Shoulder dislocations and instability are common in rugby codes, with the glenohumeral joint put into vulnerable positions during collisions, tackles, rucks (rugby union) and falling (1). With such high recurrence rates and the number of days absent because of an instability episode, many athletes often select to undergo shoulder stabilisation surgery in the offseason to help prevent ongoing issues (2). With a return to play time of 4-7 months (depending on individual recovery, resources etc.), this often fits well in the off-season, with athletes only missing a few games of the following season.
To ensure a seamless and successful return to play, it is crucial the post-operative rehabilitation and management prepares athletes for the demands of their sport on their return, leaving nothing to guesswork. In this article I will outline our approach during the Protection Phase of post-operative shoulder rehabilitation.
LATARJET OPEN STABILISATION
Latarjet open stabilisation of the shoulder is a common approach now used by surgeons to prevent ongoing instability issues in those athletes with anteroinferior bone loss or a high chance of recurrence. For an animated video of what is performed during the procedure, watch this video.
This procedure stabilises the shoulder in 4 ways:
The tip of the coracoid process is removed and attached to the front of the glenoid (shoulder socket), providing a bony bumper for the humerus, helping prevent ongoing instability episodes.
With the conjoint tendon still attached to the tip of the coracoid, it acts as a sling over the front of the shoulder when the shoulder is abducted and externally rotated (common mechanism of injury).
The coracoacromial ligament helps to stabilise the inferior capsule.
The surgeon will also tighten the capsule and repair the labrum as required.
Although recurrence rates are very low (7% in rugby union for example), it’s important to understand that this surgery may see the end of a player’s career, with increasing rates of retirement as the level of play drops post-surgery (3). It is our job as rehab professionals to ensure our athletes have the option to return, confident that their shoulders can withstand the demands of their sport.
AIMS OF THIS STAGE OF SHOULDER REHABILITATION
The goals of the protection phase of post-operative shoulder rehab are as follows:
Control swelling
Reduce pain
Protect the surgical repair (SLING!
Although a sling may be required to be worn for up to 4-6 weeks, usually around week 3 you can start very low level rehab exercises as guided by your physiotherapist.
SHOULDER PHYSIOTHERAPY DURING THIS STAGE
WEAR YOUR SLING!
From the time immediately post surgery and over the next two weeks especially, the focus needs to be around protecting the shoulder and decreasing pain and swelling. Your surgeon would’ve likely provided a brace for the first 3-6 weeks to assist the healing of the surgical repair.
Throughout the first 8-12 weeks your physio will slowly progress your rehab into greater ranges of motion, ensuring the stabilisation surgery is as successful as possible.
It's important you stick to the sling protocol!
You have just had stabilisation surgery because you had a loose shoulder. This sling protocol helps ensure the repaired structures remain tight and where they should be. Over the 6ish months of rehabilitation, there will be plenty of time to "catch up" and get back to full function. This time is however crucial to ensure the static stabilisers of the shoulder recover well and provide an increased level of stability to the shoulder.
SHOULDER PHYSIOTHERAPY
Your physio will provide you with elbow, wrist and hand exercises to maintain full range of motion during your strict immobilisation period. When cleared to do so (usually around week 3), athletes may progress into the Primary Loading Phase of their shoulder rehabilitation, adding passive mobility exercises and low-level cuff isometrics to their program, whilst still protecting the surgical repair.
During the first 2-3 weeks of your rehab, your physiotherapist can also assist in reducing your swelling and symptoms, around the shoulder, neck and ribcage. Wearing a sling and a relatively sedentary few weeks can really hit the body hard so these sessions are crucial to help ensure your body is recovering well post surgery.
POST-OP SHOULDER REHAB PROTOCOL
For insight into how we guide our athletes through not only the protection phase of shoulder rehabilitation, but all the way back to a return to sport, download a FREE COPY of our shoulder rehab protocol here. This protocol forms the basis of all our rehab programs, ensuring that athletes earn the right to progress and leave nothing to guesswork.
References;
Montgomery, C., Briain, D.O., Mullett, H. & Moran, C. 2018. A systematic video analysis of the mechanisms of shoulder dislocations in professional Rugby union. Journal of Science and Medicine in Sport, 21(1), S50.
Headey, J., Brooks, J.H. & Kemp, S.P.T. 2007. The epidemiology of shoulder injuries in English professional rugby union. The American Journal of Sports Medicine, 35(9), 1537-1543.
Mouchantaf, M., Bastard, C., Corsia, S., Metais, P. & Nourissat, G. 2024. High rates of return to play and low recurrence rate after arthroscopic Latarjet procedure for anterior shoulder instability in rugby players. Arthroscopy, Sports Medicine, and Rehabilitation, 6(2), 100912.
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