Rehabilitation exercises for an AC joint sprain or separation will depend on the severity of the injury. Exercises should begin only when the ligaments have healed, and you have no pain during normal daily activities.
The following guidelines are for information purposes. We recommend seeking professional advice.
First aid for AC joint separation injuries
Initially complete rest, immobilization and regular application of ice or cold therapy is important to reduce pain and inflammation.
When can I start AC joint sprain exercises?
Mobility exercises can begin only once shoulder movement is pain-free. This will normally be 7-14 days for grades 1 and 2 sprains.
Grade 3 injuries are more frequently treated conservatively, without surgery, but will require an even longer rest/healing period.
Exercises to restore the scapular rhythm are also important. The shoulder blade and upper arm bone should move together with the correct timing. In the injured athlete this rhythm is often lost.
AC joint sprain mobility exercises
If the shoulder has been immobilized for a period of time then it may have lost mobility or range of motion.
Pendulum exercises can begin as soon as the ligament has healed and pain allows.
Gently swing the arm forwards, backward, and sideways whilst lying on your front or bent over as seen opposite.
Gradually increase the range of motion. Repeat this with your arm swinging from side to side as well. Aim to reach 90 degrees of motion in any direction.
Front shoulder stretch
Place one forearm on a fixed point such as a doorframe or corner of a wall and gently turn away from it to stretch the front of the shoulder.
Hold the position for 10 to 20 seconds and repeat 3 times. You should feel a gentle stretch in the front of the shoulder but no pain.
External rotation stretch
Lie on your back with the upper arm at 90 degrees to your body, and the elbow bent so your hand points to the ceiling.
A partner or therapist rotates your arm at the shoulder so that the palm of the hand faces up.
Hold the position for 20-30 seconds, rest, and repeat 3-5 times.
Stretches can be done on a daily basis if you have no pain during, after, or the next day.
AC joint sprain strengthening
Strengthening the muscles surrounding and supporting your shoulder can also begin as soon as pain allows. If it is painful to do the exercises then rest a bit longer.
Strengthening should initially be isometric. This means contracting the muscles without movement.
Exercises should include external and internal rotation as well as abduction (out to the side). They can be performed using a wall as resistance.
Start off applying gentle pressure and gradually increase how hard you push.
Hold for 10 seconds, rest for 3-5 and repeat up to 10 times.
Resistance band exercises for AC joint sprain
An excellent piece of equipment to use to strengthen the shoulder is a resistance band. When using resistance bands start using a long length, if it is too easy you can shorten the band or double it up to provide more resistance.
This is the exact opposite movement of external rotation. With the same starting position, pull your hand in, towards your stomach, again keeping the elbow by your side. Note you will have to turn yourself around to apply resistance to the exercise so that you are pulling the band from your side, across your body.
This can be done by attaching the band to something stable, holding one end, with the upper arm fixed against the body and the elbow bent. Pull the band so that the hand and forearm move away from the body whilst keeping the elbow against your side.
Or hold the band between the hands with elbows at the sides and work both at the same time pulling the shoulder blades back. Perform 3 sets of 10 repetitions with a minute rest between sets.
Using the resistance band, stand on one end of the band, with the other end in your hand.
Keeping your elbow straight, pull your hand up to level with your shoulder ensuring you maintain a good posture throughout.
Again perform 3 sets of 10 repetitions. This can be performed just as easily with a small dumbbell.
Returning to sport
Before returning to any type of sport following an AC joint injury you should have a full pain-free range of motion.
On returning to contact sports, protect your shoulder by taping the joint. Add a circular piece of padding with a hole cut in the middle over the top of your shoulder for extra protection.
This can be kept in place with bandaging or a shoulder support. Stretching, mobility and strength exercises should be continued throughout the return to sports phase.