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HOW DO SHOULDER INJURIES OCCUR?
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Shoulder injuries occur after falling on an outstretched hand or the point of the shoulder, following a direct blow to the shoulder, or following overuse |
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These forces may cause there to be an over-stretching, tearing or a complete rupture of one or more of the ligaments or muscles. |
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WHAT SHOULD YOU DO IF A SHOULDER INJURY
OCCURS?
• Apply the RIC*D procedure...
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RIC*D
procedure
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You generally elevate the injured body part above the
level of the heart. The shoulder is above the level
of the heart already therefore 'elevation' has not been
included in the steps below.
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REST
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Rest
reduces further damage
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Avoid
as much movement as possible to limit further injury
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Don't
put any weight through the injured part of the body.
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ICE
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Ice
cools the tissue and reduces pain, swelling and bleeding
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Place
ice wrapped in a towel onto the injured area
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Apply
ice immediately for 20 minutes, then for 20 minutes
every two hours for the first 48 hours.
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COMPRESSION
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Compression
helps to reduce bleeding and swelling
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Hold
the ice pack firmly in place with a bandage
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Between
ice treatments maintain bandage compression.
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DIAGNOSIS
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If
the injury has not improved significantly within 48
hours, have the player assessed by a medical professional
(e.g. a doctor or physiotherapist)
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An
accurate diagnosis is essential for proper rehabilitation
of moderate to severe injuries.
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ALWAYS
seek the advice of a medical professional for an accurate
diagnosis.
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WHAT REHABILITATION SHOULD FOLLOW A
SHOULDER INJURY?
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The
following recommendations serve as a guideline only.
Always seek the advice of a medical professional for
a rehabilitation program specific to you and your injury.
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Range of motion
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Restoring
normal range of motion will allow proper function of the shoulder. |
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Shoulder movement can be improved initially using pendulum exercises (i.e. by letting your arm gently swing forwards and backwards while bending forward) |
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Passive
(assisted movement) and active (self-movement) exercises should
be introduced as improvements allow |
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A
quick and easy way to evaluate shoulder range of motion is the
Apley scratch test (stand in front of mirror):
• Reach behind your back
and touch as high up your spine as possible and then return
to normal
• Reach up behind your
head and touch as far down your back as possible
• Perform each of the
two movements with both arms
• Compare between arms.
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Cardiovascular
fitness
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Keeping fit will ensure a more comfortable return to training and competition |
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As most sports involve some running, activities such as power walking, running and stationary cycling are excellent methods of maintaining fitness |
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In sports that require upper body conditioning (e.g. swimming) more specific training should be introduced to the upper limb as comfort permits. |
Strength
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Strength
in the shoulder and shoulder blade muscles must be restored
to ensure that the joint is stable during activity |
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Strength
can first be improved by performing isometric contractions (holding
a fixed position for 10 to 20 seconds) against resistance |
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As
strength and range of motion improve, light weights or flexibands
can be used for added resistance through a greater range of
motion. |
Proprioception
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Proprioception
is the awareness of one's body position and is important
in balance and coordination |
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Injury
to the shoulder joint causes a reduction in proprioceptive ability
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Proprioception
training will help to re-educate the shoulder muscles, improve
joint stability, and protect against future injury |
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Push-ups
and chest passing a ball against a wall will improve strength
and coordination. |
Psychological
status
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Reduced
confidence following a shoulder injury may prevent an athlete
from attempting stressful movements (e.g. passing, tackling
and falling on the ground) |
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Gradually
attempting more difficult agility tasks and setting realistic
goals and time frames may help to rebuild sporting confidence |
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Return
to competition is not advised until an individual has 100% confidence
in their playing ability. |
Sport-specific
rehabilitation
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When general
function has been restored, rehabilitation should focus on preparing
the shoulder for sport-specific activity (e.g. throwing, hitting
and passing actions) |
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Sport-specific rehabilitation should be determined by the sporting
code, the level of sport and the position |
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Heavy
contact sports (e.g. rugby union and rugby league) involve large
impact forces from tackles, scrums and falls. Return to competitive
sport is possible when these stresses and other sport-related
movements no longer cause discomfort, pain and/or swelling. |
Ensure you are completely rehabilitated before returning to competition to
minimize the risk of re-injury.
REHABILITATION GUIDELINES FOR A GRADE
1 SHOULDER INJURY (SPRAIN / STRAIN / BRUISE)
| NOTE: This is an approximate guide only. Timeframes for rehabilitation and return to play may vary depending on the nature and severity of the injury. Always seek the advice
of a medical professional for a rehabilitation program
specific to you and your injury. |
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CAN YOU
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Move shoulder through full range of motion without pain? |
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YES
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| CONTINUE
TO IMPROVE RANGE OF MOTION AND STRENGTH |
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| PROGRESSION |
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Scapular
stabilising exercises |
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Rotator
cuff exercises |
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Full
range of motion |
| PROPRIOCEPTION
EXERCISES |
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Coordination
exercises |
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MAINTAIN
FITNESS
Stationary cycling, running, lower body exercises |
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CAN YOU
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Match
the strength, range of motion and proprioception
of the non-injured shoulder? |
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Perform press-ups without pain? |
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YES
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| CONTINUE
TO IMPROVE AGILITY AND SPORT-SPECIFIC DRILLS |
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| BEGIN FUNCTIONAL EXERCISES |
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Throwing
exercises |
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Swimming
stroke exercises |
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MAINTAIN
FITNESS
Stationary cycling, running, lower body exercises |
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CAN YOU
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Pass,
throw, catch a ball without pain? |
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Perform
functional tests adequately? |
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Complete all exercises with 100% confidence? |
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YES
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| CONTINUE
TO IMPROVE AGILITY AND SPORT-SPECIFIC DRILLS |
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MAINTAIN
Fitness, Range of motion, strength, proprioception |
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HOW CAN YOU REDUCE THE RISK OF
RE-INJURY?
ALWAYS
seek the advice of a medical professional before returning
to sport. Inadequate rehabilitation and a premature return
to sport will increase the risk of re-injury.
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Continue
stretching, proprioception and strengthening exercises
as part of a normal training routine |
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Correct
tackling and falling techniques should be practised at
all times |
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Avoid
breaking a fall with an outstretched arm (learn to roll
safely) |
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Proper
warm-ups should always be performed before any explosive
movements or impacts |
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Bracing
and taping may be applied for added support. Ensure that
the brace fits correctly, it complies with the rules of
the game and it is suitable for you and the sport
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If shoulder pain persists, consult a medical professional for advice on other possible contributing factors. |
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