title: Evidence-based rehabilitation of athletes with glenohumeral instability.
abstract: OBJECTIVE
  To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability.
  
  
  METHODS
  This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability.
  
  
  RESULTS
  Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function.
  
  
  CONCLUSIONS
  This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete.
  
  
  METHODS
  Expert opinion, Level V.
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium. ann.cools@ugent.be.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Cools
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.
authors.forename: Dorien
authors.initials: D
authors.lastname: Borms
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.
authors.forename: Birgit
authors.initials: B
authors.lastname: Castelein
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.
authors.forename: Fran
authors.initials: F
authors.lastname: Vanderstukken
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.|Department of Environmental Medicine, Musculoskeletal and Sports Injury Epidemiology Center (MUSIEC), Karolinska Institute, Stockholm, Sweden.
authors.forename: Fredrik R
authors.initials: FR
authors.lastname: Johansson
mesh_terms: D001265:Athletic Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000534:rehabilitation*; D016059:Range of Motion, Articular; D000068958:Return to Sport; D017006:Rotator Cuff / Q000503:physiopathology; D000070636:Rotator Cuff Injuries; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000534:rehabilitation*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology
keywords: Exercise; Rehabilitation; Shoulder instability