A shoulder dislocation occurs when the head of the upper arm bone (humerus) separates from the shallow socket of the shoulder blade (glenoid). This injury damages surrounding soft tissues, including ligaments and the joint capsule, making the joint unstable and highly susceptible to future dislocations. A structured and professionally supervised rehabilitation program is the safest and most effective way to restore full function and prevent recurrence. Any at-home rehabilitation must be performed under the direct guidance of a doctor or physical therapist.
Initial Stabilization and Protection Phase
The immediate goal following a successful reduction is to manage pain, reduce swelling, and protect the healing soft tissues. This phase involves immobilizing the arm in a sling to prevent unwanted movement that could stretch or re-injure the shoulder capsule. Sling use generally ranges from one to three weeks, with longer immobilization often recommended for younger patients who have a higher risk of recurrence.
Prolonged immobilization beyond three or four weeks can lead to joint stiffness, which is why movement is restricted but not eliminated. During this time, perform gentle exercises for the elbow, wrist, and hand several times a day to prevent stiffness and maintain circulation. The shoulder must be protected from all active movement, particularly raising the arm or rotating it away from the body.
Ice therapy helps control pain and inflammation in the acute period. It is important to keep the arm in a safe, protected position; a general rule is to avoid letting the hand move beyond the line of sight during the first three weeks. Once a physical therapist clears the shoulder to begin gentle movement, the focus shifts from protection to regaining mobility.
Restoring Range of Motion
Once initial pain and tissue healing allow, the objective is to restore flexibility and passive range of motion without straining the newly healed structures. This active-assisted phase requires movements to be slow, controlled, and within a pain-free range. The goal is to prevent the shoulder joint from becoming permanently stiff, a common complication after immobilization.
A foundational exercise in this phase is the Codman or pendulum exercise, where the patient leans forward, allowing the injured arm to hang freely. The arm is gently swung in small circles or forward and backward, using gravity to assist the movement rather than muscle contraction. This exercise lubricates the joint and encourages initial movement without stressing the ligaments.
Other beneficial movements include table slides and wall walks, which use the support of an external surface to control the range of motion. Table slides involve placing the hand on a towel and slowly sliding it forward on a table to gently increase flexion. Wall walks involve slowly walking the fingers up a wall to increase the height of the arm lift, moving only as far as comfortable. These assisted movements are progressed to active range of motion, where the patient moves the arm independently, before any resistance is introduced.
Building Strength and Stability
The transition to strength training is the most significant step in preventing a future dislocation, as muscle strength must compensate for any residual ligamentous laxity. The primary focus is on strengthening the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), which keep the humerus centered in the glenoid socket. Strengthening the scapular stabilizers is equally important for providing a stable base for the arm to move.
Initial strengthening often begins with isometric exercises, such as gently pressing the arm against a wall. Once isometrics are tolerated, light resistance is introduced using elastic bands or light weights for dynamic exercises. Internal and external rotation exercises, performed with the elbow bent at a 90-degree angle and tucked into the side, are fundamental for targeting the rotator cuff.
Scapular stability exercises, like shoulder blade squeezes or standing rows with a resistance band, reinforce the control of the shoulder blade. Progression must be gradual, increasing the number of repetitions before increasing the resistance level, to ensure muscle endurance and proper form. Strengthening should eventually include multi-directional movements to prepare the shoulder for the demands of daily life.
Preventing Recurrence
Long-term success centers on maintaining strength and developing dynamic stability to prevent the joint from returning to high-risk positions. The highest risk position for a second dislocation is typically a combination of arm abduction (lifting the arm out to the side) and external rotation (rotating the arm away from the body). Patients should be mindful of avoiding this position, especially during the initial months following injury.
The final stage of rehabilitation incorporates advanced exercises aimed at improving proprioception, the body’s sense of joint position and movement. This includes dynamic stability drills, such as rhythmic stabilization exercises, or progressing to plyometric activities like medicine ball tosses. These drills train the muscles to react quickly and automatically to sudden, unexpected forces that could compromise the joint.
A commitment to a long-term maintenance program is necessary to ensure strength parity between the injured and uninjured shoulders. Continued strengthening of the rotator cuff and scapular muscles, even after returning to full activity, reinforces the joint against future trauma. Returning to sports or heavy labor should only occur once the shoulder demonstrates full, pain-free range of motion, adequate strength, and the ability to tolerate sport-specific maneuvers.