Case Study: Overcoming Shoulder Instability in a 25-Year-Old Rugby Player
In the world of professional rugby, athletes push their bodies to their limits. A sport that combines speed, strength, and high-impact collisions requires optimal physical conditioning. However, despite rigorous training, players often encounter injuries or deficiencies that can impact their performance.
Our physiotherapist Tilemachos had one such case involving a 25-year-old rugby player who presented to our clinic with concerns of shoulder instability during tackles. Through careful assessment and a targeted rehabilitation program, Tile was able to help him return to the field without any complaints of instability. Here’s his story.
The Initial Presentation: A Rugby Player's Struggle with Instability
Our patient, a 25-year-old male, had been playing rugby for over 10 years. He had experienced shoulder discomfort in the past, but it wasn’t until recent games that he began noticing persistent instability, particularly during high-impact tackles. The sensation was most evident when he engaged in the T position during contact—something that commonly occurs during the sport.
Shoulder instability can lead to significant performance issues, as it affects an athlete’s confidence in tackling and other dynamic movements. The player was concerned about not only his current ability but also the risk of a more serious injury. He was eager to address the issue before it became a recurring problem.
The Assessment: Identifying Key Deficits
Upon examination, we conducted a series of tests to assess the player’s shoulder function. One of the most telling tests was the ASH (Athletic Shoulder) test, which helped evaluate shoulder stability and strength during specific movement patterns. It quickly became apparent that the athlete was struggling in two key areas: strength and rate of force development—particularly in the T position of the ASH test. This position requires a significant amount of shoulder stability and control, particularly in the overhead or extended positions often encountered in tackles.
Additionally, we identified deficits in internal rotation strength, an important factor in controlling shoulder mechanics during the sport. Weakness in this area can affect the ability to stabilize the shoulder during forceful movements, such as those seen during a rugby tackle. We also noted a slight imbalance in the shoulder’s scapular control, but the primary focus was on restoring strength and stability.
The Rehabilitation Program: Targeted Progressive Loading
Once the deficits were identified, we designed a tailored rehabilitation program to address the specific needs of the player. The key areas of focus were:
Strengthening the Shoulder Complex: A focus on the rotator cuff muscles and scapular stabilizers was crucial. Exercises like resisted external and internal rotation, as well as scapular retraction and protraction, were incorporated into the program.
Improving Rate of Force Development: The player needed to develop explosive power in his shoulder to handle the intensity of tackles and high-impact collisions. Plyometric exercises and dynamic movements were integrated to enhance his rate of force development.
Progressive Loading: Over the course of 8 weeks, the intensity of the exercises gradually increased. This progressive loading helped the player build both strength and confidence in his shoulder, while reducing the risk of re-injury. We included sport-specific drills like tackling dummies, reactive shoulder movements, and functional exercises to simulate game conditions.
Internal Rotation Strength: We placed a significant emphasis on improving internal rotation strength using targeted resistance exercises. This was a critical factor in stabilizing the shoulder joint during movement and tackling.
Progress and Results: Strength Reaches Target and Instability Resolves
Throughout the 8-week program, the athlete made consistent progress. His strength targets were steadily achieved, and his rate of force development improved significantly. By the end of the rehabilitation program, we observed substantial gains in both his internal rotation strength and stability during the T position of the ASH test. These improvements translated into better shoulder control, reducing the risk of instability during tackles.
More importantly, after completing the program, the player reported no further issues with shoulder instability. He was able to return to rugby with confidence and successfully participated in matches without any recurrence of instability. His shoulder now felt strong and stable, and he was able to perform tackles at the same high level as before, if not better.
Conclusion: The Importance of a Targeted Rehabilitation Approach
This case highlights the importance of a detailed and individualized rehabilitation plan when dealing with shoulder instability, especially in high-performance athletes. Through a thorough assessment, we identified the player’s key deficits and addressed them through a progressive shoulder loading program. In just 8 weeks, the athlete was able to regain the strength and stability required for safe and effective tackling in rugby.
For athletes suffering from similar issues, it’s crucial to approach rehabilitation with a focus on strengthening the shoulder complex, improving dynamic strength and control, and progressively loading exercises. With the right approach, athletes can return to their sport with greater confidence and reduced risk of injury.
If you’re an athlete dealing with shoulder instability or any other sports-related injury, don’t hesitate to seek professional guidance. With the right assessment and a targeted rehabilitation program, you can get back to performing at your best.
Our aim at Technique Health & Fitness is to keep London fit, active & healthy through our team of highly experience physiotherapists, osteopaths & strength & conditioning specialists. We are evidence based and data driven in our approach to treatment.
Our team includes physios and S&C coaches with a rugby playing background all of whom would be delighted to support your ability to play injury-free and be there to fix you if you become injured.
We have clinics in the City and Vauxhall and our physios and osteos would love to help.
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