Shoulder instability is a common condition, particularly among young, active individuals. Shields et al., 2018 reported that the annual incidence of shoulder dislocation in the general population was approximately 23.9 per 100,000 person-years, with nearly half of these dislocations occurring during sporting activities and in patients between the ages of 15 to 29 years.
What Is Shoulder Instability?
The shoulder is a ball and socket joint, made up of the upper arm bone (humerus) and a shallow socket in the shoulder blade (glenoid). This socket is surrounded by cartilage (labrum), ligaments, and a joint capsule that all help to hold the joint together. The shoulder relies heavily on muscles, especially the rotator cuff, for dynamic stability. Because it is designed to move in many directions, it’s naturally less stable than other joints in the body.
Shoulder instability occurs when these stabilising structures become stretched, weakened, or damaged, allowing the shoulder to feel loose, unstable or even “pop out.” This can happen following a traumatic injury, constant and repeated overhead activities (such as throwing or swimming), or simply due to ligamentous laxity (ligaments that stretch that little bit more).
Instability can present as a full dislocation (when the ball comes completely out of the socket), a subluxation (a partial shift that usually self-corrects), or ongoing feelings of the shoulder “slipping” or being unreliable.
What Causes It?
There are several types and causes of shoulder instability. One common classification includes:
- TUBS – Traumatic Unidirectional instability with a Bankart lesion, often from a specific injury like a fall or sports tackle
- AIOS – Acquired Instability from Overuse Syndrome, often due to repeated overhead movements (e.g., swimmers, throwers, gymnasts).
- AMBRI – Atraumatic Multidirectional instability, often related to joint hypermobility or lax ligaments (Hill, 2024)
The most common is anterior instability, where the shoulder slips forward out of the joint. This is commonly occurs both in contact sports or activities with repetitive overhead movement (Provencher et al., 2020).
How Does It Feel?
Patients often describe pain when using the shoulder, particularly when lifting overhead or during sports. Many also experience a sensation of weakness or the shoulder “giving way.” Clicking, catching, or recurrent episodes of dislocation can also occur. In some cases, people avoid using their arm out of fear that the shoulder might dislocate again (Ladd et al., 2021).
Risk Factors
A 2024 systematic review (Wright et al.) highlighted key risk factors for first-time and recurrent shoulder instability, including:
- Age under 30 (especially in males)
- Participation in contact or overhead sports (e.g. AFL, rugby, swimming, tennis)
- Joint hypermobility
- A previous shoulder dislocation or subluxation
Understanding these factors is key in both prevention and management.
Assessment and Diagnosis
At Total Body Physio, our physiotherapists start with a thorough assessment,
including:
- A detailed patient injury history, understanding symptoms, and functional limitations
- Physical tests to evaluate joint mobility, shoulder strength, and stability
- Scapular and postural assessment to identify any contributing issues
- In most instances, we will refer for an X-ray immediately after dislocation to confirm joint alignment and rule out bone injuries such as a Bankart lesion (damage to the labrum and glenoid) or Hill-Sachs lesion (compression injury to the humeral head).This may be followed by an MRI referral to assess for labral tears, capsular and ligament damage, and rotator cuff pathology (Broida et al., 2021). It can also help determine whether conservative rehab or surgical repair is warranted.
Early assessment allows us to identify the root cause and tailor a treatment plan specific to the patient’s needs—whether they want to return to sport, work or simply look after their kids.
How Physiotherapy Helps
Physiotherapy is usually the first line of treatment for shoulder instability. Our approach is based on up-to-date research and adapted to the patient’s lifestyle and goals.
Initial management can vary depending on whether it is an acute traumatic dislocation, an acquired instability due to overuse or atraumatic multidirectional instability.
Through the course of rehabilitation there will be a focus on:
- Ensuring full movement, addressing compensations and muscular tightness using manual therapy techniques, massage, and stretching.
- Strengthening the rotator cuff and scapular muscles to create dynamic shoulder stability
- Improving movement control through proprioceptive exercises and coordination drills
- Correcting posture and biomechanics, often targeting the thoracic spine, core and hips with the kinetic chain in mind
- Gradual return to activity or sport with progression guided by clinical testing and strength data using our AxIT strength testing system (DeFroda et al., 2021)
Recent studies show that structured rehab programs lasting 3 to 12 months can significantly reduce pain, improve function, and prevent recurrence (Kłaptocz et al., 2021; Jeanfavre et al., 2018).
When Is Surgery Required?
While many people recover well with physiotherapy alone, surgery may be required for:
- Patients with recurrent instability
- Those involved in high-risk sports
- People with associated damage to the labrum or bone
A 2022 systematic review conducted by Alkhatib et al., found that surgical stabilisation reduced recurrence rates to 7%, compared to 47% with non-operative treatment. However, surgery is not always the best option. Non-surgical management is often more successful in older patients, those with milder instability, or people who can modify their activities (Rehabil et al., 2017).
Exercise
Functional External Rotation:
Strengthens the rotator cuff to keep the shoulder centred in the joint.
How? Stand adjacent to a wall with your elbows crossed over. Hold a light weight in the upper hand with elbow bent to 90°, then slowly rotate your arm upward pivoting at your elbow—this strengthens the rotator cuff to help keep the shoulder centred in its socket.
TheraBand Pull a parts
Improves postural support and shoulder blade stability.
How? Hold a resistance band with arms outstretched and pull it apart, squeezing your shoulder blades together—this improves posture and scapular stability.
Lateral Hop:
Builds strength and control around the shoulder blade.
How? Stand facing a wall, perform a wall push-up, then at the top, push your shoulder blades forward (protracting) to activate the serratus anterior.
Final Thoughts
Shoulder instability can be a frustrating and limiting condition, but it is very treatable. Whether it is an acute dislocation or someone has been dealing with repeated instability for years, physiotherapy offers a clear, research-backed pathway to recovery.
If you, a family member or a patient is experiencing shoulder pain, clicking, or a sense of instability, don’t ignore it—early intervention makes a huge difference. At Total Body Physio, we work with GPs, surgeons, and patients to provide comprehensive, personalised care.
If you or someone you care for has an injury, a flare up, requires some rehabilitation or experiences an increase in pain, give the clinic a call on 9713 2455 or book online.