Home Program for Shoulder Instability and Scapular Dyskinesis

What you are treating

The shoulder socket is shallow, so the joint depends on muscle to keep the ball centered. Two groups do that work: the rotator cuff, four small muscles that hug the ball, and the seventeen muscles that steer the shoulder blade so the socket stays under the ball as the arm moves. A loose shoulder, whether from a dislocation or from naturally loose tissue, and a shoulder blade that moves out of rhythm are two sides of the same problem, and the program for both is the same, in the same order: loosen what is tight, retrain the shoulder blade, then strengthen the cuff, then return to the sport.

The order matters. Strengthening the cuff on top of a badly positioned shoulder blade trains a bad pattern. A few weeks on the blade first makes everything after it work.

Two rules:

• Keep the shoulder blade "set" during every exercise: gently down and back, as if sliding it into a back pocket. Not pinched hard, just set.
• For an unstable shoulder, stay out of the risky position (arm out to the side and rotated back, like cocking to throw) until the therapist clears it. For a shoulder that slips backward, keep the elbows close to the body when pushing.

Stage 1: loosen what is tight (daily, from the start)

• Doorway chest stretch. Forearm on a door frame with the elbow at shoulder height, step through until you feel the front of the chest. 20 seconds, 3 rounds each side. This loosens the pectoralis minor, which tips the shoulder blade forward.
• Cross-body stretch. Pull the arm across the chest with the other hand, keeping the shoulder blade down. 20 seconds, 3 rounds.
• Sleeper stretch. Lie on the sore side with the arm straight out in front and the elbow bent to 90 degrees. Use the other hand to push the forearm gently toward the floor. 20 seconds, 3 rounds. Skip this one if the shoulder slips backward.
• Upper back extension. Lie on your back with a foam roller or a rolled towel across the upper back and let the chest open, moving the roller up and down a few inches. 1 to 2 minutes.
• Upper trapezius and levator stretch. Tilt the ear toward the shoulder, then turn the nose toward the armpit. 20 seconds each, 2 rounds each side.

Stage 2: retrain the shoulder blade (weeks 1 to 4, daily)

These are low-load exercises that teach the lower trapezius and the serratus anterior to fire. Quality counts, not weight.

• Scapular clocks. Hand on a wall at shoulder height, move the shoulder blade up, down, in, and out without moving the hand. 10 slow circles each direction.
• Wall slides. Forearms on a wall with a small band around the wrists, slide the arms up the wall while pressing out gently into the band, keeping the blades down. 3 sets of 10.
• Scapular retraction. Standing or lying on the stomach, squeeze the blades down and together. Hold 5 seconds, 15 times.
• Prone Y, T, and W. Lying face down, lift the arms into a Y, then a T, then a W, with thumbs up, blades down and back. 10 each, no weight at first, then 1 to 2 pounds.
• Serratus punches. Lying on your back, arm straight up, push the fist toward the ceiling by sliding the shoulder blade forward, then let it settle. 3 sets of 15.
• Wall push-up plus. Push-up against a wall, and at the top push a little further so the shoulder blades spread apart. 3 sets of 10. Progress to the knees and then the floor over the next weeks.
• Low rows with a band. Band anchored in front at waist height, pull the elbows back with the blades down. 3 sets of 15.

Stage 3: strengthen the rotator cuff (weeks 3 to 8, every other day)

Add these once the blade holds its position through stage 2. Use a light band; a rolled towel under the elbow keeps the arm in the right place.

• External rotation, elbow at the side and bent to 90 degrees, rotating the forearm outward against a band. 3 sets of 15.
• Internal rotation, the same with the band pulling the other way. 3 sets of 15.
• Side-lying external rotation with a 1 to 3 pound weight. 3 sets of 15.
• Scaption raises: arm raised to 45 degrees in front of the body line, thumb up, to shoulder height only. 3 sets of 12.
• Band pull-aparts at shoulder height. 3 sets of 15.
• Rows and lat pulldowns with a light weight, elbows close, blades set.
• Closed-chain work: hands on a table, shift weight side to side; then a quadruped position with a push-up plus; then a plank on the forearms. 30 seconds, 3 rounds.

Stage 4: return to the sport (weeks 8 and beyond)

• Build toward sport positions gradually: the external rotation exercises move from the elbow at the side to the arm raised to 90 degrees, and the band work moves to a standing, cocked position, only when the shoulder is pain-free and steady.
• For throwers and swimmers: a graded return (a throwing program or a yardage ladder) over four to six weeks, built with the therapist and the coach, and a look at the mechanics that caused the problem.
• For contact sports after a dislocation: a brace that limits the risky position for the first season back.
• Keep stage 2 and 3 as a 10-minute routine three times a week for the whole season. The pattern returns with fatigue.

Notes for the physical therapist

• Sequence: posterior capsule and pectoralis minor flexibility, thoracic extension, then scapular stabilizer activation (lower trapezius and serratus anterior) with motor control, then rotator cuff strengthening in progressively higher elevation, then sport-specific loading.
• Anterior instability: avoid loaded abduction-external rotation for the first 6 weeks; posterior instability: avoid loaded horizontal adduction and deep push positions; MDI: a six-month program with the Watson or Rockwood progression as a frame, and a check of the kinetic chain (hip and trunk).
• Watch for scapular substitution in every exercise; regress the load before letting the upper trapezius take over.
• Return-to-sport criteria: symmetric scapular control on observation, external rotation strength within 10 percent of the opposite side, no apprehension, and completion of a sport-specific progression.
• Post-operative patients (Bankart, posterior labral repair, capsular plication) follow my written protocol timeline; the exercises are the same, the dates are not.

When to call

• The shoulder dislocates or slips and does not settle.
• Numbness, tingling, or weakness in the arm or hand.
• Pain that is worse after four weeks of the program rather than better.
• Winging that is sudden or severe, which can mean a nerve injury.

Learn more

OrthoInfo (AAOS), Chronic Shoulder Instability: orthoinfo.aaos.org (opens in a new tab)

My guides to anterior shoulder instability, posterior shoulder instability, multidirectional and global shoulder instability, and scapular dyskinesis.

This program is a starting place and a set of suggestions for your physical therapist, not a prescription. Your therapist will adjust it to your exam. Stop and call us if the shoulder slips out, if there is numbness or weakness in the arm, or if an exercise causes sharp pain.