S HOULD E R

DISLO C AT ION
REHABILITATION PROTOCOl

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Sports Medicine & Physiotherapy
922 Anzac Parade, Maroubra, NSW 2035 | Level 1, 213 Bronte Road Waverley, NSW 2024
ABN: 95 730 992 792 | Phone: 02 8068 7161 | admin@[Link]
S H OULD ER DI SL O C AT I O N
A shoulder dislocation occurs when the “ball” of your humerus (upper arm bone) is
pulled out of its normal position in the shoulder “socket” (glenoid labrum). A dislocation
is accompanied with extreme pain and an inability to move your arm until it is relocated
back into the socket. It is the most commonly dislocated large joint and has an
estimated prevalence of 2% - 8% in the general population.

A shoulder subluxation is a partial shoulder dislocation, when the shoulder joint comes
part way out before relocating.

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M e chani sm o f I n jury
There are many ways in which a shoulder dislocation and subluxation occur, however
the main ones are listed below:
1. Traumatic shoulder dislocation: this occurs when the shoulder is in a non-optimal
and vulnerable position and is displaced out of its joint socket. It is commonly seen
when the arm is out to the side e.g. in a tackle or fall
2. Repetitive shoulder ligament strain: Repetitive movements and stretching into the
shoulder joint e.g. throwing sports like baseball
3. Genetic hypermobility: Ligaments are an important support structure in the shoulder,
and people with genetic hypermobility (born with loose ligaments and connective
tissue) are more prone to dislocation and subluxation.

Recurrent Shoulder Dislocations

Individuals younger than 25 years old are likely to re-dislocate with non-operative
management. Surgery reduces risk of recurrent instability.
The risk of recurrent dislocations is influenced by the age at the time of initial
dislocation. In patients <20 years old the rate of recurrent instability is 72–100%, in
those aged between 20-30 years it is 70–82% and in patients >50 years old it is 14–
22%.

Prognosis
Once the shoulder joint has been restored to its optimal position after a shoulder
dislocation, it can take up to a year for the rehabilitation to be completed (although most
people return to sport after 12 weeks if non-surgical and 6-months if surgical).

P rotocol U s er G uide
This protocol is a guide for both clinicians and patients outlining the conservative (non-
surgical) rehab of a shoulder dislocation. Every person’s situation is different, therefore
you must move through the protocol at your own pace and the progression criteria
should dictate how quickly you go; it is not timeline based. Use pain as a guide. If the
pain increases consult your physio/surgeon.

Clinicians should use a clinical reasoning approach in prescribing an exercise

rehabilitation program and management advice for each phase. This protocol
briefly suggests typical exercises for each phase, but programs should always be
individualised.
Acute Pha se (7 days P os t-i nju ry )
Immobilisation with a sling for the first few days to promote healing of shoulder joints.
It is important to be careful with your arm in this phase and to not move your shoulder in
vulnerable positions.

G oa ls P recau t i on s Re comme nd e d Criteria to Progress

Progra m to Next phase
• Patient • Screen for 1. Education on the Pain controlled
understands contraindications importance of
timeframes of and red flags e.g. compliance of
healing process neural symptoms rehab program
and rehabilitation and Bankart 2. Ice therapy for pain
process lesions relief (GameReady
• Wean from sling • No overhead in clinic or ice-bath
movements with at home)
weights

Ph a se 1: E a rly r e ha b ( W e e ks 2-3)
G oa ls P recau t i on s Re comme nd e d Criteria to Progress
Progra m to Next phase (tick
when complete)
• Patient • Screen for 1. Manual therapy to □ Full active range
understands contraindications address muscular of motion in
timeframes and red flags e.g. tightness, pain and shoulder
of healing neural symptoms function
process and and Bankart
□ Minimal
2. Ice therapy for pain pain and
rehabilitation lesions relief (GameReady inflammation
process • No overhead in clinic or ice-bath
• Normal movements with at home) □ 4/5 strength in
rotator cuff and
scapulohumeral weights 3. AAROM with stick deltoid
rhythm • Avoid ER beyond
• Obtain full active 0deg
4. Activation and □ Minimal winging
strengthening of of scapula with
range of motion • No combination RC muscles. wall push up
• Muscle of abduction/
re-education external rotation
5. Closed chain □ No evidence of
stabilisation instability
and activation movements exercises
especially RC □ Good
muscles 6. Fitness understanding
maintenance: of normal
• Maintain fitness Gym-based posture
exercises for upper
body, bike

S H O U L DER DIS LO C ATI ON 04

 P has e 2 –
S tr en gth Pha se ( 4-6 we e ks )

G oa ls P recau t i on s Re comme nd e d Criter ia to

Progra m Progr e s s to
Ne xt p ha s e
( tick when
complete)
• Full AROM • Avoid exercise that 1. Mobility exercises □ No swelling
• Normal causes more than 2. Reformer Pilates □ Pain free AROM
scapulohumeral moderate pain based rehabilitation and normalised
rhythm at faster (>3/10) scapulohumeral
3. Strengthening
speeds • No overhead program for upper rhythm
• Regain shoulder movements with body □ Strength within
stability into weights 95% of the other
4. Stability and
flexion range 90° • No combination perturbation ex’s side
and above of abduction/
5. Aerobic/endurance
• Decrease external rotation
activity
pain and movements
6. Manual therapy to
inflammation
address muscular
• Increase tightness, pain and
shoulder function
strength

S H O U L DER DIS LO C ATI ON 05

 P has e 3 –
F un cti ona l Str e ngt he ni ng
( 7 -12 we e ks)

G oa ls P recau t i on s Re comme nd e d Criter ia to

Progra m Progr e s s to
Ne xt p ha s e

• Pain free • Avoid activity 1. Advanced • Upper extremity

functional that causes pain proprioception/ test passed (95%
weight-bearing greater than 3/10 perturbation in comparison to
activity on VAS exercises other side)
• Advanced • Slow progression 2. Advanced • Full functional
strengthening towards combined strengthening for strength,
• Initiate sport abd/ER shoulder and full stability and
specific exercise kinetic chain proprioception
rehab 3. Continue aerobic • Specific
activity movement
4. Sport Specific screen for your
Drills individualised sport
to the client • Pain free return
5. Functional taping if to sport
needed for sport/ • Knowledge
work of dislocation
prevention

NB: It is
recommended to
continue program
for 6 weeks after
full return to your
normal activities/
sport.

S H O U L DER DIS LO C ATI ON 06

 P has e 4 –
Dyn amic strengt h a nd s ta b i li t y
p has e (5 month s -1 ye a r )

G oa ls P recau t i on s Re comme nd e d Criter ia to

Progra m Progr e s s to
Ne xt p ha s e

• Continue • Avoid ER above 1. Manual therapy Surgeon and

to improve 90deg until after 6 to improve ROM, physio will clear
muscular months alignment and for return to sport
strength and reduce mm tone once sports/activity-
stability 2. Graded specific criteria
• Return to strengthening are met (usually
desired activities program : isotonic at 6months + for
movements (see contact sports)
• Prevention of
recurrence videos)
3. Fitness
maintenance:
Stationary bike,
xtrainer
4. Biomechanical
retraining
5. Plyometrics
6. Proprioception
training

S H O U L DER DIS LO C ATI ON 07

 RETUR N TO SPOR T T E S T I NG
This is a general return to sport test and an individualised testing routine should be used
for each client and their relevant goals and sport.

E x e r c i s es D e scription Crite ria To Pr o g r e s s

Back to Sp o r t
Timed push up test How many push ups can • Males >18
be completed in 1 minute • Females > 12

Hand held dynamometer Testing internal and 95% within each other
external rotation strength Also aim to have Internal
against the dynamometer. rotation strength no more
than 1.6x external rotation
strength on the same side.

Seated Medicine Ball throw Sitting with the back Best of 3 trials
against a wall with legs • Excellent 5.76m+
extended. Bring ball to • Good 5 - 5.75m
chest and throw whilst • Average 4.25 - 4.99m
keeping back against the • Below average 3.5 -
wall. 4.24m
Males 6lbs females 4lbs • Poor 0 - 3.49m
ball

Closed Kinetic Chain Upper In push up or modified Males 24

Extremity Stability Test push up position with Females 27
hands 36 inches apart.
Count how many times one Usually get improvement of
hand can touch the other in 3-4 between tests.
15 seconds
3 attempts with 45 seconds
rest

S H O U L DER DIS LO C ATI ON

 RETUR N TO SPOR T T E S T I NG
This is a general return to sport test and an individualised testing routine should be used
for each client and their relevant goals and sport.

E x e r c i s es D e scription Crite ria To Pr o g r e s s

Back to Sp o r t
Timed push up test How many push ups can • No pain
be completed in 1 minute • 95-100% function of the
uninjured side
• Good form/technique

Hand held dynamometer Testing internal and • No pain

external rotation strength • 95-100% function of the
against the dynamometer. uninjured side
• Good form/technique

Seated Medicine Ball throw Sitting with the back • No pain

against a wall with legs • 95-100% function of the
extended. Bring ball to uninjured side
chest and throw whilst • Good form/technique
keeping back against the
wall.
Males 6lbs females 4lbs
ball
Closed Kinetic Chain Upper In push up or modified • No pain
push up position with • 95-100% function of the
Extremity Stability Test
hands 36 inches apart. uninjured side
Count how many times one • Good form/technique
hand can touch the other in
15 seconds
3 attempts with 45 seconds
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Sports Medicine & Physiotherapy
922 Anzac Parade, Maroubra, NSW 2035 | Level 1, 213 Bronte Road Waverley, NSW 2024
ABN: 95 730 992 792 | Phone: 02 8068 7161 | admin@[Link]