Shoulder dislocations are a common injury in rugby and they more than often recur. This is just what we have seen with our most capped Welsh rugby player, Alun Wyn Jones. Alun Wyn has often been the talk for being almost indestructible, he’s a force to contend with and has been a reliable key player for the Welsh team for 15 years!
However, during the warm up game in the lead up to the Lions tour to South Africa this summer, Alun Wyn came off in the early minutes of the game after sustaining a shoulder dislocation, leaving most of us thinking it would be the last we would see of him for that tour. In true Alun Wyn fashion, he was back on the plane ready to play only 18 days later and started all three tests for the Lions against South Africa. A great recovery, for what I am sure was the outcome of Alun Wyn’s determination and the support of the medical team set up at WRU.
Just three months later the autumn tests began for Wales against the All Blacks. Alun Wyn claimed his 149th cap for Wales before reinjuring that same shoulder that nearly ended his Lions tour. Now, I believe news has broken (as reported in The Guardian last week) that he will be undergoing surgery.
Although I am sure for Alun Wyn and all Welsh rugby fans this news is devastating, from a clinical point of view it isn’t unexpected. Once a shoulder has dislocated for the first time, it has been suggested in medical research that it is around 90% likely to happen again. Physiotherapy is the main port of call for most first time dislocations but recurrent dislocation often requires a surgical stabilisation.
How and why do shoulder dislocations occur in Rugby?
Shoulder joints are the most mobile joint in the body, often described like a golf ball on a tee. Because the socket of the joint (golf tee) is quite flat, it doesn’t offer a lot of stability but it does allow the head of the long arm bone (golf ball) a lot of movement. The stability of the joint is offered by the surrounding connective tissues and the groups of muscles around the shoulder. This leaves the joint more vulnerable to dislocation when high forces are placed on the shoulder, as we see in rugby contact.
A backwards force being placed on an outstretched arm or a direct impact to the shoulder are the most common causes of a shoulder dislocation. A tackling manoeuvre can often replicate this force, leading to injury.
When can we expect a player to return to rugby following a shoulder stabilisation surgery?
On average, players will be able to return to play approximately 6 months following their surgery. However, time shouldn’t be the main criteria for allowing their return. It is essential that players follow a structured rehabilitation protocol under the guidance of a professional. This ensures their readiness for a return to play and lowers the risk of reinjury.
Considerations before returning to play:
How we measure readiness to return is vast and varied, every player and sport has their differences. The evidence and research is forever growing on rehabilitation and how we can get athletes back into their sports. The aim is often to get back as soon as possible but also to perform as strongly as possible. Below are some key considerations that need to be made.
- Psychological readiness to return
- Restored movement of the shoulder
- Regained strength
- Sport specific function tests
We wish Alun Wyn Jones the best recovery and look forward to seeing him back in the Welsh lineup.
If you have experienced a shoulder dislocation, come and have an assessment with one of our Physiotherapists. You can book in by using the link below. We can help support you on your recovery and reduce your risk of reinjury.
Written by Mairéad Haswell
MSK Physiotherapist BSc Hons MCSP