We’re tough on our shoulders here on the Northern Beaches
The shoulder joint has evolved to give us mobility, sacrificing some stability along the way and volleyballers, footy players and plenty of others (myself included) in my Dee Why office have felt the effects of that.
Dislocation and subluxation of the glenohumeral joint occurs relatively frequently in active populations, with 9 out of 10 first-time shoulder dislocations resulting from forceful collisions, falling on an outstretched arm, or a sudden wrenching movement.
In populations under 25 it has been estimated that the recurrence of dislocation after an initial injury could be up to 90%. This means that the treatment of a dislocation and focus on rehabilitation could save you plenty of pain down the road.
When the shoulder is moving normally, the ball stays centred against the socket. With chronic shoulder instability this mechanism goes wrong.
What is chronic shoulder instability?
Shoulder instability occurs when the ligaments and muscles providing stability and mobility to the joint are unable to keep the humeral head in the glenoid fossa.
This is where your shoulder can feel ‘loose’ and dislocate or subluxate with little or no force applied. You might even dislocate your shoulder by reaching across your body to pull the blankets over you!
Poor posture, weak core stability and dysfunctional motor control of the rotator cuff muscles or surrounding shoulder muscles can all effect stability.
People with shoulder instability will often notice a clicking or popping sensation in the shoulder during certain movements, a loss of power in the affected shoulder and a feeling of weakness during certain activities.
There are several factors that can contribute to the development of shoulder instability.
Some of these factors may include:
- history of previous shoulder subluxation or dislocation
- inadequate rehabilitation following a shoulder dislocation
- intensive participation in sports or activities placing the shoulder at risk of developing instability
- muscle weakness (particularly of the scapular stabilizers and rotator cuff)
- muscle imbalances
- poor posture
- abnormal biomechanics or sporting technique
- thoracic spine stiffness
- poor posture
- inadequate warm up
People who have chronic shoulder instability commonly experience:
- Pain when reaching backward or above shoulder height
- Glenohumeral joint pain
- Shoulder stiffness
- Tingling or burning in the lower arm and hand or localised numbness of the skin overlying the deltoid muscle
- Rotator cuff weakness
How can physiotherapy treat shoulder instability?
Physiotherapy treatment for shoulder instability is vital for the healing process and ensuring the best outcome for you. Anxiety, fear and avoidance of movement are all common emotional reactions to shoulder instability, and physiotherapy can help to minimise their impacts.
Physiotherapy looks to strengthen stabilising muscles like the trapezius, rhomboids, and serratus anterior, and increase scapular stability which is required for proper rotator cuff function.
We may use a combination of the below to treat shoulder instability:
- Short term use of a sling for pain relief only
- Postural re-education
- Soft tissue therapy
- Dry needling
- Joint mobilisations
- Motor control training of specific muscles and
- Manual therapy
- protective shoulder taping
- progressive exercises to improve rotator cuff strength, shoulder blade stability, shoulder strength, posture and core stability
- activity modification advice
- biomechanical correction (correction of throwing technique, swimming stroke, volleyball serve)
- clinical Pilates
Be sure to follow your bespoke treatment plan. Although it is a slow process, your commitment to physiotherapy is the most important factor in returning to all the activities you enjoy without pain or fear of instability.
 Hovelius L, Eriksson K, Fredin H, et al. Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg Am 1983;65:343-9.
 Kibler WB, Sciascia A. The role of the scapula in preventing and treating shoulder instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:390.