SHOULDER DISLOCATION

Shoulder dislocation means the humeral head pops out of the glenoid. 90% are anterior dislocations. Physio treatment focuses on getting motion back, protecting the healing structures, and rebuilding stability so it doesn’t pop out again.

1. *Early phase: post-reduction, 0-3 weeks*

Goal is to protect the labrum, capsule, and rotator cuff while preventing stiffness.

- *Immobilization*: Sling for 1-3 weeks depending on age and surgeon protocol. Younger people often immobilize shorter to avoid stiffness.

- *Gentle movement*: Pendulum exercises, elbow/wrist/hand motion from day 1. Avoid active shoulder motion and external rotation.

- *Pain control*: Ice, gentle scapular setting. Don’t force range - you’re healing a torn labrum/capsule in many cases.

- *Avoid*: External rotation, abduction >90°, and posterior loading for 4-6 weeks.

2. *Motion and scapular control phase: 3-6 weeks*

Once cleared by your surgeon/physio, start restoring motion safely.

- *Passive and active-assisted ROM*: Wand exercises, table slides. Get forward flexion and internal rotation back first.

- *Scapular strengthening*: Serratus punches, scapular retraction, lower trap activation. The scapula is the base for shoulder stability.

- *Rotator cuff isometrics*: Submaximal holds in neutral positions. No resisted external rotation yet if you had an anterior dislocation.

- *Posture work*: Rounded shoulders increase re-dislocation risk. Chin tucks, thoracic mobility.

3. *Strengthening phase: 6-12 weeks*

Once full passive ROM and minimal pain:

- *Rotator cuff strengthening*: Bands for external/internal rotation, starting light. Eccentric control is key.

- *Scapular and deltoid strength*: Prone Y/T/W, lateral raises, rows. The rotator cuff and scapular muscles are your dynamic stabilizers.

- *Proprioception*: Rhythmic stabilization, ball on wall drills. Teach the shoulder where it is in space.

- *Closed kinetic chain work*: Wall push-ups, planks on hands. Safer for early stability work.

4. *Functional and return-to-sport phase: 3-6 months*

Only start once you have full ROM, good strength, and no apprehension.

- *Plyometrics*: Ball tosses, reactive catches. Builds dynamic stability.

- *Sport-specific drills*: Throwing mechanics, swimming strokes, push-up progression. Break it down and build up.

- *Agility and contact prep*: For contact sports, you need controlled exposure to simulated contact and falling mechanics.

- *Return criteria*: Full ROM, 90% strength vs other side, no apprehension with movement, passes functional tests.

5. *What affects recurrence risk*

- *Age*: Under 25 have 80%+ recurrence risk without surgery. Over 40 have <10%.

- *Labral tear/Bankart lesion*: If it’s torn, it won’t heal perfectly without surgery in many cases.

- *Hill-Sachs lesion*: Dent in humeral head makes it more unstable.

- *Hyperlaxity*: Loose joints need more stability training.

Surgical vs conservative

First-time dislocation in young, active people often ends up surgical because the labrum tears and won’t heal. Older people, low demand, or first-time with good stability often do well with conservative rehab. Post-surgery rehab follows a similar timeline but is slower.

What not to do

Don’t rush back to overhead sports or contact. Don’t skip scapular and rotator cuff work - that’s what prevents recurrence. And don’t ignore apprehension. If your shoulder feels like it wants to slide out, you’re not ready.

Timeline

- Conservative rehab: 3-4 months to return to sport

- Post-surgery: 4-6 months for non-throwing, 6-9 months for throwing/contact

Shoulder dislocation rehab is long because you’re rebuilding dynamic stability around a joint that’s naturally unstable.

Was this your first dislocation, and do you know if there was a labral tear? That changes whether we’re aiming for stability training or post-surgical rehab.

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