Understanding and Managing Shoulder Instability in Rugby: A Comprehensive Guide

Shoulder instability is a common concern among all athletes, especially rugby players, due to the physical demands and high-impact nature of the sport. In this blog, we’ll delve into the causes, significance, management strategies and exercises to mitigate the risk and manage shoulder instability in rugby players.

Understanding Shoulder Instability in Rugby:

Shoulder instability refers to the excessive movement of the humeral head within the shoulder joint, leading to a feeling of looseness or slipping. In rugby, Crossfit and other contact sports, this may occur for various reasons;

• Traumatic Injuries: Direct impacts, tackles and collisions during gameplay can cause sudden dislocations or subluxations of the shoulder joint. A subluxation is a mini-dislocation.

• Overuse and Repetitive Stress: The repetitive overhead motions involved in passing, tackling and lifting during training and matches can lead to gradual weakening of the stabilising structures of the shoulder, increasing the risk of instability.

• Muscle Imbalance: Weakness or imbalance in the muscles surrounding the shoulder joint, particularly the rotator cuff and scapular stabilisers, can contribute to instability.The muscle imbalances may be related to the lower limb too. If you have an old knee injury, certain athletes may compensate with increase use of the shoulder for certain lifts in the gym/or adaptations on the pitch. 

• Anatomical Factors: Certain anatomical variations, such as a shallow glenoid socket or lax ligaments, predispose individuals to shoulder instability.

Significance of Shoulder Instability in Rugby:

For anyone who has dislocated their shoulder, or any other joint for that matter, they will know the pain it can cause. As a result of this and the resulting treatment required, it can keep you out of contact sport for a significant spell. If managed poorly, you’re likely to have some serious apprehension about tackling and being tackled, as well as many other parts of the game. Shoulder instability not only affects a player’s performance on the pitch but also poses significant long-term consequences if left untreated or mismanaged:

• Recurrent Injuries: Players with unstable shoulders are more prone to recurrent dislocations or subluxations, leading to prolonged periods of rehabilitation and time away from the game. In some cases, it may lead to a surgical stabilisation 
• Degenerative Changes: Chronic instability can accelerate the development of degenerative changes within the shoulder joint, such as labral tears, cartilage damage and osteoarthritis, potentially jeopardising an athletes playing longevity.
• Functional Limitations: Instability can impair shoulder function, affecting passing accuracy, tackling ability, and overall performance on the field. It’s worth noting that this may not be limited to rugby. It may lead to pain and limiting shoulder function during normal every day activities as well.
• Poor Rehab: consider if the rehab included a full program involving isolated strengthening exercises, compound movements (horizontal push & pull/vertical push & pull exercises), strength endurance exercises and finally some type of plyometric/explosive exercises. 

Management Strategies:

Effective management of shoulder instability at Pro Health Physio involves a multidisciplinary approach, incorporating physiotherapy, surgical intervention and then preventive measures:

Physiotherapy:

Physiotherapy is, more often than not, the first port of call after a dislocation or other instability injury. Whilst general rehabilitation guidelines vary depending on the kind of instability noted, all focus on increasing glenohumeral stability and correcting irregular muscle patterning around the glenohumeral joint (Gaballah et al., 2017). 

Scapulothoracic exercises typically make up the early components of many rehab protocols, before rotator cuff control and strengthening exercises are added. Closed chain exercises can then be incorporated, building up to more open chain alternatives (Brukner & Khan, 2016). 

Pro Health Physio wholly believes, though, that it is the physiotherapists responsibility to suitably progress their athletes’ exercises dependent on their sporting needs and current capacity/presenting symptoms. In rugby, this will depend on their position as well. Equally, it goes without say that a rugby players exercises to prepare them to return to play will be very different to that of a long distance runner. No two rehab pathways and programmes should be the same.

Although the actual exercises will differ, all programmes should incorporate range of movement exercises, strengthening work, proprioceptive training, game specific drills and then injury prevention strategies.

One such programme as outlined by Gaballah et al. (2017) noted the benefits of using elastic resistance bands in an athletes’ rehabilitation programme. Given their simplicity and versatility, in addition to their low price, the authors note how banded exercises are an effective way to not only increase rotator cuff strength, but also improve dynamic stabilisation and overall joint stability.

Surgical Intervention:

Unfortunately, physio is not always the answer. If a shoulder dislocation is mismanaged, the likelihood of re-injuring becomes much higher. After dislocating twice or more, a surgical opinion is always warranted. A surgical repair will usually consist of one of the following;

• • Bankart Repair: Surgical procedure to repair a torn labrum and restore stability to the shoulder joint, usually performed arthroscopically.
  • Capsular Shift: Tightening of the stretched or lax joint capsule to reduce excessive joint movement and prevent recurrent instability.
  • Laterjet Procedure: Transfer of a piece of bone from the coracoid process to the anterior glenoid to create a bony block, enhancing shoulder stability.

Pro Health Physio have extensive links with local surgeons in the North East, in addition to national & international recommendations if you are considering surgical intervention. For more information or guidance, make an appointment to arrange a referral from our team. 

To conclude, shoulder instability is a significant concern for rugby players, impacting performance, career longevity and long-term joint health. By understanding the causes, significance, and management strategies outlined in this guide, players, coaches and healthcare professionals can work together to mitigate the risks, optimise rehabilitation outcomes and promote safe participation in the sport.

If you’ve dislocated a shoulder or any other joint in the past or more recently and you’re not sure what you should be doing or still feel apprehensive about tackling your opponent, get in touch with us at Pro Health Physio. 

With appointments in the early morning, late evening and at weekends, we are flexible to make sure get sen when suits you best. 

For more information, email us at admin@prohealthphysione.com or call us on 01916030422