Incorporating Sport Specific Exercises for Older Adults with Glenohumeral Dislocation

Created by: Taylor Guardalabene, SPT 

 

Background

Prior to starting physical therapy school, I obtained my bachelor’s degree in Athletic Training. I have had experience working with many different athletes including children, college aged, and middle aged adults. One group that I had little experience working with was the elderly population. Even though my experience was limited with this population, I think it is important for older adults to maintain an active and healthy lifestyle. During my second year of physical therapy, Dr. Mike McMorris was seeking help to publish a case study about a patient that he worked with in the clinic. This patient was an 73 year female who sustained an anterior glenohumeral dislocation. Despite this injury, the patient responded very well to physical therapy treatment, and was able to return to playing golf within 12 weeks after her injury. I thought that this sounded very interesting, and I wanted to get involved in order to learn more about doing sport specific rehabilitation for older adults because it is very useful in the clinic.

When beginning to look for research about sport specific exercises for older adults, there was very little evidence mentioning sport specific or functional exercises for glenohumeral dislocation. Most of the literature discusses conservative treatment with basic rotator cuff strengthening without implementing exercises in multiple planes or incorporating core strengthening. Because of this limited research, I wanted to create an exercise protocol with functional exercises that could be used when treating an older adult with glenohumeral dislocation. For my Capstone project, I wrote a literature review which will serve as the background paper for the case study Mike McMorris is working on publishing, an exercise handout for glenohumeral dislocation, and a PowerPoint which I plan to present at my next clinical rotation;  an outpatient sports medicine clinic.

Overview/Purpose

Anterior glenohumeral dislocation is an injury that occurs when the humerus translates completely out of the glenoid.¹Approximately 20% of dislocations occur in adults over the age of 60 years old.² Older adults typically sustain a glenohumeral dislocation from a fall on an outstretched hand.³ Due to age related changes in tissues, older adults can sustain other injuries associated with dislocation including rotator cuff injury, humeral fracture, and nerve or vascular injury.³ Surgery is typically only recommended for patients who require management of other injuries such as rotator cuff repair or fracture management. In cases where there are no other associated injuries with the glenohumeral dislocation, conservative physical therapy treatment is recommended.⁴

Physical therapists play a major role in the rehabilitation of glenohumeral dislocations in older adults, since a majority of patients receive conservative management. Treatment typically consists of early range of motion followed by progressive rotator cuff strengthening.³In older adults there is very little literature reporting use of sport specific or functional exercises during the rehabilitation of glenohumeral dislocations. Despite this lack of evidence, the American College of Sports Medicine recommend regular physical activity in adults over the age of 65 in order to prevent chronic diseases and slow the aging process.⁵The position statement also reports that older adults can make similar muscle strength gains as younger participants when completing moderate resistance exercise training.⁵ Physical therapists can incorporate sport specific or functional exercises into the plan of care so that older adults are able to return to their prior level of function and maintain an active and healthy lifestyle.

Statement of Need

I realized there was a need for this project when I began to do research for sport specific rehab for older adults during our Evidence Based Practice II class. Most of the research that I found only described treatments such as range of motion and rotator cuff strengthening. In order to return to a sport or functional activity the plan of care should also incorporate core strengthening and stabilization, scapular strengthening, and shoulder stabilization. One of our primary goals as physical therapists is to get patients moving and maintain a healthy lifestyle. However, if the recommended protocol for glenohumeral dislocation does not allow the patient to return to their prior level of function, then it is likely that they will not be able to play sports such as golf, swimming, tennis, etc. Having a published case study of an example of an older adult who was able to return to playing golf after glenohumeral dislocation, will be very beneficial to clinicians, and hopefully encourage them to push their patients to the best of their ability.

Products

I created three products for my Capstone project. The first is a paper and literature review about glenohumeral dislocation, which will serve as part of the background and discussion portions of a case study that will potentially be publish. Along with the paper, I created an three phase exercise protocol for glenohumeral dislocation for older adults. The final phase of the exercise protocol focuses on multidirectional exercises and core strengthening that are beneficial for overhead functional activities and sports. The final product is a presentation that I created to present to PTs and PTAs at my final clinical rotation, which is an outpatient sports clinic. This information would be very beneficial to this group because it can encourage them to take on more elderly patients, and market to that population.

Capstone Presentation

Capstone Paper

Capstone Exercise Handout

Evaluation

I utilized feedback from my advisor and committee members throughout the semester while working on my project. I sent several drafts of my products to my advisor, and made edits as appropriate. I also sent my final products to my committee members, and then made final additions and corrections to my products prior to finalizing everything. The committee members provided feedback forms, which I utilized to improve my Capstone project.

I also created an evaluation form for my presentation. I have no presented the product yet, but I plan to present at my final clinical rotation, which begins in a few weeks. Upon completion of the presentation, I will provide the audience with my feedback form in order to gain information about the content and the presentation.

Presentation Feedback Form

Self-Reflection

Working on this Capstone project has provided me with many learning opportunities. I was able to improve my writing skills, and learn about the process for a case study to be published. I was also able to create an exercise handout, which will be useful to me and to many other clinicians in the future. I definitely feel more confident providing sport specific exercise to the elderly population with glenoumeral dislocation, which is something I was not confident prior to this project. I have also learned how to effectively communicate with other PTs, and improve my time management skills in order to complete my project in a timely manner. Overall, I am very pleased with how my Capstone project turned out. I think this information can be useful to outpatient physical therapists and physical therapy students across the nation, especially if they plan to work with older adults. I am very thankful for this learning experience, and I hope that my products will be useful to many clinicians for years to come.

Acknowledgments

I would like to express my gratitude for everyone that has helped me throughout this process, and I am grateful for all of the help I have recieved. I would personally like to thank my advisor, Dr. Mike McMorris for helping me throughout the duration of this project, and providing me with useful constructive feedback about my products. I would also like to thank my Capstone committee members Dr. Mike Gross and Dr. Jyotsna Gupta for their expertise and feedback for this project. I really appreciate everyone taking the time to help me throughout this process. Lastly, I would like to thank my classmates for their support throughout the duration of physical therapy school, and always keeping a positive mindset.

References

1. Image: http://wondrlust.com/action/5044/
2. Dislocated Shoulder. American Academy of Orthopaedic Surgeons2017. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/dislocated-shoulder/. Accessed February 3, 2019.
3. Murthi AM, Ramirez MA. Shoulder dislocation in the older patient. J. Am. Acad. Orthop. Surg.2012;20(10):615-622. doi:10.5435/JAAOS-20-10-615.
4. Shin S-J, Ko Y-W, Lee J. Traumatic anterior shoulder dislocation in elderly patients. Arthrosc. Orthop. Sports Med.2016;3(1):24-31. doi:10.14517/aosm15010.
5. Chalidis B, Sachinis N, Dimitriou C, Papadopoulos P, Samoladas E, Pournaras J. Has the management of shoulder dislocation changed over time? Int. Orthop.2007;31(3):385-389. doi:10.1007/s00264-006-0183-y.
6. American College of Sports Medicine, Chodzko-Zajko WJ, Proctor DN, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med. Sci. Sports Exerc.2009;41(7):1510-1530. doi:10.1249/MSS.0b013e3181a0c95c.