Understanding Shoulder Instability (and How Physiotherapy Can Help You)

Do you ever feel like your shoulder could give way or slip out during everyday movements, like reaching for something on a high shelf?

Shoulder instability is a common issue that can affect just about anyone (not just athletes). It can lead to pain, weakness, or a fear of movement (especially in overhead positions), which can limit both daily activities and sporting performance.

Let’s take a closer look at what’s really going on inside your shoulder and how physiotherapy can help you regain stability and confidence.

‍A Quick Look at the Shoulder's Anatomy

The shoulder (glenohumeral joint) is a ball and socket joint and the most mobile joint in the body. It is supported by four rotator cuff muscles:

1. Supraspinatus
2. Infraspinatus
3. Teres minor
4. Subscapularis

Together, they act as a vice-like grip on the head of the humerus, keeping it centered in the socket during movement.

‍However, increased mobility comes at the cost of stability.

Think of your shoulder like a golf ball sitting on a tee. Just like the ball relies on the tee to stay in place, your shoulder relies on a combination of ligaments, the joint capsule, and the rotator cuff muscles to stay stable. If any of these supporting structures become overstretched, weakened, or injured, the shoulder can start to feel loose or unstable...

What is Shoulder Instability then?

Shoulder instability happens when the head of the humerus doesn’t stay securely in the shallow socket of your shoulder blade (the glenoid fossa), causing the upper arm bone to move around more than it should, a movement referred to as ‘translation’.

This can occur due to a traumatic injury, repetitive strain/overuse, or general joint laxity/hypermobility. Let's break these down:

‍1. Traumatic instability 

• Usually caused by an injury, sudden impact (dislocation), or fall.
• Very common in contact sports (ie. football) ‍

2. Atraumatic instability 

• Develops gradually over time through repetitive strain or muscle imbalance
• Common in sports that require throwing (ie. baseball, cricket or tennis)

3. Multidirectional instability 

• The shoulder moves excessively in more than one direction:
  
  • Anterior (front)
  • Inferior (downward)
  • Posterior (back)
• This is more common in individuals with naturally flexible joints or connective-tissue laxity (this may be genetic)

 Common Symptoms of Shoulder Instability

• Recurrent shoulder dislocations or subluxations
• Pain during overhead activities
• Weakness or fatigue in the shoulder
• Clicking or slipping sensations
• Apprehension or fear that the shoulder will “give way” or “slip”

In some cases, instability may not feel like the shoulder is slipping out at all, it may present as generalised shoulder pain or exertional pain, particularly with overhead and movements.

How Can Physiotherapy Help You?

Physiotherapy and conservative management are typically the first line of treatment for shoulder instability. With the right injury-rehabilitiion program and guidance, most people can return to full, pain-free shoulder movement without surgery. A physiotherapist will assess your shoulder mechanics, muscle control, strength and posture to identify the underlying cause of your instability. 

All rehabilitation plans are tailored specifically to each individual’s needs, goals, and clinical presentation. Individual treatment often focuses on:

• Strengthening the rotator cuff and shoulder blade stabilisers 

• Improving neuromuscular control 

• Correcting postural habits and movement patterns

• Gradually reintroducing sport-specific rehabilitation exercises or work-related activities and tasks 

Do I Need Surgery?

Surgery is ONLY considered for specific individuals, particularly younger overhead or contact athletes with excessive joint laxity, recurrent dislocations, or instability that doesn’t improve with conservative management. Your orthopaedic shoulder specialist will assess your individual case and advise on the most appropriate surgical option if required. Common surgical options include:

1. Arthroscopic Bankart repair:

• The most common procedure for anterior instability. It involves re-attaching and tightening the torn labrum and capsule to restore the shoulder’s stability. The labrum is a ring of cartilage that helps to deepen the shallow socket (golf ball on a tee), which increases it overall stability. 
• Arthroscope refers to small instruments and a camera that is inserted into the shoulder (keyhole).

2. Capsular plication (capsular shift):

• Tightens a stretched shoulder capsule, helping the joint fit more securely in the socket.
• Often used for posterior or multidirectional instability.

3. Latarjet procedre:

• ‍‍Used when there is significant bone loss from repeated dislocations.
• This involves transferring a small piece of bone, to the front of the socket (glenoid) to provide a bony block, providing additional stability.

4. Remplissage procedure: 

• Sometimes performed alongside a Bankart repair to fill in a bony defect on the humeral head (called a Hill-Sachs lesion), which can occur following traumatic dislocation events.

Physiotherapy plays an essential role both before (“prehab”) and after surgery, helping to build strength, restore range of motion and control pre-operatively, while facilitating progressive rehabilitation post-operatively to help patients return to sport and everyday life. 

When to See a Physiotherapist

If your shoulder frequently “pops out,” feels unstable, or you’ve had multiple dislocations, it’s important to get it properly assessed. Early management helps prevent further injury and improve your performance in sport and everyday activities.

We understand how shoulder instability can be frustrating, but it doesn’t have to hold you back on doing the things you love.

Physiotherapy is highly effective in improving strength, control, and confidence in your shoulder. If your shoulder feels unstable or you’re unsure how to manage it, book in today for an assessment with a Physiotherapist to get you back on track.