Address safety, settle excessive irritability and maintain useful movement.
What to do
Protect from painful compression and heavy lifting
Use sling briefly only if needed for comfort and clinician-directed
Maintain elbow, wrist and hand movement; begin shoulder ROM as tolerated
Exercise dosage
Pendulum/assisted ROM: 5–10 reps several times/day
Elbow/wrist ROM: 10–20 reps daily
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Restore shoulder ROM progressively
Strengthen rotator cuff and scapular muscles
Reintroduce pushing, carrying and cross-body tasks
Exercise dosage
Band external rotation and rows: 2–3 x 10–15
Scapular control drills: 2–3 sets
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Progress overhead and contact-sport demands
Restore push-up, lifting and work-specific capacity
Consider orthopaedic review for persistent symptoms or high-grade injury
Exercise dosage
Push/pull progression: 2–4 x 6–12
Sport-specific contact exposure only after adequate healing and clearance
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Gentle shoulder and scapular mobility may help secondary stiffness.
Avoid direct forceful AC joint mobilisation in acute injury.
Modalities — Use / Avoid
Ice may be used briefly for comfort.
Sling is short-term comfort support, not prolonged immobilisation.
Return / Discharge Criteria
Near-full functional ROM
Painless or acceptable cross-body and overhead tasks
Strength and contact tolerance appropriate to injury grade
Medical clearance where indicated
Common Clinical Mistakes
Ignoring fracture or high-grade separation
Repeatedly stressing the AC joint early
Using deformity alone to determine function
Clinical Pearls
Rockwood grade and functional symptoms both inform management.
Many low-grade injuries recover with progressive non-operative care.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
