Comparison of 2 rehabilitation programs for multidirectional MDI: which exercise program is the best and what is the rationale behind it?

Birgit Castelein, New in / Friday, January 11th, 2019

A new study of Warby et al. (2018, BJSM) compared 2 exercise programs of 12 weeks in patients with non-traumatic multidirectional instability. The effect on function and satisfaction (with questionnaires investigating instability, such as WOSI & MISS) and pain, muscle strength, scapular movement was investigated at 6, 12 and 24 weeks. Participants attended a weekly 30-minute physiotherapy session for 12 weeks in either the Watson MDI program or the Rockwood Instability program, where they were prescribed and progressed through a set program of specific exercises to perform at home.

The Rockwood Instability program focuses on strengthening all 3 parts of the Deltoid and Rotator Cuff (internal and external rotation) with the arm in lower degrees of shoulder elevation. There is no focus on faulty scapular biomechanics. This program is often used for the rehabilitation of MDI. The Watson program focuses on retraining and maintaining good scapula and humeral head motor control before any rotator cuff and deltoid strengthening.The stages progressed via an increase in load and an increase in range of glenohumeral joint elevation. The final stages incorporated functional exercises.  

Both exercise programs resulted in positive changes for all variables at all follow-up moments.

The Watson program produced significantly better outcomes than the Rockwood program at 12 weeks for the WOSI and limiting factor in abduction and at 24 weeks for the WOSI, MISS, and pain scores, in comparison with the Rockwood Program. Possible explanations are the primary focus on the proximal stability of the scapula, before incorporating training of the Deltoid or Rotator Cuff, and integration of exercises in a functional setting.

Reference: Warby SA, Ford JJ, Hahne A, Watson L, Balster S, Lenssen R, Pizzari T. Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial. AJSM 2018 Jan;46(1):87-97. doi: 10.1177/0363546517734508. Epub 2017 Oct 19.

Written by: Birgit Castelein

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