The glenohumeral joint, known commonly as the shoulder joint is a highly mobile ball and socket joint. Multidirectional shoulder instability (MDI) refers to a condition which is characterised by symptomatic excessive laxity of the glenohumeral joint in more than one direction. This translates to difficulty keeping the humerus head (ball) centred inside the glenoid fossa (socket). The main two types of patients this condition occurs in are:
a) Individuals with inherited joint laxity who have sustained multiple mild shoulder injuries; and
b) Athletes who have participated in sports with high overhead activity load, leading to repetitive microtrauma of stability structures of the shoulder.
Symptoms of MDI include a feeling of "looseness" around the shoulder, audible "popping" and "clicking" of the shoulder and pain. Individuals presenting with this injury will likely be positive on the following clinical tests; sulcus sign, load and shift test and the anterior apprehension test.
The current consensus in terms of physio management of MDI is extensive exercise rehabilitation, prior to considering surgical options.
Here are the key components when planning an effective physiotherapy rehab program for MDI:
Specificity - Reduced muscular strength and neuromuscular control are key findings associated with MDI. Therefore, a rehab program should include a) scapulothoracic stabilisation exercises, b) rotator cuff strengthening exercises and c) functional training with a sport specific focus for athletes returning to play.
Progressive Overload - Once you are able to perform a given exercise correctly, without the need for verbal, tactile or visual cues - the load must be adapted. Your program should be evolving to provide more resistance, or more instability, such that muscles and tendons are continually responding to change in stimulus forcing them to adapt.
Address the Kinetic Chain - Given that this type of injury commonly occurs in the overhead throwing athlete, it is imperative that programming includes exercises that are going to improve the strength and mobility of the entire kinetic chain. Overhead athletes require a strong and stable lower body, and trunk in order to transfer force from the ground, to the upper extremity for throwing. Therefore it is necessary to include components that target this to reduce the likelihood of re-injury upon return to play.
Littered throughout this blog are some images of examples of exercises that may be included in a MDI rehab program. For programming specifics, or more information on shoulder injuries in general - chat to your local physio.
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