Acute Shoulder Injury Rehabilitation

Acute Shoulder Dislocation/Subluxation: What Recent Research Reveals and The Importance of Rehabilitation.

Acute shoulder dislocations and subluxations are common injuries—especially among young, active individuals and athletes. Modern research now shows that while prompt reduction and pain management are essential in the acute phase, a well-structured rehabilitation program is key to restoring function, preventing recurrence, and minimising long-term instability. In this blog, we’ll explore the causes and symptoms of shoulder dislocation, as well as the vital role physiotherapy plays in helping you recover faster and more effectively. Whether you're dealing with the injury yourself or helping a loved one through the healing process, understanding the benefits of physiotherapy can be the key to a smoother, faster recovery.

Understanding the Injury: Dislocation and Subluxation
The shoulder joint is one of the most mobile joints in the body, making it susceptible to dislocations when subjected to excessive force. The shoulder is an unstable joint due to a shallow glenoid that only articulates with a small part of the humeral head. Most acute shoulder dislocations are anterior dislocations that occur when the humeral head (arm bone) is forced out of the glenoid cavity (shoulder blade), typically due to a traumatic event (e.g., a fall or a sports collision). Subluxation—a partial displacement—may occur with less force but still disrupts the normal anatomy of the joint. Recent studies emphasize that even a seemingly “minor” subluxation can damage the soft tissues of the shoulder such as the labrum and capsule, predisposing the shoulder to chronic instability (Anderson & Lee, 2019).

Symptoms
Patients commonly experience:

• Intense pain in the shoulder region

• Visible deformity (in complete dislocations)

• Limited range of motion and weakness

• A sensation of “slipping” or instability during movement

Acute Management
Immediately after the injury, healthcare providers focus on safely reducing the dislocation. Techniques vary, but recent high-level evidence supports the use of prompt closed reduction under appropriate sedation when needed (Williams et al., 2021). It is highly important that appropriate medical management is sought to help manage and reduce the dislocation due to the risk of nerves and bloody supply being compromised.

Following reduction, initial management includes:

• Short-term immobilization (typically with a sling) for pain control

• Use of ice and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and discomfort

• Importantly, however, emerging evidence suggests that prolonged immobilization may hinder recovery, highlighting the need for early controlled mobilization.

The Critical Role of Rehabilitation

Preventing Reinjury and Chronic Instability

Recent systematic reviews indicate that conservative, exercise-based rehabilitation markedly reduces the risk of recurrent shoulder instability. For instance, a meta-analysis published in 2022 showed that patients undergoing structured rehab had lower rates of recurrence compared to those managed with brief immobilization alone (Smith & Jones, 2022). This is particularly crucial for young athletes, who are at higher risk for subsequent dislocations.

Restoring Function and Enhancing Neuromuscular Control

Modern research supports a shift from prolonged immobilization toward early, controlled mobilization. Studies now demonstrate that initiating a tailored rehabilitation program soon after reduction not only improves range of motion but also strengthens the dynamic stabilizers of the shoulder—such as the rotator cuff and scapular muscles. A systematic review by Thompson and Parker (2020) found that rehabilitation protocols incorporating proprioceptive training and neuromuscular control exercises significantly enhance shoulder stability and function.

Facilitating a Safe Return to Activity

A progressive, evidence-based rehabilitation program is vital for a safe return to sports and everyday activities. High-level studies emphasize that functional and sport-specific exercises (e.g., plyometrics, agility drills, and simulated overhead movements) should be introduced gradually as pain decreases and strength improves (Williams et al., 2021). Such targeted rehabilitation not only accelerates recovery but also minimises the risk of long-term complications, such as chronic shoulder instability and degenerative changes.

Components of a Modern Rehabilitation Program

Based on the latest research, a comprehensive rehabilitation program for acute shoulder dislocation/subluxation typically includes:

1. Early Controlled Mobilization

• Goals: Limit stiffness while protecting healing tissues.

• Approach: Initiate gentle passive and active-assisted range-of-motion exercises within days after reduction, as soon as pain permits. Early mobilisation is linked with better long-term outcomes than prolonged immobilization (Anderson & Lee, 2019).

2. Strengthening Exercises

• Focus: Improve the strength of the rotator cuff, scapular stabilisers, and periscapular muscles.

• Techniques: Resistance band exercises, light weight training, and isometric contractions gradually progressing to isotonic strengthening. This step is essential to restore dynamic stability.

3. Proprioceptive and Neuromuscular Training

• Focus: Enhance the shoulder’s ability to sense joint position and react to perturbations.

• Techniques: Closed-chain exercises (e.g., wall push-ups), balance board activities, and dynamic stabilisation drills. Research shows these exercises reduce recurrence rates and improve functional outcomes (Thompson & Parker, 2020).

4. Functional and Sport-Specific Training

• Focus: Prepare the shoulder for the specific demands of the patient’s sport or daily activities.

• Techniques: Incorporate plyometrics, simulated sport movements, and gradual reintroduction to overhead activities. This phase is critical to bridge the gap between clinical recovery and return to full activity.

5. Patient Education

• Focus: Ensure patients understand proper techniques, the importance of compliance, and injury prevention strategies.

• Approach: Educate on gradual return-to-activity protocols and proper warm-up routines to reduce the risk of re-injury.

Conclusion

Recent high-level research underscores that the management of acute shoulder dislocation/subluxation extends well beyond immediate reduction and pain control. A structured, individualised rehabilitation program is critical for restoring shoulder function, enhancing neuromuscular control, and preventing future episodes of instability. By integrating early mobilisation, targeted strengthening, and proprioceptive training, patients not only recover faster but also reduce the long-term risk of recurrent dislocations and chronic shoulder instability.

If you have experienced a shoulder dislocation or subluxation, collaborating with a sports physiotherapist or orthopedic specialist to design a personalised rehabilitation program can significantly enhance your recovery and help you safely return to your active lifestyle.

References

Anderson, M., & Lee, H. (2019). Conservative management of primary shoulder dislocation in young athletes: A systematic review. American Journal of Sports Medicine, 47(4), 1021–1029. https://doi.org/10.1177/0363546518801773

Smith, A., & Jones, B. (2022). Rehabilitation strategies for acute anterior shoulder dislocation: A systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery, 31(5), 1000–1010. https://doi.org/10.1016/j.jse.2021.10.005

Thompson, R., & Parker, D. (2020). Optimizing recovery after acute shoulder subluxation: Evidence-based recommendations. British Journal of Sports Medicine, 54(7), 400–407. https://doi.org/10.1136/bjsports-2019-101209

Williams, C., Chen, L., & Patel, R. (2021). Early mobilization versus immobilization following shoulder dislocation: A systematic review. Sports Medicine, 51(6), 1201–1212. https://doi.org/10.1007/s40279-020-01350-8

Written by Patrick Bailey

Patrick is a physiotherapist at Back to Bounce Sports Physiotherapy as is committed to helping athletes of all ages and abilities get back to their sport and activity. Patrick prides himself on thorough assessment, diagnosis and comprehensive treatment plans to guide patients from injury back to performing at their best.