The following is an outline rehabilitation program for acromioclavicular joint sprain or separation.
Phase 1: Protect & settle
Goals: reduce pain, protect the AC joint, maintain comfortable movement.
Rehab
- Sling briefly if needed for comfort
- Ice/cold therapy
- Pendulum exercises
- Assisted shoulder flexion within comfort
- Scapular setting/retraction
- Elbow/wrist/hand movement
Progress when:
- Resting pain is minimal
- Arm can hang comfortably
- Flexion/abduction to ~90° with little pain
- No significant increase in symptoms after exercises
Phase 2: Restore movement
Goals: regain near-full pain-free ROM and begin loading.
Rehab
- Active flexion and abduction
- Wall slides
- External/internal rotation
- Isometric flexion, extension, abduction and rotation
- Scapular retraction/depression
Avoid aggressive cross-body adduction initially because it compresses the AC joint.
Progress when:
- Near-full ROM
- Normal everyday activities are pain-free
- Isometric resistance produces little/no AC joint pain
- No next-day flare
Phase 3: Strength
Goals: restore rotator-cuff, deltoid and scapular strength.
Rehab
- Resistance-band internal/external rotation
- Rows
- Shoulder extension
- Scaption
- Serratus punches
- Light dumbbell strengthening
- Wall push-ups → incline push-ups
Progress when:
- Full pain-free ROM
- No AC tenderness with normal activities
- Push/pull exercises are pain-free
- Strength approximately 80%+ of the uninjured side
Phase 4: Advanced loading
Goals: tolerate heavier and overhead forces.
Rehab
- Full push-ups
- Overhead press progression
- Planks/shoulder taps
- Loaded carries
- Medicine-ball work
- Progressive horizontal pushing/pulling
- Sport-specific drills
Progress when:
- Full ROM without pain
- No pain with cross-body adduction
- No pain during or the day after heavy loading
- Strength 90%+ of the opposite shoulder
- Functional tests appropriate to the sport are symmetrical
Phase 5: Return to sport
Gradually restore speed and power whilst increasing unpredictable/contact loading.
For contact sport, I’d require full pain-free ROM, near-symmetrical strength, pain-free sport-specific loading and confidence taking contact/falling onto the shoulder before unrestricted return.
The key rule throughout is: progress only when the current load causes no meaningful pain during exercise and no increase in symptoms later that day or the following morning.
