Rehabilitation of shoulder injuries is essential for restoring function and improving quality of life. In this guide, we explore proven techniques—from mobility exercises to strength training—to help you recover effectively and avoid future setbacks.
Written by Bridie Nicholson (APA Titled Sports and Exercise Physiotherapist)
Shoulder Dislocations and Recurrent Instability in Sport
Rehabilitation of shoulder dislocations is crutial to prevent reinjury or long term impairments. Unfortunately, shoulder dislocations are incredibly prevalent in sports, especially contact sports like rugby or football. Young male athletes are the highest at-risk group. Recurrence rates vary by age:
- Aged under 20: 72-100% recurrence risk
- Aged 20-30: 70-82% recurrence risk
- Aged over 50: 14-22% recurrence risk (Polyzois et al, 2016)
Why Surgical Management Is Recommended
For younger athletes in contact sports or high-stress activities (e.g., throwing), surgery is often the first choice (Handoll et al, 2004).
Surgical reconstruction reduces recurrence risk to 7% when paired with criteria-based rehab (Reddy et al, 2024). So rehabilitation of shoulder dislocation is needed regardless of if you have surgery or not. But wait! Without structured rehab, the risk of redislocation increases by 500% (Reddy et al, 2024). This significantly reduces the benefits of surgeryTypes of Shoulder Reconstruction Surgery
The type of shoulder reconstruction that your surgeon may recommend will depend on the structures damaged.
- Labral Repair: Repairs Bankart lesions (tears to the labrum).
- Remplissage Procedure: Anchors rotator cuff tendons to address Hill-Sachs lesions.
- Latarjet Procedure: Transfers bone from the shoulder blade to the joint socket for severe instability. Each procedure has a slightly different post-operative rehabilitation protocol based on which structures need to be protected. During the post-surgery phase it is important to consult with a Sports and Exercise Physiotherapist who understands the relevant differences for each procedure. It is also imperative that the physiotherapist has strong communication with the surgeon as different phases of rehabilitation must be approved by the surgeon. Your surgeon's instructions will guide the early stages for rehabilitation of shoulder dislocations and the physiotherapist takes the lead in the later stages.
Post-Surgery Rehabilitation: 5 Critical Phases
Phase 1: Acute Protection (Weeks 0-6)
- Arm immobilized in a sling
- Strict range-of-motion precautions
- Pain management strategies
Phase 2: Subacute Protection
- Restore full, pain-free shoulder range of motion
- Gradual progression under physiotherapist guidance
Phase 3: Strengthening Phase
- Rebuild shoulder complex strength
- Critical: Avoid rushing this phase to prevent re-injury
- Regular strength testing required for progression
Phase 4: Power, Plyometric & Stability
- Plyometric exercises (e.g., medicine ball throws)
- Unstable surface training (e.g., balance boards)
- Functional movement testing before progression
Phase 5: Sport-Specific Training
- Tailored programs for athletes (e.g., throwing drills for baseball pitchers)
- Controlled contact drills for rugby/football players
- Final return-to-sport testing required
Criteria-Based Return to Sport Testing After Shoulder Reconstruction
Key Takeaway: A time-based return to sport increases re-injury risk by 5x compared to a criteria-based model (Reddy et al, 2024).
You cannot rely on time alone to decide when to return to sport. Rigorous, phase-specific testing is critical to ensure your shoulder is truly ready.
How Criteria-Based Testing Works
- Phases 1-4:
- Strength benchmarks
- Full pain-free range of motion
- No apprehension (fear of dislocation)
- Muscle endurance thresholds
- Final Phases:
- Plyometric capacity (e.g., medicine ball throws)
- Stability under load (e.g., single-arm balance tests)
- Sport-specific power metrics
- Functional movement analysis (e.g., throwing mechanics)
Why This Matters
These tests often reveal subtle deficits in shoulder function that time-based protocols miss. For example:
- A rugby player might regain full strength but lack explosive power for tackling.
- A swimmer could have normal range of motion but poor rotator cuff endurance for repetitive strokes.
🗒️ Case Study: A 22-year-old AFL player passed time-based criteria at 6 months post-op but failed power testing. Extended rehab reduced his re-injury risk by 83% (Reddy et al, 2024).
References
- Polyzois, I., et al. (2016). Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. Archives of Bone and Joint Surgery, 4(2), 104–108.
- Handoll, H. H., et al. (2004). Surgical vs non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database of Systematic Reviews, CD004325. DOI link
- Reddy, R. P., et al. (2024). Criteria-based return to sport testing after open Latarjet. Physical Therapy in Sport, 65, 23–29. DOI link
Author
Bridie is a Titled Sport and Exercise Physiotherapist, as awarded by the Australian College of Physiotherapists, who is passionate about making modern, high-quality physiotherapy care available to all people, not just professional athletes.
With more than 7 years of experience Bridie has worked with a variety sporting and professional teams including the Brisbane Roar Football Team, NHL (Ice Hockey), Canadian Basketball, Ultimate Frisbee, Para-Swimming, running, boxing, powerlifting, rugby and AFL.
Bridie was the Head Physiotherapist for the Brisbane Roar A-League Team from 2021-2024, is a consultant for the UQ ParaSTART Paralympic swimming development program and runs the physiotherapy services for Villanova College contact sports.
Bridie treats all people (athletes or not) and is passionate about providing individualised, comprehensive, evidence-based management.
She has a special interest in shoulder pain (including shoulder surgery rehabilitation), knee pain and low back pain.
