Izzi Ord-Kinnear, Physiotherapist (Palmyra clinic)
Footy, rugby, and every other collision sport out there all have one thing in common: shoulders cop an absolute beating. Between tackling technique, falls on outstretched arms, and the occasional shoulder charge nobody meant to throw, it’s one of the most common areas I end up working with in the clinic and on the field.
Common Shoulder Injuries in Contact Sport
A few injuries turn up again and again in contact sport shoulders:
- AC joint injuries (“shoulder separations”), from landing directly on the point of the shoulder. Interestingly, how bad the joint looks on imaging doesn’t reliably predict how much it’ll actually bother you. Research has found the standard grading system (Rockwood 1 to 6) correlates poorly with a person’s actual symptoms, so the picture is only part of the story.
- Dislocations and instability, where the ball comes fully or partially out of the socket, almost always forwards.
- Labral tears, tears to the rim of cartilage around the socket, often happening alongside a dislocation or from repetitive tackling load.
- Fractures, most commonly the collarbone from a fall onto the shoulder, occasionally the top of the arm bone itself.
Scans: When They Help and When They Don’t
The honest answer: usually, not straight away. A good history and a hands-on exam get us most of the way to a diagnosis, and imaging is best saved for when it’ll actually change what we do, when the diagnosis genuinely isn’t clear, when things aren’t improving as expected, when there’s significant weakness, or when a scan is needed for surgical planning.
After an acute dislocation, an X-ray is standard to confirm the joint’s back in place and rule out a fracture. Beyond that, more detailed imaging is used selectively rather than as a routine box-tick.
Plenty of pain-free shoulders show “abnormal” findings on a scan, rotator cuff changes especially, and more so as we get older. So a scary-sounding report doesn’t automatically mean surgery, or even that the finding is the cause of the pain.
Surgery vs Conservative Management
This is genuinely one of the more debated calls in sports medicine.
The traditional approach to a first-time dislocation has been conservative: rest, then rehab, with surgery kept in reserve if it happens again. That’s still a reasonable path for plenty of people. But for younger athletes in contact and collision sports, the research on that default is actively being argued over rather than agreed on.
Studies in younger, more active groups report re-dislocation rates after conservative management anywhere from around 45% up to over 90% in the highest-risk groups, while surgical stabilisation generally brings that down to somewhere between 2% and 14%, with similar or better rates of getting back to sport. A big part of that gap is simple: going straight back into a contact sport means re-exposing a shoulder to the exact kind of load that caused the problem in the first place.
None of this means every young athlete needs surgery after one dislocation. It means it’s worth an honest conversation with a surgeon about the options, factoring in age, sport, how the shoulder performs on exam, and what the athlete actually wants out of their season, rather than assuming there’s only one “correct” path.
Rehab Principles: Strength, Stability and Staying Mobile
Whatever the injury or treatment path, the rehab principles look fairly similar:
- Rotator cuff and scapular strength. These muscles are the shoulder’s main support crew, and building them back up (and often beyond where they started) is central to reducing reinjury risk.
- Stability retraining. Getting the shoulder comfortable and controlled through the positions it’ll actually meet in a tackle or a fall, not just in a nice, controlled gym environment.
- Don’t let the rest of the arm seize up. If you’re in a sling, your shoulder might be having a rest, but your neck, elbow, wrist and hand don’t need to. Keeping those moving (within whatever limits you’ve been given) helps avoid a second problem stacking on top of the first, and makes the return to full shoulder rehab much smoother once you’re cleared to start.
- Progressive, milestone-based loading. Good rehab is guided by what the shoulder can actually do, not just how many weeks have ticked over on a calendar.
When to See a Physio
Come in and get it looked at if you’ve had a dislocation or instability episode (even if it went back in by itself), if pain or weakness is hanging around longer than a couple of weeks, if you’re about to head back into full contact training after any shoulder injury, or if you’re working through fracture or post-surgical rehab. Earlier assessment generally means a smoother, faster path back, not a slower one.
What to Expect in Your Physio Appointment
First, we talk about how it happened, what your sport actually demands of you, and whether this is a first episode or a repeat visitor. Then a hands-on assessment: range of motion, specific tests for instability, the labrum, and the AC joint, and a look at how the whole shoulder girdle is working together.
We also use VALD strength testing equipment to get objective numbers rather than relying on a “feels about right” strength check, comparing side-to-side differences and tracking progress against real data over time rather than a gut feeling.
From there, your plan gets built around you: your age, your position, your sport’s specific demands, and your own goals and timeline.
Get Assessed Before You Return to Play
If a shoulder injury has taken you off the field this season, don’t just wait it out and hope. Book an appointment and we’ll figure out exactly what’s going on and the fastest realistic way back.
