Meet Campbell Antonio: Bringing an Elite Sport Approach to Physiotherapy
Meet Campbell Antonio, PEAK Senior Coach and Physiotherapist, and learn how his elite-sport experience shapes his approach to rehabilitation and performance.
Read More
Blog
Shoulder Dislocation Rehabilitation
Why Not Just Getting Stronger Matters After a Dislocation
Shoulder dislocation rehabilitation is about more than getting stronger. Learn how progressive physiotherapy can rebuild movement, control, confidence and the capacity to return to sport.
Share this Article:
A shoulder dislocation can be a confronting injury. One moment you are playing sport, reaching for a ball, tackling, falling or trying to stop yourself from hitting the ground. Next, your shoulder is out of position and you are suddenly wondering when or how you will be able to trust it again.
For an athlete, getting the shoulder back into place is only the beginning. The bigger challenge is rebuilding enough strength, movement, control and confidence to return to the demands of your sport. That is where shoulder dislocation rehabilitation becomes so important.
As a physiotherapist with a particular interest in shoulder instability and sports rehabilitation, I enjoy working with athletes through this process. My experience working across rugby, volleyball, football and other sporting environments has reinforced how important it is to look beyond whether the shoulder simply feels better and instead ask whether it is ready for what the athlete needs to do.
Why Is Rehabilitation Important After a Shoulder Dislocation?
The shoulder is designed to provide a huge amount of movement, but that mobility also means it relies heavily on the surrounding muscles, ligaments and other structures to maintain stability.
Following a dislocation, these structures can be affected. Depending on the injury, there may also be damage to the labrum, bone or other stabilising structures around the shoulder.
This is one reason why a shoulder dislocation should not simply be viewed as an isolated event that is “fixed” once the joint has been reduced.
The rehabilitation process needs to restore the qualities that allow the shoulder to function under load.
That includes restoring movement, rebuilding strength, improving neuromuscular control and progressively exposing the shoulder to the positions and forces it will experience during sport.
There is also the psychological side.
It is common for athletes to feel apprehension after a dislocation, particularly when the shoulder approaches the position in which the original injury occurred. An athlete may have regained good strength but still hesitate when reaching overhead, tackling, blocking, falling or placing the arm into a vulnerable position.
Current international consensus recommendations for anterior shoulder instability recognise strength, range of motion, proprioception, pain and apprehension, as well as psychological factors, as important considerations when returning athletes to sport.
“Rehabilitation is not simply about making the shoulder stronger.
It is about making the athlete confident and capable enough to use that strength when it matters.”
Surgery or Non-Surgical Management?
One of the first questions many athletes ask after a shoulder dislocation is: “Do I need surgery?”
There is no universal answer.
The decision between surgical and non-surgical management depends on a number of factors, including the athlete’s age, sporting demands, number of previous instability episodes, the nature of the injury, bone loss, associated structural damage and individual goals. These factors are recognised in international consensus recommendations for anterior shoulder instability.
For some athletes, particularly those with recurrent instability or specific structural injuries and high demands for their shoulder, surgery may be recommended.
For others, a structured rehabilitation program may be an appropriate first approach.
The important point is that surgery and physiotherapy are not competing treatments.
Even when surgery is required, rehabilitation remains a major part of the recovery process.
A surgical procedure can repair or stabilise damaged structures, but the athlete still needs to rebuild strength, movement, coordination, confidence and sporting capacity afterwards.
Likewise, when an athlete is managed without surgery, rehabilitation needs to be purposeful and progressive rather than simply waiting for symptoms to settle.
Recent evidence-based guidance from the British Elbow and Shoulder Society describes rehabilitation following traumatic anterior shoulder dislocation as central to both operative and non-operative management, progressing from early protection through movement and strengthening and ultimately towards return to sport and higher-level function.
How Can Physiotherapy Help?
Physiotherapy can play an important role throughout the entire shoulder instability journey.
Early on, the focus may be on managing pain, restoring appropriate movement and gradually reintroducing muscle activation.
As the shoulder becomes more tolerant, rehabilitation progresses towards strengthening the muscles that contribute to shoulder stability and function.
This may include the rotator cuff, scapular musculature and larger muscles of the shoulder and upper body, alongside progressively more challenging weight-bearing and functional exercises.
But good rehabilitation should not stop there.
An athlete eventually needs to do much more than perform controlled exercises in a physiotherapy clinic.
They need to lift. Push. Pull. Reach. Land. Brace. Accelerate. Decelerate. And, depending on their sport, potentially absorb contact or compete against an opponent.
That is why the later stages of rehabilitation become increasingly performance-focused.
What Does Good Performance Rehabilitation Look Like?
The goal of performance rehabilitation is to bridge the gap between “my shoulder is healed” and “my shoulder is ready for my sport.”
That gap can be significant.
- A volleyball player needs to repeatedly serve, spike and block overhead.
- A rugby player needs to tackle, fend, brace and potentially fall onto the shoulder.
- An AFL player needs to compete for the ball, tackle, land and use their arms in unpredictable positions.
- A gym-goer may need to press, pull and lift heavy loads.
Each person therefore needs a rehabilitation program that reflects their actual demands.
This is where I think sports physiotherapy can provide something different from simply treating symptoms.
As rehabilitation progresses, I want to understand whether the athlete is actually developing the physical qualities required for their sport.
That might involve assessing strength, endurance, range of motion, power and upper-limb control. It can also involve progressively more demanding exercises and sport-specific drills.
Objective testing can be particularly useful here – especially with the use of PEAK’s AxIT software.
Rather than simply asking whether the athlete “feels ready”, testing can provide another piece of information about whether strength and performance have recovered sufficiently to progress.
Research and consensus recommendations increasingly support criteria-based rather than purely time-based approaches to return to sport following shoulder instability.
“The exact tests will depend on the athlete and sport, but the principle is simple:
Don’t just ask whether the shoulder has healed. Ask whether the athlete has rebuilt the capacity required to perform.“
Returning to Sport Is More Than a Date
It can be tempting to ask: “How many weeks until I can play again?”
But return to sport should not be based on time alone. The appropriate timeframe will depend on whether the athlete has undergone surgery, the specific procedure performed, their injury, their sport and how they are progressing through rehabilitation.
- For athletes returning following shoulder stabilisation surgery, current rehabilitation guidance recommends progression based on functional and physical milestones, confidence and symptoms rather than simply reaching a particular date.
- The same principle applies to non-operative rehabilitation. Before returning to unrestricted sport, we want to know that the athlete can tolerate the movements, forces and volume required of them.
- For a contact athlete, that may mean progressively introducing contact exposure. For an overhead athlete, it may mean building repeated high-speed shoulder movements. For a strength athlete, it may mean progressively returning to heavier pressing and pulling.
The final stages should look increasingly like the sport itself.
Why Shoulder Instability Has Become a Particular Interest of Mine
Shoulder instability is an area I have become increasingly interested in throughout my clinical and sporting experience.
Working with athletes has shown me how different the problem can look depending on the person sitting in front of you.
A first-time dislocation in a young collision-sport athlete presents a very different challenge to recurrent instability in an overhead athlete or someone returning after surgical stabilisation.
The combination of injury management, rehabilitation, strength and conditioning, objective testing and return-to-sport decision-making is what makes shoulder instability particularly interesting to me.
It is also an area I am keen to continue developing clinically and academically.
As I progress through my postgraduate training, shoulder instability and sports rehabilitation are areas I am particularly passionate about, and I am interested in continuing this work through research in the future, including the possibility of pursuing a thesis in this area from 2027.
For me, that is part of what makes sports physiotherapy exciting. The learning doesn’t stop once you graduate. The more athletes you work with, the more questions you develop about what we can do better.
What Can You Expect From Rehabilitation With Me?
My approach to shoulder rehabilitation combines the things I value most about sports physiotherapy: thorough assessment, hands-on treatment when appropriate, progressive exercise, strength and conditioning principles and objective measures when they add value.
Manual therapy can be useful for managing pain and restoring movement, particularly during the earlier stages of rehabilitation. But the longer-term goal is to build capacity.
I want to know that the athlete can not only move their shoulder comfortably, but that they can produce and absorb force, tolerate repeated loading and confidently perform the movements their sport demands.
Ultimately, my job is not simply to help you feel better. It is to help you understand your shoulder, rebuild your physical capacity and progressively return to the activities that matter to you.
The goal is to get you back to your sport — and to make sure your rehabilitation prepares you for what your sport actually asks of you.
A shoulder dislocation does not have to define your sporting future.
Whether you are recovering from your first dislocation, managing recurrent instability or working through rehabilitation after surgery, the goal should be more than simply getting the shoulder moving again.
It should be about rebuilding the strength, control, confidence and capacity required to get back to what you love.
Ready to Get Back to Sport?
Campbell Antonio is a Senior Coach and Physiotherapist at PEAK Sports & Spine Centre, with a particular interest in shoulder instability, sports injury rehabilitation and return-to-performance rehabilitation.
If you’re working towards a return to sport following a shoulder injury, book an appointment with Campbell at PEAK Sports & Spine Centre to develop an individualised rehabilitation plan.
From Prevention to Performance. Start Today!
Frequently Asked Questions
Can a shoulder dislocation heal without surgery?
In some people, non-surgical management and structured rehabilitation can be an appropriate treatment pathway. The decision depends on factors including age, recurrence, injury characteristics, sporting demands and individual goals.
Do I still need physiotherapy if I have had shoulder surgery?
Yes. Surgery can address structural instability, but rehabilitation is required to restore movement, strength, control, confidence and sport-specific capacity.
Can I return to contact sport after a shoulder dislocation?
Many athletes can return to contact sport, but the timing and rehabilitation requirements depend on the individual injury and treatment. Contact exposure should be progressively reintroduced as the athlete demonstrates appropriate strength, function, confidence and sport-specific capacity.
Why do I need to strengthen my shoulder after a dislocation?
Strengthening helps restore the capacity of the muscles responsible for controlling and stabilising the shoulder. Rehabilitation also needs to address movement control, endurance and the specific demands of the athlete’s sport.
What if my shoulder feels good but I am still nervous about using it?
That is common following shoulder instability. Rehabilitation can progressively expose you to the movements and loads that cause apprehension, helping rebuild both physical capacity and confidence.
REFERENCES
Herman, Z. J., Reddy, R. P., Fails, A., Lin, A., & Popchak, A. (2024). Rehabilitation and return to sport following operative and nonoperative treatment of anterior shoulder instability. Clinics in Sports Medicine. https://doi.org/10.1016/j.csm.2024.03.025
Hurley, E. T., Matache, B. A., Wong, I., Itoi, E., Strauss, E. J., Delaney, R. A., Neyton, L., Athwal, G. S., Pauzenberger, L., Mullett, H., Jazrawi, L. M., & Anterior Shoulder Instability International Consensus Group. (2021). Anterior shoulder instability part I-diagnosis, Nonoperative Management, and bankart repair-an international consensus statement. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, S0749–8063(21)00695-2. https://doi.org/10.1016/j.arthro.2021.07.022
Matache, B. A., Hurley, E. T., Wong, I., Itoi, E., Strauss, E. J., Delaney, R. A., Neyton, L., Athwal, G. S., Pauzenberger, L., Mullett, H., Jazrawi, L. M., & Anterior Shoulder Instability International Consensus Group. (2022). Anterior shoulder instability part III-Revision surgery, rehabilitation and return to play, and clinical follow-up-an international consensus statement. Arthroscopy : The Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 38(2), 234–242.e6. PubMed. https://doi.org/10.1016/j.arthro.2021.07.019
Willmore, E., Bateman, M., Maher, N., Chester, R., O’Sullivan, J., Horsley, I., Blacknall, J., Gibson, J., & Jaggi, A. (2024). Rehabilitation guidelines following arthroscopic shoulder stabilisation surgery for traumatic instability – a Delphi consensus. Physiotherapy, 124, 154–163. https://doi.org/10.1016/j.physio.2024.05.001
Wong, C., Jaggi, A., Kearney, R., & Gwilym, S. (2026). British Elbow and Shoulder Society practice guidelines: Rehabilitation following traumatic anterior shoulder dislocation (post-operative and non-operative care). Shoulder & Elbow, 18(3), 17585732261439731. PubMed Central. https://doi.org/10.1177/17585732261439731