Shoulder dislocation: rehab, recurrence and return to sport
A shoulder dislocation is painful and frightening, and the question straight afterwards is always whether it will happen again. The answer depends heavily on your age and sport, and good rehabilitation matters either way.
What is a shoulder dislocation?
The ball at the top of the arm bone comes fully out of the socket, almost always forwards. It usually happens when the arm is forced back while raised and turned out, such as in a tackle, a fall onto an outstretched arm, or an arm being wrenched in grappling. A subluxation is a partial dislocation that slips back in by itself.
What should I do if my shoulder dislocates?
Go to an emergency department. Don't let a teammate or coach try to put it back in, as nerves, blood vessels and bone can be damaged. The joint should be relocated by a doctor, with X-rays to check for fractures. Tell staff about any numbness in the arm or over the outside of the shoulder.
What gets damaged?
The ball tears the labrum (the cartilage rim) and the ligaments at the front of the socket as it comes out. There may also be a dent in the back of the ball or a small fracture of the socket rim. In people over 40, the rotator cuff tendons are more likely to tear.
Will my shoulder dislocate again?
It depends largely on age. In a study that followed 229 shoulders for 25 years after a first dislocation treated without surgery, 43% never dislocated again and a further 7% dislocated only once more. Recurrence was more common in younger people: 38% of those aged 12 to 25 at the time of injury eventually had stabilisation surgery, compared with 18% of those aged 26 to 40 (Hovelius et al., Journal of Bone and Joint Surgery, 2008).
Do I need surgery after a first dislocation?
Not always. A network meta-analysis found moderate-quality evidence that about half of people managed with physiotherapy after a first traumatic dislocation didn't dislocate again, and that surgical labral repair reduced the risk of further dislocation (Kavaja et al., British Journal of Sports Medicine, 2018). Surgery is more often recommended early for young athletes in contact or overhead sports, and for anyone with repeated dislocations or significant bone damage. It's a decision to make with a shoulder surgeon.
How long do I need a sling?
Usually one to three weeks for comfort, as advised by your doctor. The long-term study found that immobilisation after the first dislocation didn't change the prognosis, so prolonged immobilisation isn't generally needed.
What does rehab involve?
Early on, gentle movement within safe limits, avoiding the position of arm raised and turned out. Then progressive strengthening of the rotator cuff and shoulder blade muscles, building control through range. Later stages include overhead strength, weight-bearing through the arm, plyometric and sport-specific drills, and finally contact or grappling.
When can I return to sport?
Typically three to four months after a first dislocation managed without surgery, sometimes sooner for non-contact sport, and around four to six months after stabilisation surgery. Return should be based on full range, strength close to the other side, and confidence in the positions your sport demands.
Can I return to BJJ or contact sport?
Many people do. Grapplers need particular care with kimuras, americanas and posting on the arm, and should rebuild through drilling and positional work before live rolling. If the shoulder keeps slipping, see a surgeon before returning.
See our post on BJJ shoulder injuries.
Can I lift weights after a dislocation?
Yes, as part of rehab. Start with rows, pulldowns to the front, and pressing in a limited range. Be cautious for longer with wide-grip bench, dips, behind-the-neck presses and deep overhead positions, which put the shoulder in its vulnerable position.
What if my shoulder feels loose or keeps slipping?
Repeated subluxations or a feeling that the shoulder is about to come out in certain positions suggests ongoing instability. Each episode can cause more damage, so it's worth a specialist review.
Does a brace or taping prevent another dislocation?
Braces that limit how far the arm can go back and out are sometimes used when returning to contact sport, and some athletes find them reassuring. They restrict movement and aren't suitable for every sport or position. Strength and control remain the main protection.
How can an osteopath help?
After the shoulder has been relocated and medically assessed, we guide rehabilitation, treat the surrounding neck and upper back, and plan a staged return to your sport. We'll refer you to a sports physician or surgeon where instability or a tear is suspected.
When is it urgent?
Go to an emergency department for any shoulder that looks deformed or can't be moved after an injury, or for numbness, tingling, coldness or weakness in the arm or hand.
See our posts on SLAP and labral tears and our shoulder pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
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Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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