Some of the key shoulder injuries include acromioclavicular joint (ACJ) sprain, shoulder dislocation, clavicle (collarbone) fractures, subluxation and rotator cuff tears.
ACJ sprains, clavicle fractures and dislocations typically result from direct impact, such as a fall or contact with another player.
Shoulder dislocations are common in rugby because the shoulder is put into vulnerable positions and can encounter substantial stress. When reaching for a tackle, the arm goes into abduction and external rotation, and the force going through can result in the head of the humerus (upper arm bone) detaching from the glenoid.
The shoulder is the most mobile joint in the body. This is why it requires a lot of soft tissue to help promote stability. When it dislocates, the soft tissue around the shoulder is usually damaged and this is what takes the time to heal and recover. Due to the large range of movement at the shoulder strength work is very important before any form of contact training is attempted.
Returning to Play
You want to be sure when you return to sport you’re ready and minimising any risk of re-injury.
Rehab following shoulder injuries can be intense. Particularly following shoulder dislocations and you must follow advice to achieve the best possibility of success. With the right management you can get excellent results with shoulders.
Important Aspects of Rehab
Important aspects of rehab include strengthening your rotator cuff and scapular stabilisers, improving your proprioception and increasing your functional stability. The return to play process that will deem your readiness to go back to contact sport.
Have a watch of this video!
The first step is functional testing.. For example, press ups from the wall progressing through to full body weight press ups. With any shoulder injuries we need to establish your baseline function and build up from there.
Graded Return To Play
Graded return to play relates to the process of return to lay. The KEY word being GRADED.
You start with little challenges and build up slowly. We have to establish where there are proprioceptive deficits, train them and then ask for something more challenging from the shoulder.
Following small movements which challenge the joint slightly you may move onto practicing falling. In contact sports, there is commonly a lot of contact with the ground, so making sure you are safe and strong enough to take this stress is paramount. This would usually start by falling from the knees. Then progressing to falling onto an outstretched arm. Physio’s will also help guide you on repetitions and building this up in a safe way.
You want to avoid your first experience of load being uncontrolled. ie falling from height with load. Thats why a graded return to play under the supervision of an expert who can assess safety of joint position, biomechanics is so important. They can correct you immediately if the joint position is wrong.
Finally, you would move on to practicing sport specific skills eg. tackling, rucking, ball carrying. Initially this would be using a soft pad, moving up to person on person contact.
Each individual injury case is always different, so there is never an exact amount of time an injury will take to recover. The speed of return to play is down to the healing of the injury, but a it is also hugely dependant on the rehab followed by the player. The harder you work with your rehab, the better you will be when returning to play.
The Physio Crew Team
Written by Abbie Parsons and edited by Nicole Jones, January 2018