Some people experience instability after a traumatic shoulder dislocation, while others develop symptoms gradually because the muscles supporting the shoulder aren't providing enough control. With the right rehabilitation, many people return to work, sport and the gym without ongoing instability.
At The Addison Physiotherapy, we regularly assess and rehabilitate shoulder instability in athletes, gym-goers, swimmers and people recovering from shoulder dislocations. Our goal is to restore stability, improve confidence and reduce the risk of future episodes.
Key Takeaways
- Shoulder instability occurs when the shoulder doesn't remain securely centred in the joint.
- It often develops after a shoulder dislocation but can also occur gradually.
- Strengthening the muscles around the shoulder is essential for recovery.
- Not every unstable shoulder requires surgery.
- Early rehabilitation reduces the risk of recurrent instability.
What causes shoulder instability?
The shoulder is the most mobile joint in the body, allowing you to move your arm in almost every direction. This mobility also means it relies heavily on muscles, ligaments and the joint capsule for stability.
Shoulder instability may develop because these structures have been injured or are no longer providing enough support.
Common causes include:
- Shoulder dislocation
- Previous shoulder subluxation (partial dislocation)
- Contact sports
- Falls onto an outstretched arm
- Generalised joint hypermobility
- Repetitive overhead sports
Young athletes participating in rugby, AFL, basketball, volleyball and swimming are particularly at risk.
What are the symptoms of shoulder instability?
People commonly experience:
- A feeling that the shoulder may "pop out"
- Pain during overhead movements
- Apprehension when throwing
- Repeated shoulder dislocations
- Clicking or slipping sensations
- Weakness during pushing or lifting
- Loss of confidence using the shoulder
Some people describe the shoulder as feeling loose or unreliable rather than painful.
When should I see a physiotherapist?
It's worth booking an assessment if:
- You've experienced a shoulder dislocation.
- Your shoulder repeatedly feels unstable.
- You avoid certain movements because you're worried it will slip.
- You're returning to contact or overhead sport.
- Your shoulder feels weaker following an injury.
Early rehabilitation is important to restore strength and improve shoulder control.
Do I need imaging?
Sometimes.
X-rays are commonly performed immediately after a shoulder dislocation to confirm the joint has relocated correctly and to exclude fractures.
MRI may be recommended if:
- A labral injury is suspected.
- You've experienced repeated dislocations.
- Surgery is being considered.
- Significant soft tissue injury is suspected.
Your physiotherapist can help determine whether further imaging is appropriate.
How is shoulder instability treated?
Treatment focuses on restoring stability by improving the muscles that support the shoulder.
Treatment usually includes:
Education
Understanding how instability develops and what activities should be modified during recovery.
Load Management
Gradually reintroducing shoulder movements while avoiding positions that place excessive stress on healing tissues.
Progressive Strengthening
Strengthening the rotator cuff, shoulder blade muscles and surrounding stabilisers to improve dynamic shoulder control.
Return to Sport
A structured rehabilitation program progressively restores strength, power and confidence before returning to contact or overhead sport.
Objective strength testing and functional assessment help determine when it's safe to return to higher-level activities.
Can I keep exercising?
Usually, yes.
Following a dislocation, there may be a short period where movement is restricted while healing occurs. Once appropriate, rehabilitation focuses on restoring movement and strength.
Many lower body and cardiovascular exercises can continue throughout rehabilitation, while upper body exercises are progressively reintroduced under guidance.
Returning too quickly to heavy overhead lifting or contact sport can increase the risk of another dislocation.
How long does recovery take?
Recovery depends on the severity of the injury and whether surgery is required.
