
o ROM restrictions: as above
MOTION o Glenohumeral/scapular mobilizations as needed
EXERCISES o Active assist ROM
SUGGESTED o Continue phase 1 exercises

o Pushup plus, multilevel rows, ER/IR theraband/cable column
THERAPEUTIC
o Rhythmic stabilization supine
EXERCISES o Shoulder dumps, single leg trunk flexion bends, hip hike, squats
o Single leg balance
CARDIOVASCULAR Continue phase 1
EXERCISE Elliptical, stairmaster
PROGRESSION o Pain free ADLs
o Full active ROM without pain
CRITERIA
PHASE 3 (~7-12 wks)

REHAB GOALS o Gradual restoration of ROM
o Improve scapular, cuff strength
o Minimize pain
PRECAUTIONS
RANGE OF o Continue exercises from phase 2.
MOTION o Mobilizations as needed
EXERCISES
SUGGESTED o Continue exercises from phase 2

THERAPEUTIC o LE & core- progress strengthening, ok for UE wt bearing.
o PNF w/rubber tubing
EXERCISES o Cuff, biceps, triceps, pec, scapular strengthening
o Multilevel rows, prone scapular, scaption
o PNF in D2
o One hand pushup with light ball on wall
o Plyometrics- 90-90 supine ball toss, overhead supine ball,
medicine ball chest pass
o Sport specific LE activities
CARDIOVASCULAR Continue phase 2
EXERCISE Treadmill walking- progress to jog if no pain with 2 miles
walking fast pace
PROGRESSION o No pain with overhead activity or ADLs
CRITERIA o Normal glenohumeral & scapulothoracic mechanics
o UE weight bearing without pain
PHASE 4 (~12+ weeks)

REHAB GOALS o Full ROM in all planes
o No pain
o Improvement of strength, endurance, neuromuscular control
o Return to sport/work
PRECAUTIONS Post-activity soreness should resolve within 24 hours
Avoid post activity swelling
RANGE OF o Continue with flexibility exercises from previous phase
o Gentle end range stretching
MOTION
o LE and core flexibility
EXERCISES o Mobilizations as needed
SUGGESTED oContinue phase 3 activities. Progress with resistance/load.

oUE- return to gym exercises. Can bench press (narrow grip, low
THERAPEUTIC
weight, avoid full lock out) & overhead press (narrow grip, avoid
EXERCISES full lock out)
o thrower’s exercises: ER/IR at 0 abduction (progress to IR/ER as pain
tolerates), scaption ER full can, rows into ER at 90 abduction
seated on stability ball, lower trap seated on stability ball, elbow
flexion, elbow extension/triceps, wrist extension, wrist flexion,
supination, pronation, sleeper stretch, supine horizontal adduction
stretch into IR, Prone horizontal abduction neutral/full ER at 100,
prone row, Diagonal pattern (D2) flexion/extension
o Balance/proprioception- progress to unstable surface,
perturbations, etc
o Plyometrics- LE drills. UE- progress two handed chest pass, 2 hand
overhead, single hand 90/90
o Overhead-ok to progress to interval throwing program
o Sport specific drills ok to start
CARDIOVASCULAR Continue from phase 3, add upper body ergometer if needed. Jog/run
progression
EXERCISE
PROGRESSION o Pain free, full ROM, uncompensated under fast & resisted
conditions
CRITERIA –
o 90% strength of contralateral side rotator cuff & scapular (at least
RETURN TO 70% rotator cuff ratio).
SPORT/WORK o Completion of throwing program/sport specific program
o At least 90% functional closed kinetic chain tests
o Overhead athletes with normal mechanics/form and no pain post
activity

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Jonathan Watson, MD

REHABILITATION PROTOCOL- Nonoperative AC joint sprain

PHASE 2 (~3-6 weeks)

SUGGESTED o Continue phase 1 exercises

PHASE 3 (~7-12 wks)

SUGGESTED o Continue exercises from phase 2

PHASE 4 (~12+ weeks)

SUGGESTED oContinue phase 3 activities. Progress with resistance/load.

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