Intermediate Rehab Program for Shoulder Overuse

Pain at rest < 3/10 on visual analog scale,Passive glenohumeral range of motion within pain limits,No active rotator cuff loading causing symptoms,Scapular resting position without winging or protraction,AC joint stability on palpation,Biceps tendon tension without reproducing symptoms

→ Advance to: Phase 2: Early Mobility

Painful arc improvement > 30% from baseline,Passive glenohumeral external rotation > 30 degrees,Active scapular elevation without substitution patterns,No reproduction of catching or popping in glenohumeral joint,Tolerance to sub-maximal isometric rotator cuff contractions,Sleep disturbance from shoulder pain reduced by 50%

→ Advance to: Phase 2: Early Mobility

Passive glenohumeral flexion > 120 degrees,Passive external rotation at 90 degrees abduction > 45 degrees,Active assisted range of motion equal to passive ROM,Scapular upward rotation during arm elevation > 30 degrees,Isometric rotator cuff strength 3/5 in pain-free positions,No labral irritation with diagonal patterns

→ Advance to: Phase 3: Intermediate Strengthening

Active glenohumeral range of motion within 10 degrees of passive,Scapular control during protraction and retraction against gravity,Rotator cuff isometric strength 4/5 in all directions,Biceps tendon resistance test negative for tenderness,AC joint load test negative for pain,Tolerance to 10 minutes of functional activity without flare-up

→ Advance to: Phase 3: Intermediate Strengthening

Full active range of motion in all planes,Rotator cuff manual muscle testing 4+/5 in external and internal rotation,Scapular stabilization against resistance in all planes,Glenohumeral proprioception within 10 degrees of contralateral side,Functional reaching without compensation patterns,Tolerance to loading equivalent to 2 kg without symptoms

→ Advance to: Phase 4: Advanced Strengthening

External rotation strength at 90 degrees abduction > 70% contralateral,Internal rotation strength at 90 degrees abduction > 70% contralateral,Scapular endurance test > 60 seconds,Labral slap test negative for pain or clicking,Biceps resistance test 5/5 without tenderness,Shoulder outcome scores improving by > 15 points

→ Advance to: Phase 4: Advanced Strengthening

Rotator cuff strength 5/5 in all directions,External rotation at 90 degrees abduction > 85% contralateral,Internal rotation at 90 degrees abduction > 85% contralateral,Scapular control during loaded overhead activities,Throwing progression without pain or fatigue,Plyometric readiness demonstrated without compensation

→ Advance to: Phase 5: Return to Activity

External rotation endurance > 15 repetitions at 50% body weight,Internal rotation endurance > 15 repetitions at 50% body weight,Proprioceptive accuracy within 5 degrees of contralateral side,Functional shoulder rotation velocity > 70% contralateral,AC joint stress test negative,Tolerance to sport-specific training volume without regression

→ Advance to: Phase 5: Return to Activity

Full sport-specific range of motion,Rotator cuff peak torque > 90% contralateral side,Scapular kinematics within normal limits during overhead motion,Biceps tendon speed test 5/5 without symptoms,Functional assessment battery score > 90% contralateral,Return to sport training without limitations

→ Advance to: Phase 5: Return to Activity

Complete sport-specific workload tolerance,Shoulder outcome measures at pre-injury levels,No apprehension with overhead or throwing positions,AC joint stability confirmed under load,Glenohumeral translation within normal limits,Psychological readiness for full return

→ Advance to: Discharge

Maintenance of full ROM without stiffness,Rotator cuff strength 100% contralateral,Scapular stability during high-intensity activity,No recurrent symptoms with activities of daily living,Patient satisfaction with functional outcome,Independence with home maintenance program

→ Advance to: Discharge