Shoulder Rehabilitation Using Aquatic, Land-based, and Self-Rehab

Patients were immobilized for 4 weeks in a sling with the shoulder internally rotated and performed exercises at home during the immobilization phase. The exercises consisted of shoulder pendulum movements, self-assisted elbow flexion and extension, as well as gentle self-assisted passive anterior forward elevation up to 90°. In all 3 groups, patients started their rehabilitation programs after the immobilization phase of 4 weeks:
Aquatic therapy was mainly performed in a swimming pool (depth 125-140 cm, temperature 28-31 °C) supervised by a physiotherapist 2 to 3 times per week. Patients were asked to kneel or sit to submerge both shoulders to perform exercises consisting of progressive passive and active motion of the shoulder for 4-6 weeks, then additional strengthening exercises in a swimming pool for 2-4 months (Table 1).Table 1

Aquatic therapy exercises

Week 0 to 4	Patients were immoblized in a sling but were asked to perform gentle passive motion exercises
Week 4 to 6	Emphasis is placed on increasing passive and active range of motion. Exercises consist of progressive passive and active motion with the shoulders submerged in water
Week 6 to 20	Emphasis is placed on increasing shoulder strength while continuing to increase range of motion. Exercises consist of active motion with resistance using rubber bands and water weights with the shoulders submerged in water.

Land-based therapy was performed at a rehabilitation center supervised by a physiotherapist 2 to 3 times per week. Patients performed progressive passive and active motion of the shoulder for 4-6 weeks, then additional strengthening exercises for 2-4 months.
Self-rehabilitation therapy was performed at the patient’s home without physiotherapist supervision. Patients were given a protocol, as well as additional explanations and demonstrations by a physiotherapy every 7-10 days during follow-up visits, and were instructed to perform 15–30 minutes of exercise per day. The program consisted of progressive passive and active motion of the shoulder for 4-6 weeks, then additional strengthening exercises for 2-4 months.