Final Instructional Design Project
Final Instructional Design Project
Final Instructional Design Project
PO ST - SU R G I C A L
R E H AB I L I TAT I O N
PR O TO C O L :
H O W TO C R E AT E A
R E T U R N - TO - P L AY
P R O TO C O L F O R S O C C E R
GOALKEEPERS POST-
SHOULDER SLAP TEAR
S U R G I C A L R E PA I R
EDAE 639
INSTRUCTIONAL DESIGN
Contents
Overview ................................................................................... 3
Why............................................................................................. 4
Instructional Methods ............................................................. 5
Vocabulary and Abbreviations Used................................... 5
Goals and Objectives .............................................................. 7
Important Note ......................................................................... 8
Schedule and Phases of Rehabilitation ............................... 9
Phase 1. 0-4 Weeks Post-Operative.................... 10
Phase 1 Activity: ..................................................... 11
Phase 2. 4-8 Weeks Post-Operative.................... 12
Phase 2 Activity: ..................................................... 13
Phase 3. 8-12 Weeks Post-Operative ................. 14
Phase 3 Activity: ..................................................... 15
Phase 4. 12-26 Weeks Post-Operative ............... 16
Phase 4 Activity: ..................................................... 17
Phase 5. 6 Months Post-Operative and Beyond18
Phase 5 Activity: ..................................................... 19
Evaluation................................................................................ 20
Colleague and Peer Formative Evaluation ...... 20
Learner Formative Evaluation ............................ 20
Summative Evaluation ........................................... 20
Appendix ................................................................................. 22
Jobe Exercises Example ........................................ 22
Learning Assessment Example ............................ 23
Summative Evaluation Interview Questions .... 28
Visual Representation of ID Model .................... 29
P O S T - S U R G I C A L R E H A B I L I TAT I O N
PLAN
HOW TO CREATE A RETURN-TO-PLAY PROTOCOL FOR SO CCER
GOALKEEPERS POST-SHOULDER S LAP TEAR S URGICAL REPAIR
OVERVIEW
Goals
The athletic trainer will be able to rehabilitate a NCAA Division I soccer goalkeeper back to full
participation following surgical fixation of a superior labrum anterior-posterior (SLAP) tear of
the shoulder.
The athletic trainer will learn how to take a goalkeeper through exercises and progressions that
will optimize their rehabilitation in the following categories of exercises:
a. Mobility
b. Strength
c. Proprioception
d. Sport-specific
Sport-Specific Objectives
1. Given a student-athlete soccer goalkeeper post-SLAP tear surgical fixation, the athletic
trainer will be able to create a catching progression from so that the student-athlete is able
to effectively stop shots on goal.
2. Given a student-athlete soccer goalkeeper post-SLAP tear surgical fixation, the athletic
trainer will be able to design a throwing progression so the student-athlete can throw a
soccer ball 30 yards before bouncing.
3. Given a student-athlete soccer goalkeeper post-SLAP tear surgical fixation, the athletic
trainer will be able to produce a diving progression that reteaches the student-athlete to
dive from their feet to save a shot and land in a way that protects their shoulder from
injury.
IMPORTANT NOTE
The student-athlete must be able to complete the goals of the phase before progressing onto the
next phase of the rehabilitation process. The weeks listed next to each phase are soft guidelines;
they are minimums. The athletic trainer should progress the student-athlete through each phase
under the supervision of a team physician and/or operating surgeon. These phases are designed
to allow adequate time for the stitches (internal and external), tendons, muscles, and newly
repaired labrum to heal. The athlete may progress slower that the printed guidelines, but not
faster. The athletic trainer will first have to progress the goalkeeper through mobility exercises,
and then add strength and proprioceptive exercises. It is only once the athlete has full mobility,
strength, and proprioception, that the athletic trainer should progress them to sport-specific
exercises. Clearance from the operating surgeon is required before the student-athlete begins the
throwing and diving progressions and other sport specific exercises (generally occurs around 5-6
months post-operative).
SCHEDULE AND PHASES OF REHABILITATION
For this instruction, the athletic trainer will have to create a rehabilitation protocol based
on the following phases of rehabilitation. Examples are given of what types of exercises should
be implemented during each phase, but it is up to the discretion of the athletic trainer to
determine how and when the athlete progresses. The athletic trainer should look at the goals of
each phase, and create a daily exercise program that will allow the athlete to reach each phase’s
specific goals.
PHASE 1. 0-4 WEEKS POST-OPERATIVE
General Observation Immobilization in sling/brace at all times.
Evaluation Goals
Pain Controlled
Range of Motion (ROM) minimum
Scapular plane elevation See limits below
External rotation See limits below
Internal rotation See limits below
Sleeping – in sling/brace 4 weeks
Frequency Passive and Gentle Active Assisted ROM
Flexion to 60° (week 1), 75° (week 2), 90° (weeks 3-4)
ER in scapular plane to 15° (weeks 1-2), 30° (weeks 3-4)
IR in scapular plane to 45° (weeks 1-2), 60° (weeks 3-4)
Strengthening
Submaximal/Subpainful Isometrics
Flexion (elbow bent)
Extension (elbow bent)
Abduction (elbow bent)
External Rotation
Internal Rotation
No biceps isometrics for 2 weeks
1. Why would the athletic trainer want to limit the athlete’s shoulder range of motion in the
first four weeks post-surgery?
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2. What are possible hand and elbow range of motion and hand gripping exercises the
athlete could perform in this phase of rehabilitation?
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3. What is the difference between passive range of motion and active assisted range of
motion? Why is it important to do both?
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PHASE 2. 4-8 WEEKS POST-OPERATIVE
General Observation Immobilization is removed.
Evaluation Goals
Pain Controlled
Range of Motion (ROM) minimum
Scapular plane elevation See limits below
External rotation See limits below
Internal rotation See limits below
Frequency Passive and Gentle Active Assisted ROM
Flexion to 145° (weeks 4-6), 180° (weeks 7-9)
ER at 45° ABD to 50° (weeks 5-6)
ER at 90° ABD to 90-95° (weeks 7-9)
IR at 90° ABD to 70-75° (weeks 7-9)
Light ROM at 90° ABD (weeks 5-6)
Strengthening
Neuromuscular Control Exercises
Rhythmic Stabilization Drills (initiate at week 7)
Proprioceptive Drills (weeks 3-4)
Isotonics
Prone Extension to Neutral
Prone Rowing and Prone Horizontal ABD to Neutral
Full Can Exercises
Theraband Exercises
IR/ER at 0° of abduction (initiate at week 7-8)
Modalities Cryotherapy
Electrical Stimulation
Interferential
Pain and Inflammation Control
Precautions No lifting objects (of any weight)
Goals Maintain integrity of surgical repair
Gradually restore full range of motion
Restore muscular strength and balance
PHASE 2 ACTIVITY:
1. What phase of healing is the shoulder labrum in during this phase of rehabilitation? Why
is it important to take this into consideration when planning rehabilitation exercises for
the athlete?
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3. You find out your athlete has been taking their dog out for walks daily. They generally
hold the leash in the hand of the affected shoulder. Should you allow this to continue?
Why or why not?
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PHASE 3. 8-12 WEEKS POST-OPERATIVE
General Observation Normal Scapulohumeral Coordination.
Evaluation Goals
Pain Unremarkable
Range of Motion (ROM) minimum
Scapular plane elevation See limits below
External rotation See limits below
Internal rotation See limits below
Frequency Passive and Gentle Active Assisted ROM
Flexion to 180° (weeks 7-9)
ER at 90° ABD to 90-95° (weeks 7-9)
IR at 90° ABD to 70-75° (weeks 7-9)
Full ROM should be achieved by week 10
Strengthening
Neuromuscular Control Exercises
Supine Rhythmic Stabilization Drills (initiate at week 7)
Proprioceptive Drills
PNF Stretching with Manual Resistance (weeks 8-10)
Isotonics
Prone Extension to Neutral
Prone Rowing and Prone Horizontal ABD to Neutral
Full Can Exercises
Advance to more aggressive strengthening (weeks 10-12)
Theraband Exercises
Advance theraband program for strengthening ROM
1. What is considered normal scapulohumeral coordination? How would you assess for
this?
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2. What are the different types of PNF stretching? How do you perform them?
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3. What is the purpose and benefit of Jobe exercises? Are there any that you would not want
the athlete to perform during this phase of the rehabilitation protocol?
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PHASE 4. 12-26 WEEKS POST-OPERATIVE
General Observation Normal Scapulohumeral Coordination.
Strength is 80% of contralateral side.
No pain or tenderness.
Evaluation Goals
Pain Unremarkable
Range of Motion (ROM) minimum
Scapular plane elevation Full
External rotation Full
Internal rotation Full
Frequency Passive and Active ROM
Stretch as needed to maintain full ROM, especially ER
Stretching Exercises
Continue daily stretching
Capsular stretches vs Muscular stretches
Strengthening
Neuromuscular Control Exercises
Supine Rhythmic Stabilization Drills
Proprioceptive Drills
PNF Stretching with Manual Resistance
Isotonics
Aggressive Strengthening Program – continue to progress
Prone Extension to Neutral
Prone Rowing and Prone Horizontal ABD to Neutral
Full Can Exercises
Advance to more aggressive strengthening
Theraband Exercises
Advance theraband program for strengthening ROM
Plyometrics
Light plyometric program (initiate in weeks 14-16)
Advance plyometric program (weeks 20-26)
Functional Activities
Restricted sports (initiate in weeks 14-16)
Initiate sport specific program (catching, throwing, etc.)
Modalities Cryotherapy
Electrical Stimulation
Interferential
Pain and Inflammation Control
Precautions Avoid loading posterior labrum and posterior shoulder capsule
No narrow grip bench press, no flys, etc.
Goals Gradually restore full function
Advance muscular strength and balance
PHASE 4 ACTIVITY:
1. What is the difference between a capsular stretch and a muscular stretch? Which is
generally more comfortable for the athlete?
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2. What are your criteria for beginning sport-specific activities, such as catching and
throwing?
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3. Why do you not want the athlete to load the posterior labrum or posterior shoulder
capsule?
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PHASE 5. 6 MONTHS POST-OPERATIVE AND BEYOND
General Observation Full non-painful ROM.
Satisfactory stability.
Strength is 90% of contralateral side.
No pain or tenderness.
Evaluation Goals
Pain Unremarkable
Range of Motion (ROM) minimum
Scapular plane elevation Full
External rotation Full
Internal rotation Full
Frequency Stretching Exercises
Continue daily stretching
Capsular stretches vs Muscular stretches
Strengthening
Neuromuscular Control Exercises
Supine Rhythmic Stabilization Drills
Proprioceptive Drills
PNF Stretching with Manual Resistance
Isotonics
Aggressive Strengthening Program – continue to progress
Prone Extension to Neutral
Prone Rowing and Prone Horizontal ABD to Neutral
Full Can Exercises
Advance to more aggressive strengthening
Theraband Exercises
Advance theraband program for strengthening ROM
Plyometrics
Advanced plyometric program
Functional Activities
Progress sport specific program (throwing, diving, etc.)
Modalities Cryotherapy
Electrical Stimulation
Interferential
Pain and Inflammation Control
Precautions No restrictions
Goals Gradually restore full function
Advance muscular strength and balance
Gradual return to full sport participation
PHASE 5 ACTIVITY:
1. Should the athlete be allowed to participate in weight room activities in this phase of
rehabilitation? Why or why not?
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2. How would you progress the athlete’s sport specific program? What activities or
exercises would you have them doing?
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3. Create a rough draft of a sport-specific throwing and diving program for your student-
athlete. Attach separately.
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EVALUATION
SUMMATIVE EVALUATION
At the completion of the rehabilitation protocol when the student-athlete has been cleared
by a team physician for full athletic participation in their sport, an interview process will take
place. The purpose of this interview process is to look at the potential benefit the rehabilitation
protocol design program had for athletic trainers and student-athletes. Multiple questions will be
asked of the athletic trainers, student-athletes (sample questions in Appendix), and other
stakeholders and a final report will be compiled with themes from the interview responses. From
these themes, further evaluation will be completed to determine if any additional teaching or
resources are needed for the athletic trainer to create and progress a full rehabilitation protocol
for the athlete. All of this information will be shared with the program stakeholders.
Athletic trainers do not have the luxury of getting to “do-over” an athlete’s rehab if
something does not progress according to plan or if, when the athlete returns to full participation,
they decide they do not feel comfortable with a movement or exercise. Because of that, this
evaluation will impact the next athlete who has to go through surgery and rehabilitation for a
shoulder labral tear. The athletic trainers will be responsible for taking the feedback and from the
interviews and changing how the rehabilitation process is done based on what is needed.
APPENDIX
Name: DOI:
Prone ER 3x10
Prone Horizontal Abduction
3x
5/5/5
TB PNF D1 and D2 Patterns 2x15each 2x15each
Ice X X
Notes:
Athletic Trainer:
Soccer Goalkeeper Throwing and Diving Progression Example
Criteria for Progressing to Next Step:
Pain-free after completing step
If step is able to be completed pain-free, repeat step the next day
No more than two days of throwing in a row
May progress to next step if pain-free, no swelling, or any other symptoms
Two days per step – two steps each week
Schedule Example: Step Two (Monday/Tuesday), Rest (Wednesday), Step Three
(Thursday/Friday), Rest (Saturday/Sunday)
Throwing Diving
Step One (warm-up throws) Start at 7 months
*Start with a tennis or lacrosse ball to get Step One (8-12 balls)
the motion correct and pain-free Sit on ground
Stand 5-15ft away from Receive ball with 2 hands elbows in, 2-3
wall/goal/partner times each side
1 arm underhand roll to R and L sides (5 o Controlled collapse to the ground,
rolls each) forward and to both sides
2 arms overhead (5 tosses) 5 minute rest
2 arms overhead with bounce (5 tosses) Receive ball with 2 hands elbows in, 2-3
1 arm overhead (5 tosses) times each side
1 arm overhead with bounce (5 tosses) o Controlled collapse to the ground,
forward and to both sides
Start at 5-6 months Step Two (12-18 balls)
Step Two (20-30 throws total) Sit on ground
Warm up throws Receive ball with 2 hands extended from
10ft from a wall, 10-15 throws at 50% body, 2-3 times each side
effort o Controlled collapse to the ground,
5 minute rest forward and to both sides
10ft from a wall, 10-15 throws at 50% 5 minute rest
Receive ball with 1 hand extended from
body, 2-3 times each side
o Controlled collapse to the ground, to
both sides
Step Three (30-36 throws total) Step Three (12-18 balls)
Warm up throws Kneel on ground
10ft from a wall, 10-12 throws at 75% Receive ball with 2 hands elbows in, 2-3
5 minute rest times each side
10ft from a wall, 10-12 throws at 75% o Controlled collapse to the ground,
5 minute rest forward and to both sides
10ft from a wall, 10-12 throws at 75% 5 minute rest
Receive ball with 2 hands elbows in, 2-3
times each side
o Controlled collapse to the ground,
forward and to both sides
Step Four (20-30 throws total) Step Four (10-15 balls)
Warm up throws Kneel on ground
20ft from a wall, 10-15 throws at 50% Receive ball with 2 hands extended from
5 minute rest body, 2-3 times each side
20ft from a wall, 10-15 throws at 50% o Controlled collapse to the ground,
forward and to both sides
5 minute rest
Receive ball with 1 hand extended from
body, 2-3 times each side
o Controlled collapse to the ground, to
both sides
Step Five (30-36 throws total) Step Five (8-12 balls)
Warm up throws Standing
20ft from a wall, 10-12 throws at 75% Receive ball with 2 hands elbows in, 2-3
5 minute rest times each side
20ft from a wall, 10-12 throws at 75% o Controlled collapse to the ground, to
5 minute rest both sides
20ft from a wall, 10-12 throws at 75% 5 minute rest
Receive ball with 2 hands elbows in, 2-3
times each side
o Controlled collapse to the ground, to
both sides
Step Six (20-30 throws total) Step Six (8-12 balls)
Warm up throws Standing
30ft from a wall, 10-15 throws at 50% Receive ball with 2 hands extended from
5 minute rest body, 2-3 times each side
30ft from a wall, 10-15 throws at 50% o Controlled collapse to the ground, to
both sides
5 minute rest
Receive ball with 1 hand extended from
body, 2-3 times each side
o Controlled collapse to the ground, to
both sides
Step Seven (30-36 throws total) Step Seven
Warm up throws Standing
30ft from a wall, 10-12 throws at 75% Receive ball outside of shoulder range
5 minute rest o Push off of the ground
30ft from a wall, 10-12 throws at 75% Either collect ball or tip ball out of goal
5 minute rest Control body when making contact with the
30ft from a wall, 10-12 throws at 75% ground