Phases of rehabilitation after shoulder dislocation

Shoulder dislocation is a common injury that can cause significant pain and limited mobility. Whether it occurs due to a sports-related incident or an accident, proper rehabilitation is crucial for a successful recovery. Rehabilitation after shoulder dislocation typically involves several phases, each focusing on specific goals and exercises. In this blog post, we will explore the different phases of rehabilitation and what you can expect during each stage of the recovery process.

Phase 1: Acute Phase (approximately 0-3 weeks)

During the acute phase, the primary goal is to reduce pain and inflammation, promote healing, and protect the injured shoulder. This phase typically lasts for the first four weeks after the dislocation. Treatment may involve immobilization with a sling or brace, pain management techniques, and gentle range of motion exercises to prevent stiffness. But how long should that sling be worn?

Should You Wear a Sling After a Shoulder Dislocation?

This is a particularly interesting question because the research distinguishes between whether someone uses a sling and how long they wear it.

In our New Zealand prospective cohort study, Olds et al. (2019), we followed 128 people aged 16–40 years following a first-time traumatic anterior shoulder dislocation.

We found that:

• 36% experienced at least one further dislocation during the first 12 months.
• People who had used a sling following their dislocation were less likely to experience recurrent instability.
• The duration of immobilisation, which ranged from 1 to 70 days, was not associated with recurrence risk.

This suggests that early sling use may be relevant, but wearing a sling for longer does not necessarily provide additional protection.

However, this was an observational study. Although sling use was associated with better outcomes, the study could not establish that wearing a sling directly prevented recurrence.

Does Longer Immobilisation Reduce the Risk of Another Dislocation?

A systematic review by Paterson et al. (2010) compared different immobilisation durations following a first-time anterior shoulder dislocation.

In patients younger than 30 years, recurrent instability occurred in:

• 41% of those immobilised for one week or less.
• 37% of those immobilised for three weeks or longer.

This difference was not statistically significant.

More recently, the 2026 ESSKA–ESA European consensus concluded that early mobilisation within the first week may produce outcomes comparable to three weeks of immobilisation.

Together, these studies suggest that prolonged immobilisation is not routinely necessary to reduce recurrence.

So What Do We Recommend?

In our 2024 clinical concepts paper, we recommended using a sling according to pain and symptoms, generally for no longer than three weeks.

For many patients, the sling can be reduced or discontinued sooner as comfort improves.

Early rehabilitation may involve:

• Moving the hand, wrist and elbow.
• Gradually restoring comfortable shoulder movement.
• Introducing gentle muscle activation, including low-load isometric exercises.
• Resuming simple everyday activities as tolerated.

The aim is not to force movement or aggressively stretch the shoulder.

It is to restore comfortable movement and begin rebuilding muscle control while respecting the injured tissues.

The important message: a sling may be helpful early, but longer immobilisation does not automatically mean better healing or greater shoulder stability.

Phase 2: Early Motion Phase (approximately 3-6 weeks)

Once the acute phase is over, the focus shifts to regaining range of motion and improving shoulder stability. As pain settles, the emphasis shifts towards restoring active movement and developing shoulder muscle control. A shoulder dislocation can damage structures such as the labrum, joint capsule and ligaments. These structures contribute to passive stability. But the shoulder also relies heavily on its muscles to maintain control during movement. The rotator cuff, including the subscapularis and infraspinatus, and the muscles controlling the shoulder blade are particularly important. Easy painfree isometric exercises are shown below.

In Olds and Uhl (2024), we described a direction-specific rehabilitation approach, addressing motor control and strengthening of the anterior and posterior rotator cuff and the muscles responsible for shoulder co-contraction.

What Does This Mean for Rehabilitation?

Rather than simply trying to restore full movement as quickly as possible, rehabilitation should help the patient control their shoulder through progressively more challenging positions.

For example, early exercises might involve:

• Active shoulder movement within a comfortable range.
• Gentle rotator cuff activation.
• Controlled internal and external rotation.
• Shoulder blade control exercises.
• Supported weight-bearing exercises.
• Low-load strengthening through a gradually increasing range of motion.

An athlete may initially manage exercises with the arm close to the body but find movements at shoulder height more challenging. We progressively introduce those positions as muscle control and confidence improve.

Progression is based on the ability to move and control the shoulder, rather than simply achieving a particular range of motion.

Phase 3: Strengthening Phase (approximately 6-12 weeks)

In the strengthening phase, the emphasis is on building strength and stability in the shoulder joint. This phase typically starts around eight weeks after the injury. Physical therapy exercises may include resistance training, such as using resistance bands or weights, to target the muscles around the shoulder and shoulder blade. The goal is to improve muscle strength and endurance to support the joint and reduce the risk of future dislocations.

In our 2024 clinical concepts paper, we described the progression from motor control and basic strengthening to movements involving greater load, speed and range.

Building Strength Through Different Ranges

At Flawless Motion, we also encourage patients to think beyond basic rotator cuff exercises. A shoulder needs to develop strength in the positions where it will eventually be used. Depending on individual requirements, rehabilitation may involve:

• Dumbbell strengthening for the rotator cuff, biceps and triceps.
• Rows, reverse flies and other shoulder blade exercises.
• Increasing weight-bearing activities.
• Progressive strengthening below shoulder height.
• Progression into higher and overhead positions.
• Increasing resistance, repetitions and total training volume.

We generally begin with more controlled movements and gradually increase the physical challenge. For example, someone might start with three sets of ten repetitions using a manageable weight. As their strength improves, they may increase the weight, adjust the repetitions and progressively increase their overall training volume. This allows the shoulder to develop the capacity required for more demanding activities.

Does Everyone Need Supervised Physiotherapy?

Interestingly, the answer is not necessarily. The ARTISAN randomised controlled trial by Kearney et al. (2024) followed 482 adults after a first-time traumatic anterior shoulder dislocation. The researchers compared an advice session, supporting materials and access to physiotherapy if needed with the same advice plus a routine programme of physiotherapy. At six months, the additional physiotherapy programme did not produce a clinically worthwhile improvement in average shoulder function. However, the participants had a mean age of approximately 45 years, and patients being considered for surgery were excluded. These findings cannot automatically be applied to a 16-year-old rugby player preparing for collision sport. The trial also does not establish whether a particular progressive strengthening programme is superior to another.

The important message is that rehabilitation should be appropriate to the individual. Some people may recover with good advice and self-management, while others have greater physical or psychological demands that require more specialised input.

Phase 4: Functional Phase (12+ weeks)

The final phase of rehabilitation focuses on restoring full function and returning to normal activities. This phase typically begins around 12 weeks after the injury, but the timeline may vary depending on individual progress. Physical therapy exercises may involve functional movements that mimic daily activities or sports-specific movements. The goal is to improve overall shoulder function, stability and performance.

In Olds and Uhl (2024), the later stages of rehabilitation incorporate increasing speed, changes in movement direction, perturbations and unexpected movements. These challenges help bridge the gap between controlled strengthening and real-world activities. Advanced rehabilitation may include:

• Increasing strength and power through relevant ranges.
• Plyometric and reactive exercises.
• Weight-bearing activities under increasing load.
• Sport-specific movement patterns.
• Fatigue-based training.
• Controlled exposure to contact and unpredictable movements.

The exact progression depends on the sport or activity.

When Can You Return to Sport?

There is no single timepoint that guarantees safe return. The 2026 ESSKA–ESA consensus emphasises shoulder movement, stability, strength, endurance and the ability to meet the demands of the sport when considering return to activity. We also need to consider psychological readiness. In research examining the Shoulder Instability Return to Sport After Injury (SIRSI) scale, Olds and Webster (2021) highlighted the different psychological components relevant to returning to sport, including confidence, fear of reinjury and emotions. An athlete may have regained considerable physical strength but still feel apprehensive about another dislocation. That apprehension deserves assessment and appropriate rehabilitation, rather than simply being dismissed.

Return to sport is not a date on the calendar. It is a decision based on physical capacity, shoulder stability, confidence and sporting demands.

Control, Capacity, Confidence and Demand: A Framework for Shoulder Rehabilitation

One useful way to understand rehabilitation is through four interconnected components.

Control

Can the muscles coordinate effectively to maintain shoulder stability through different movements and positions?

Capacity

Does the shoulder have sufficient strength, endurance and power for the activities the patient wants to perform?

Confidence

Does the patient trust their shoulder, particularly in positions or activities they previously associated with dislocation?

Demand

Can the shoulder tolerate the speed, fatigue, repetition, contact and unpredictable forces associated with work or sport?

This Control–Capacity–Confidence–Demand framework helps translate the clinical evidence into practical rehabilitation goals. It builds on the direction-specific motor control and progressive strengthening principles described by Olds and Uhl (2024), alongside research into psychological readiness. The framework is a clinical approach to organising rehabilitation, rather than a separately validated prediction tool.

How Do We Know Who Is at Risk of Another Shoulder Dislocation?

An important part of rehabilitation is understanding that not everyone has the same risk of recurrent instability. In our 2015 systematic review and meta-analysis, we identified younger age, male sex and hyperlaxity as important factors associated with recurrence. Our 2019 prospective cohort study extended this understanding by examining physical and psychosocial factors, including bony Bankart lesions, sling use, shoulder activity, pain and disability, and fear of reinjury. These findings contributed to the development of the Predicting Recurrent Instability of the Shoulder (PRIS) tool. We subsequently validated PRIS in a separate prospective cohort of patients with first-time traumatic anterior shoulder dislocations. In Olds, Ellis and Kersten (2020), the validation study found that PRIS was particularly useful for identifying patients who would not experience further shoulder instability. However, its ability to identify everyone who would experience recurrent instability was more limited. This means PRIS may help inform an individual patient's prognosis, but it cannot determine whether that patient should undergo surgery or predict the benefit they would obtain from an operation.

Explore the PRIS prediction tool

Does Everyone Need Surgery After a Shoulder Dislocation?

No. But some patients are at substantially higher risk of recurrence and may benefit from early surgical stabilisation. This is particularly relevant in younger athletes and those involved in contact or collision sports. The decision should consider individual recurrence risk, structural injuries, the potential consequences of further instability and the patient's goals and preferences. Surgery and rehabilitation should not be presented as opposing concepts. Rehabilitation remains important regardless of the treatment pathway.

For a detailed explanation of the research comparing surgery with non-operative management, read:

Does Every Young Athlete Need Surgery After a Shoulder Dislocation? Understanding Number Needed to Treat

Remember that the duration of each phase may vary depending on the severity of the injury and individual factors. It is essential to work closely with a healthcare professional or physical therapist who can tailor the rehabilitation programme to your needs and monitor your progress.

Conclusion

Rehabilitation after shoulder dislocation involves several phases, each with specific goals and exercises. By following a structured rehabilitation programme, you can work towards restoring shoulder function and reducing the risk of future dislocations. Consult a healthcare professional for personalised guidance throughout the process.

Dr Margie Olds has written an ebook specifically for patients who have had a shoulder dislocation and are completing rehabilitation. It may also be useful for physiotherapists and trainers who are not familiar with current research and evidence regarding shoulder instability rehabilitation.

Get the Recover Strong ebook

References

Prospective cohort studies and prognostic research

1. Olds MK, Ellis R, Parmar P, Kersten P. (2019). Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation. BMJ Open Sport & Exercise Medicine, 5. Read the article.
2. Olds M, Ellis R, Kersten P. (2020). Predicting Recurrent Instability of the Shoulder (PRIS): A Valid Tool to Predict Which Patients Will Not Have Repeat Shoulder Instability After First-Time Traumatic Anterior Dislocation. Journal of Orthopaedic & Sports Physical Therapy, 50(8):431–437. Read the article.

Systematic reviews

3. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. (2015). Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British Journal of Sports Medicine, 49:913–922. Read the article.
4. Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. (2010). Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. Journal of Bone and Joint Surgery American Volume, 92(18):2924–2933. Read the article.

Rehabilitation and return to sport

5. Olds M, Uhl TL. (2024). Current Clinical Concepts: Nonoperative Management of Shoulder Instability. Journal of Athletic Training, 59(3):243–254. Read the open-access article.
6. Kearney RS, et al. (2024). Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial. BMJ, 384. Read the article.
7. 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):604–608. Read the guidelines.
8. Alentorn-Geli E, et al. (2026). Age- and time-specific management of traumatic anterior shoulder instability: The 2024 ESSKA–ESA Formal Consensus. Part 2: Treatment and return to sports. Knee Surgery, Sports Traumatology, Arthroscopy, 34:3040–3051. Read the article.
9. Olds M, Webster KE. (2021). Factor Structure of the Shoulder Instability Return to Sport After Injury Scale: Performance Confidence, Reinjury Fear and Risk, Emotions, Rehabilitation and Surgery. American Journal of Sports Medicine, 49(10):2737–2742. Read the article.

This article is provided for educational purposes and does not replace individual clinical assessment. Rehabilitation decisions should account for associated injuries, clinical findings, individual recurrence risk and the advice of the treating healthcare professional.