Shoulder instability is a common injury that occurs during contact and non-contact activities. It is the result of increased laxity (looseness) of the joint capsule and weakness in the shoulder area, specifically the rotator cuff muscles. With a weak rotator cuff, there is an increased risk of developing this “laxity” from overuse. Instability can also develop from a traumatic injury, such as a dislocation. Physical therapy can help to strengthen the rotator cuff muscles and those around the shoulder blade to get you back to doing what you want and help prevent reinjury.
Laxity in the capsule creates looseness in the integrity of the joint. Instability is created when the arm is placed in certain positions and gives the individual a sense that the shoulder is “slipping” out of the socket. Swimmers and pitchers are at high risk due to the repetitive overhead movement of the arm creating the most common reason for shoulder instability; overuse.
Of course the symptoms, location and intensity will all vary. Below are some common symptoms to watch out for if you experience shoulder pain:
- Pain with pushing, pulling, or carrying heavy objects
- Pain when performing an overhead activity
- Pain during or after exercise
- A feeling that the shoulder is “shifting” (including in bed at night)
- Fear of putting the shoulder in certain positions
- Numbness and tingling sensations in the affected arm
- Clicking and popping sensations with movement
- Weakness when performing athletic movements, especially overhead and away from the body
- Loss of performance ability in sport activities
- Fatigue with repetitive activity*
A mobility assessment of the shoulder joint in various positions will help a Physical Therapist determine if it’s shoulder laxity leading to instability or another type of injury. They will also include strength tests of the rotator cuff and scapula (shoulder blade). These checks, along with a thorough patient history will aid the PT in making a determination. X-rays or an MRI may be ordered by a physician for a more detailed diagnosis.
Once your Physical Therapist evaluates the extent of muscular imbalances and areas of weakness, they may recommend that you modify or stop movements that exasperate the injury. Alleviating the inflammation and pain should be the first step in treatment. Your PT or physician may also suggest a sling to help with the pain and show you the appropriate way to apply heat and ice to lessen any discomfort.
The program your PT creates will include exercises to build the shoulder’s stability and strength, with a gradual increase to more dynamic and challenging movements specifically geared toward your goals and activity. Manual therapy techniques may be used in conjunction with physical strength training to optimize the results. After your range of motion and strength are restored you will be able to progressively participate in your sport or activity on an interval basis.
How can you prevent shoulder instability? Preventing instability of the shoulder falls into 3 categories:
- Strengthening and stretching the scapular muscles and the muscles of the rotator cuff. Athletes may perform scapular and rotator cuff strengthening exercises 3-4 times per week.
- Some overhead athletes need to stretch the posterior capsule with instability.
- Monitoring the volume of activity performed. This practice is just as important as strengthening exercises. Baseball players will often use pitch counts to avoid overuse injuries, while swimmers attempt to maintain weekly yardage totals.
- Maintaining proper form and technique. Good coaching on proper form and technique by a qualified coaching professional can be a valuable asset in preventing injuries in the young athlete population.*
If you feel you may be suffering from instability of the shoulder, please contact the Excel or Apex Physical Therapy clinic nearest you to schedule a consultation.
*Move Forward – PT’s Guide to Multidirectional Instability