We are already onto our 3rd blog about everything rugby injuries. This time it is all about shoulder instability, one of the most common injuries I see rugby players sustain. Hopefully this blog gives you some insight into the different types of shoulder instability there are and how they are best managed. If you missed my last few blogs about rugby injuries, you can find them all on my blog page.
The shoulder joint has the largest range of movement in the human body and allows us to do such a wide variety of tasks and sports. However, as it has the greatest range of movement, it is also very common that it becomes unstable. Especially if you play rugby. There are so many moving parts in your shoulder joint, all of which must work in perfect unison in order for you to have a strong and stable shoulder.
If there is any condition out there that you want to rehab properly first time round it's shoulder instability. Once you have had one episode of shoulder instability the chances of having another exponentially increase after every subsequent episode. So, if you have recently had some shoulder instability or dislocation it is pivotal to not return to play until you have been fully cleared to play by a physio.
There are three main factors that can cause someone to have shoulder instability. These factors were established following extensive research coming out of the national orthopaedic centre in Stanmore. Understanding which of the three factors contributes to your shoulder instability is the key to informing us on how to effectively manage your shoulder. In this blog I will explain which each of the type of shoulder instability is and how each type is best managed.
Please forgive me if I go into too much detail, I am a bit of a geek when it comes to shoulder instability.
Type 1 – Traumatic Structural:
Traumatic structural instability is the most common type of shoulder instability I see in young rugby players and especially those playing at a high standard who put tremendous force into tackles. To explain it simply, this type of shoulder instability means you have managed to put so much force through your shoulder (usually during a tackle or scrum) that you have torn the cartilage in your shoulder which helps deepen the socket and keep the joint stable. This is often caused by a one off incident. This type can often repair itself but if the tear is significant and causes persistent symptoms/dislocations it will require surgery. If I thought there was significant structural damage, I can refer you for an MRI that would establish whether or not you are a candidate for surgery.
If the tear is not bad enough for surgery, then these are treated by performing the right physio exercises to strengthen the rotator cuff. The rotator cuff are four muscles who's primary responsibility is to stabilise the shoulder joint. They work hardest at abduction and external rotation, this is the most likely position your shoulder is in when a dislocation occurs.
Some good examples of effective high level rotator cuff rehab can be seen on this video. That said, if you have just suffered a suspected shoulder dislocation please do not try these before seeing us, as there is a small chance these could cause re-dislocation if tried too soon.
Type 2 – Atraumatic Structural
This is the second most common cause of shoulder instability and let’s just say it is more common in those playing in the veteran’s teams than the 1st IX. This type of shoulder instability is caused by years and years of flying into tackles and scrums. Over time the forces that you put on the labrum (cartilage) will take its toll and can cause a tear, just like in type 1. The main difference however is there is no specific trauma at onset. As this type progresses over time it can present as shoulder pain or a shoulder dislocation following a fairly low energy trauma. For example, I saw one rugby veteran last week who’s shoulder popped out from simply getting his daughter out of her car seat.
Type 2’s are more often than not treated with a high-level specific strengthening program similar to the one seen above however it is vital the right exercise is prescribed by a physio. This said, if the structural damage is significant you may also require an MRI and surgery. This can all be determined during your physio assessment.
Type 3 – Muscle Patterning (Non-Structural)
This is the rarest cause of shoulder instability and it's a good job it's so rare, as it is by far the hardest type of shoulder instability to manage. If you were to MRI someone with type 3 shoulder instability it would be completely normal, however they would experience more frequent shoulder dislocations than the other two types of shoulder instability combined. Those with type 3 shoulder instability are often those who can party trick their shoulder out of socket. They are able to disengage their rotator cuff (which are the primary stabilisers remember) and engage their more powerful deltoids. This combination causes their shoulder to pop out with little to no external force applied. The treatment for this type of shoulder instability is complex but not impossible. If this sounds like you, please stop party tricking your shoulder out of place, this can cause permanent damage to the cartilage in your shoulder and make your shoulder instability worse. If you are having regular shoulder instability episodes you need to get in touch.
Remember it is rare to only have one type of shoulder instability in isolation, usually it's a combination of two or even all three types. Determining which types are in play and which to address first is vital for effective shoulder instability management.
I hope you have found this blog all about shoulder instability interesting. I hope you can see from this blog and my others that I am passionate about rugby specific rehab and so if you feel like you need to get checked over by a professional don't be shy get in touch. Let’s get you back on that pitch sooner rather than later!
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