The Effect of Exercise Based Management on Multidirectional Instability of the Glenohumeral Joint: A Pilot Randomised Controlled Trial.

12 physiotherapy sessions (one 60 minute session and eleven 30 minute session one to one) delivering the Lyn Watson MDI Program. This rehabilitation program is primarily based around maintaining good scapula and humeral head control through 6 stages. Assessment of the effect of manual correction determines the position of scapula and/or humeral head control that improves a patient’s objective asterisk(s). This position is then adopted in a ‘setting’ action whist performing drills in the relevant stages. Exercises are performed with theraband or weights for resistance. An outline of the 6 stages of the Lyn Watson protocol is as follows: Stage 1- Coronel Plane Strengthening 0 to 45 degrees Abduction: Scapula upward rotation and tilting Internal Rotation/External Rotation from 0 to 45 abduction with theraband Standing/bent over rows 0 to 45 degrees abduction Stage 2- Building Posterior Musculature Bent over rows Side lie external rotation Standing rows Stage 3: Flexion Drills Flexion Drills from 0 to 45 degrees Abduction Stage 4: Coronal Plane Strengthening 45 to 90 degrees Abduction Internal Rotation/External Rotation from 45 to 90 degrees abduction with theraband Standing/bent over rows 0 to 45 degrees abduction Flexion to 90 degrees abduction Stage 5: Specific Strength Drills Bent over rows (Posterior deltoid) Supine and sitting flexion (Anterior deltoid) Lateral Raises (Middle deltoid) Stage 6: Sports Specific and Functional Specific Drills Drills determined by the requirements of the patient. Load and progressed to allow for return to sport or function. Each week will be used to review, prescribe and progress the exercise program. A trained trial physiotherapist will deliver the program and compliance will be monitored by exercise log sheets. Each participant will be asked to perform his or her prescribed exercise program at home (home exercise program). This will involve the participant performing 3 to 7 exercises with the use of therabands and weights, which will be provided to the participant as part of the trial. The exercise program will take between 15 and 20 minutes to complete and will be performed two to three times a day; to once every two days, depending on the phase of the program. At the beginning of the program, the exercises will focus more on recruitment of muscle (exercises performed two to three times a day) and later in the program the exercises may focus more on muscle strength (exercises performed once every second day). At the end of the 12 week program and after the 12 week outcome measures have been taken, participants who score less than a minimal detectable change on both primary outcome measures have the option to cross over into the alternative treatment arm for a subsequent 12 weeks.