The shoulder consists of the ball and socket joint known as the gleno humeral joint and has a close relationship with four neighbouring joints, the shoulder blade on the chest wall (scapula-thoracic joint), the outside ends of the shoulder blade and the collar bone or clavicle (acromio-clavicular joint) and the inside end of the collar bone and the sternum (sterno-clavicular joint).
The gleno humeral joint is where most of the movement comes from and to make it so mobile the “cup” or socket that the head sits in is quite shallow and has a ring of cartilage around the rim. The muscles surrounding the joint add to the stability particularly four that make up the rotator cuff: supraspinatus, infraspinatus, subscapularis and teres minor. These are the deepest muscles underneath deltoid, etc and this rotator cuff needs strengthening exercises to prevent common rugby injuries such as impingement. This is all complex stuff but unfortunately, shoulders are!
We will look at various aspects of injuries within the shoulder region over the next couple of articles, here we will look at one or two of the ball and socket ones.
Shoulder dislocation is not uncommon whilst playing rugby and can be as a result of direct contact such as a tackle or poor landing. Landing with the ball under the hand but the arm outstretched, as may happen in a try or catching a player breaking through with the arm stretched out to the side, can also lead to dislocation. The head of the humerus may pop out of its socket forward, backward or underneath, depending on which direction the force came from and prevents any movement of the arm. There is usually a noticeable difference in the contour or shape of the injured shoulder to the other.
There are a lot of delicate structures around the shoulder such as nerves and blood vessels, so it is usually necessary to arrange for an X-Ray to see if there is a break in the bone before the joint is put back into place. Although relocation by slamming the shoulder into a nearby wall may be common in the movies, it is not usually recommended in the field of rugby! Recovery time is dependent on how much damage has occurred to the surrounding muscles and cartilage.
If surgical repair is not required, rehab involves starting with regaining full range of movement in the shoulder complex and strength and stability of the rotator cuff. These exercises would start with simply moving the arm as much as possible in forward, sideways, inward and outward directions. A light weight (tin of beans) may then be added to the movement until able to progress to resisted work from a stretch band.
All through the specific work for the shoulder, it is vital that CV fitness and endurance are maintained. It may be very uncomfortable to run initially but cycling in the gym would reduce impact and abdominal & glute exercises, wall slides and heel raises, etc, can be maintained. Running with the arm supported by a collar and cuff can be introduced as pain allows.
Weight bearing or leaning on the hand with the arm straight helps the stability function of the rotator cuff and the shoulder blade if practiced correctly. This can progress to press ups on the wall, the floor on knees, to full press-ups by 6-8 weeks. It is also important as with lower limb injuries that balance work is practiced. This can include some lower limb stuff as well as hand eye co-ordination skills.
Getting a ball back in your hands keeps you focussed on rugby and will work the shoulder rotation nicely!